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count body areas and organ systems

  1. #1
    Smile count body areas and organ systems
    Medical Coding Books
    I am seeing alot of physicians mix body areas such as Neck and Extremities with organ systems. I try to make the Neck and Extremities fit into the Body Organs so that they can still be counted.

    How would you count the following:
    General, HEENT,Neck, Heart, Lungs, Abdomen, Neurological exam, Extremities, Rectal Exam deferred.

    I counted 1 General as Constitutional
    2 Neck as Muskular Skeletal
    3 Heart as CV
    4 Lungs as Respiratory
    5 Abdomen as GI
    6 Neuro

    I did not count Extremities because I thought that would fall into CV and I did not count deferred Rectal exam because I thought that would fall into GI and that both organ systems have been already counted.

    Please let me know what you think? and if you also get 6


  2. #2
    The 1995 guidelines ALLOW you to use BODY AREAS and ORGAN SYSTEMS...

    The following Body Areas are recognized:
    Head, including face
    Chest, including breasts and axillae
    Genitalia, groin, buttocks
    Back, including spine
    Each extremity

    Organ Systems:
    Ears, nose, mouth, throat

    You documented:
    General/Constitutional - Organ System
    HEENT- Organ System
    Neck- Body Area
    Heart, CV- Organ System
    Lungs, Respiratory- Organ System
    Abdomen, GI- Organ System
    Neurologic- Organ System
    Extremities- Body Area ....... how many extremities were examined?

    You have 6 organ systems, and 2+ body areas (depending on how many extremities examined)

    Either way you look at it, you have (documentation supporting of course) a detailed exam based on the 1995 guidelines.

    In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam.

    It is not appropriate to "assign" body areas to organ systems.
    Last edited by ARCPC9491; 03-11-2009 at 07:57 AM.

  3. #3
    Do you know if that is the same for all states? I thought you had to use either Body Areas or Organ systems and could not mix them. I

    We are in Pennsylvania and go by Highmark Medicare Services

    To get a Detailed Exam we have to apply the 4 X4 rule which means 4 bullets in 4 different systems.

    Thanks for responding. I want to know how everyone views this as I am getting many different answers here.

    The highmark medicare website is very vague.


  4. #4
    hmm.... well the guidelines are the guidelines. The contractors can interpret them the way they like. I have a different contractor, and I'm not aware of the 4x4 rule.... sorry I couldn't help!

  5. #5
    Greeley, Colorado
    It has always been my understanding that you cannot mix body areas with organ systems for 95 guidelines. It has to be either/or, not both...
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Interesting..I've always been taught you could and that's how I apply it..I need to stop doing that then. I primarily use 1997 guidelines thankfully!

  7. #7
    North Carolina
    Now that's interesting.

    My auditing software has it broken 3 ways. One template for body template for organ systems...and one template with both

    Now I'm confused.... I'm going to check this out.
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

    CLICK to give FREE mammograms!

  8. #8
    LOL... it's always something right Rebecca.... I'm just as confused as you... I'm going to look into it too. Let me know what you find!!

  9. #9
    North Carolina
    Using 95 DG's, a comprehensive exam requires 8+ organ systems. Now...I'm ok Whew!.........
    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...

    CLICK to give FREE mammograms!

  10. #10
    What are you referring to when you say you can't use body areas/organ systems combined?

    I know you can't for a comprehensive exam... as per my previous statement... "In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam."

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