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Thread: count body areas and organ systems

  1. #1
    Join Date
    Apr 2007

    Smile count body areas and organ systems

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    North Carolina


    Now that's interesting.

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

    Now I'm confused.... I'm going to check this out.

  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
    Join Date
    Apr 2007
    North Carolina


    Using 95 DG's, a comprehensive exam requires 8+ organ systems. Now...I'm ok Whew!.........

  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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