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"EPF" vs "Detailed" Exam

  1. Default "EPF" vs "Detailed" Exam
    Medical Coding Books
    Hi All!
    This is a HUGE debate in our office...what makes an exam a "detailed" exam vs an "EPF"?? There are sooooo many views on this that I think we're all confusing each other

    Thanks for any help you can supply

  2. #2
    This is why 97 guidelines are so great. There is no debate, 6-11 bullets are EPF 12 or more detailed.

    My personal preference is to use 97 because 95 guidelines are so vague and up to individual interpretation.

    Just my 2cents,

    Laura, CPC

  3. #3
    Milwaukee WI
    Default Well..
    1995 guidelines are vague and much more open to interpretation, that's for sure!

    For a both the EPF and the Detailed exam you need to cover 2-7 body areas and/or systems. The only difference in the guidelines is that for EPF you have a "limited exam of the affected body area or organ system AND other related systems" and for the Detailed exam you have an "extended exam of the affected body area or organ system AND other related systems."

    But the terms "limited" and "extended" are never clearly defined.

    I've seen guidelines that say if you cover 2-4 body areas/systems it's EPF.
    If you cover 5-7 body areas/systems it's detailed.

    I've seen guidelines that say that you have to have at least 4 "bullet points" in the affected body area/system to have it be an "extended exam" and then all you need is one more related system - and that equals detailed.

    The best thing to do in your practice if you are going to use the 1995 guidelines is to come to a decision about how you are defining the detailed exam, put it in writing, and stick to that standard.

    I hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 04-22-2009 at 01:22 PM.

  4. #4
    It is my understanding that a detailed exam (per the open to interpretation 95 guidelines) would mention between 2 and 7 BA/OS. One of these - the affected area/system - should be thoroughly evaluated and documented. For example, if the provider does a skin exam and takes vitals and checks heart/lung and there is mention only of a rash on the cheek, then that's limited. However, if the skin exam elaborates on findings on the whole body - thoroughly describing each part that was examined - then it might be a detailed exam. Of course, there are many different opinions on this issue and there is always the "if in doubt compare to 97-bullets" concept.
    Hope this is useful.

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