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Thread: Detailed Exam

  1. #1
    Join Date
    Apr 2007
    Location
    Rome, Georgia Chapter - Rome Coding Professionals
    Posts
    38

    Question Detailed Exam

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    Does anyone have any information where Medicare changed their stance regarding the requirements for a detailed exam? At one time CMS required 2 systems with detail documented to have a detailed exam. I am hearing now that CMS will accept one organ system with detail to have a detailed exam
    Thank you,
    Debby

  2. #2
    Join Date
    Apr 2007
    Location
    Kansas City, MO
    Posts
    749

    Default

    I have seen various audit tools that have various formulas for a detailed exam based on the 95 Guidelines. I don't know that anything may have necessarily changed, but you could start with you Medicare carrier. When I work with physicians I tend to go with the 2 or more systems with Detail. If you read the guideline below literally, it should be at least 2 or more with detail.

    Detailed -- an extended examination of the affected body area(s) and other symptomatic or related organ system(s).
    Angela Jordan, CPC
    AAPC of Kansas City
    National Advisory Board Representative Region 5

    Medical Revenue $olutions
    Senior Managing Consultant

    angela@medicalrevenuesolutions.com

  3. #3
    Join Date
    Apr 2007
    Location
    north seattle wa
    Posts
    103

    Default

    I found a power point presentation done by Noridian (our local carrier) that had it broken down this way:

    PF=1, EPF= 2-4, D=5-7. C=8 or more.

    Hope this helps.

    Wendy

  4. #4
    Join Date
    Apr 2007
    Location
    north seattle wa
    Posts
    103

    Default recalled powerpoint

    According to Linda Windley at Noridian, this powerpoint presentation was requested to be taken off of their website on April 23, 2008 because they could not verify the 2-4 for the expanded exam and th 5-7 for the detailed exam. She stated to continue to use the 95 or 97 guidelines.

    So I guess it is back to the vaugeness of Medicare. Sorry guys.

  5. #5

    Default

    Medicare did not change its stance in regards to detailed exam as per 1995 guidelines.

    Please review the following source:

    http://www.empiremedicare.com/cbtcou...m%20Levels.pdf

    Detailed. An extended examination of affected body area(s) and other
    symptomatic or related organ system(s) (up to 7, at least two items per system).

    Hope this helps!
    Thanks,
    Jagadish, CCS-P, CPC

  6. #6
    Join Date
    Apr 2007
    Location
    Columbus, OH
    Posts
    6

    Default Detailed Exam

    Debby,

    Per '97 Guidelines, a detailed exam requires 12+ bulleted elements in 2+ systems.

    Per '95 Guidelines, a detailed exam requires 2-7 systems - more detail.

    I'm in Ohio - so the Medicare Carrier is Palmetto.

    Hope this helps!
    Susan

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