Results 1 to 6 of 6

Detailed Exam

  1. #1
    Rome, Georgia Chapter - Rome Coding Professionals
    Question Detailed Exam
    Medical Coding Books
    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,

  2. #2
    Kansas City, MO
    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, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  3. #3
    north seattle wa
    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.


  4. #4
    north seattle wa
    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. Default
    Medicare did not change its stance in regards to detailed exam as per 1995 guidelines.

    Please review the following source:

    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!
    Jagadish, CCS-P, CPC

  6. #6
    Default Detailed Exam

    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!

Similar Threads

  1. Detailed exam on everyone!
    By chriskhans in forum E/M
    Replies: 7
    Last Post: 11-19-2015, 07:54 AM
  2. EPF or Detailed Exam?
    By lenamarie73 in forum Orthopaedics
    Replies: 1
    Last Post: 05-18-2015, 12:31 PM
  3. Exp. problem focused exam or detailed exam??
    By in forum E/M
    Replies: 3
    Last Post: 08-08-2014, 09:41 AM
  4. Detailed Exam-Is there some
    By nyyankees in forum E/M
    Replies: 12
    Last Post: 04-05-2013, 05:13 PM
  5. Expanded PF vs detailed exam
    By mpl5btx in forum E/M
    Replies: 3
    Last Post: 03-02-2012, 06:43 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.