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Thread: EPF vs. Detailed Exam in 95 GL

  1. #1

    Default EPF vs. Detailed Exam in 95 GL

    AAPC: Back to School
    I'm struggling here to understand some of the 1995 guidelines. For example, some of my FIs accept 2-4 body areas or organ systems as an EPF exam and 5-7 as detailed, but some of my FIs say it is 2-7 body areas or organ systems as an EPF and a detailed exam, but they don't clarify how to tell the differance. My question is, for those of you whose FI states 2-7 body areas or organ systems for an EPF or detailed exam, how do you tell what is EPF vs. what is detailed? I guess what I'm saying is, if I have 6 body areas, how do I know if I have an EPF or a detailed exam? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Detailed = EXTENDED exam of affected area

    For a detailed exam on 1995 guidelines you need an EXTENDED exam of the affected body area or organ system, plus other related system(s).

    I tell the doctors that they have to cover at least four elements of exam of the affected body area/system before I count it as extended. Then give me one other related system and I'll count it as detailed.

    For example, patient with injury to right forearm. (I'm making this up off the top of my head ... ortho coders be kind ...)
    Pleasant 15 YO, well groomed, in NAD. Right forearm has numerous bruises and contusions. Normal range of motion without pain at elbow. Patient has pain with with dorsal flex of wrist, and ROM is limited as result. No edema. Pulse strong. No tingling or numbness in fingers. No cyanosis.

    I would say this was an extended exam of the affected body area (left forearm), plus other related systems (Constitutional). (Of course you could count it as 5 organ systems, too: Skin, MS, CV, Neuro, Constitutional)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    This does help. Thanks so much for clarifying this.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

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