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E&M audits using "HEENT negative" one system or 2?

  1. #1
    Default E&M audits using "HEENT negative" one system or 2?
    Medical Coding Books
    If a provider states "HEENT" negative under 95 guidelines, do you count this as 2 systems (eyes and ENT)or do you only count 1 system? Can anyone tell me where it says this in black and white?

  2. #2
    north seattle wa
    Default Heent
    Medicare's 1995 documentation guidelines recongizes Eyes as an organ system as well as Ears, Nose, Mouth and Throat as an organ system,so I would count it as 2.
    The documentation guidelines also state that "negative" is sufficient to document normal finding related to unaffected area(s) or asymptomatic organ systems(s).

    The documentation guidelines can be found in the Physicians guide to Medicare. I saved it to my H drive- much easier than trying to navigate back to it!


  3. Default
    I agree with Cottrell, 2 systems for 95 guidelines.

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