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Thread: 95 Exam EPF vs Detailed

  1. #1
    Join Date
    Apr 2007

    Question 95 Exam EPF vs Detailed

    AAPC: Back to School

    Can someone please clarify on the 95 exam requirements how to "count" per se examination criteria for the difference between the EPF which states "a limited" examination of the affected area or organ system and other symptomatic organ systems(s), and the Detailed exam which states, an "extended" examination of the affected body area(s) and other symptomatic or related organ system(s). Thank you!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default It depends

    The 1995 guidelines are very vague. I know I have answered this question before. Don't want to seem mean or uncaring ... but please check the E/M, Auditing, Family Practice forums for this topic. There is a lot of information posted previously.

    F Tessa Bartels, CPC, CEMC

  3. #3

    Default EPF vs. Detailed exam

    Here is how Highmark Medicare defines a detailed exam: "Under the 1995 guidelines both the expanded problem focused examination and the detailed examination provide for the examination of up to 7 systems or 7 body areas. This has led to variability in reviews utilizing the 95 guidelines, and requiring an interpretation for proper and consistent implementation of the E/M guidelines. By providing a tool we call 4X4 (4 elements examined in 4 body areas or 4 organ systems satisfies a detailed examination; however, less than such can be a detailed exam based on the reviewers clinical judgment) our reviewers and the physicians in J12 MAC have a clinically derived tool to assist in implementing the E/M guidelines and decreasing one area of ambiguity."

  4. #4


    Where is it written that we need 7 elements to the examine? All I can find is auditing tools that tell me this. I want to see it in writing.

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