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Thread: 95 Musculoskeletal exam

  1. #1

    Default 95 Musculoskeletal exam

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    Does anyone know of any documentation anywhere that would state what would be required in order to get a comprehensive musculoskeletal exam using the 95 guidelines?

    I have a Physiatrist who will never get a comprehensive exam using the 97 guidelines so this is a bit of a challenge. He does have a very large exam of all extremities, plus spine, neck, cardio, constitutional, neuro, psych, and skin. Normally I would fall to the 95 multisystem guidelines but there is not enough there for that either.

    According to the auditing software we use it states that the Provider can have a written policy defining what a comprehensive exam to them means.
    That just seems wrong to me so I was wanting something else to go on.



  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    under 95 guidelines it states for a comprehensive exam it is a complete exam of one body system or a comphrehensive mulitsystem exam which is defined as an examination with findings of 8 out of 12 body systems. A written policy is not going to work he must document enough in the patient's medical record.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    So a comprehensive exam using 95 would mean all the requirements of the 97musculoskeletal exam?

  4. #4


    Since your physician is a psychiatrist I would imagine that he/she spends alot of time in counseling. If this is the case, I would suggest utilizing the "time caveat" (i.e. greater than 50% in counseling and/or coordinating care - CPT 2010 page 10).

    Required documentation for E/M level based on time:
    - Total Time
    - Percentage of Time (greater than 50%)
    - What was discussed during counseling and/or what was coordinated

    Just a thought

  5. #5


    This physician is not a psychiatrist he is a physiatrist. He deals with musculoskeletal pain issues. Counseling wouldnt work for him because he spends the majority of his office time on his exam. Not in counseling/coordination of care.

    There has to be someone out there that is having this situation. Unless other Drs out there are just dealing with billing for a detailed exam only.

  6. #6
    Join Date
    Apr 2007
    Columbia, MO


    Quote Originally Posted by katelliott80 View Post
    So a comprehensive exam using 95 would mean all the requirements of the 97musculoskeletal exam?
    That is the basic premis.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7


    He doesn't qualify using the single system musculoskeletal exam for 97 guidelines?
    adrianne, cpc

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