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EPF Vs DET PE - 1995 DGs

  1. Default EPF Vs DET PE - 1995 DGs
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    When asked for the opinion on differentiation between EPF Vs DET PE as per 1995 guidelines, I got the response from my MAC as following:

    "The Medical Review staff currently differentiates detailed from EPF by the development/expansion of the systems being addressed (e.g., general physical assessment of 3 systems versus expanding on those 3 systems by addressing additional elements within those systems)"

    Can somebody help me in understanding/interpreting this.
    Thanks,
    Jagadish, CCS-P, CPC

  2. Default
    "The Medical Review staff currently differentiates detailed from EPF by the development/expansion of the systems being addressed (e.g., general physical assessment of 3 systems versus expanding on those 3 systems by addressing additional elements within those systems)"

    This is one of the reasons I don't use 1995, too subjective and too hard to defend in an audit. And who's too say if 4 systems meet DET but 3 only meet EPF, do you still get a DET exam?

    Basically what your MC payer is saying is for each area or organ systems examined (each of the 2-7) there would be a difference in the exent of the exam of that system. Meaning under an EPF there would be simple, brief statement of exam but under DET there would be additional or more specific info

    For example:
    EPF for cardio----RRR, no rales
    DET for cardio---a little tachycardic but no murmur or rub, no edema, no JVD, equal pulses bilat


    Problem Focused – a limited examination of the affected body area or organ system
    (exam of 1 body area or organ system documented)

    Expanded Problem Focused – a limited examination of the affected body area or organ system and other symptomatic or related organ system(s) (exam of 2-7 body areas or organ systems documented)

    Detailed – an extended examination of the affected body area(s) and other symptomatic or related organ system(s)
    (exam of 2-7 body areas or organ systems documented)

    Comprehensive – a general multi-system examination
    (examination of 8 or more ORGAN SYSTEMS)

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