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Thread: Coding for a hand specialist

  1. #1

    Exclamation Coding for a hand specialist

    AAPC: Back to School
    I am implementing an auditing program for our clinic and we have a hand surgeon who works in our office. Is it ok to develop specific starndards fit to her specialty? For an example, we have talked about adding Finkelstein's maneuver, Empty can test, Crank and grind tests as "bullets" under the musculoskeletal heading of the listed organ systems on my audit tool. Is this acceptable????
    I really have only used the 1997 guidelines and when looking at the 1995 guidelines, I am certain that our hand specialist would benefit from using them but I need to come up with a standard for my audits so that I can make a definitive decision based on her note on whether the exam is EPF or detailed.

    PLEASE PLEASE PLEASE HELP!! I am the only one on this auditing project and I am the only certified coder in our office. I would really appreciate any insight on this matter.

    Thanks so much!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Yes, absolutely

    1995 guidelines for COMPREHENSIVE exam are - general multi-system exam (8 or more organ systems) or complete exam of single organ system.

    Given that a hand specialist would not be also examining the lower extremities, back/spine, etc, I think it would be unlikely that you'd ever meet that standard.

    However ... I would still recommend that you develop that list of bullet points for a comprehensive HAND exam. This allows the auditor to use the 1995 guidelines to identify what is a limited exam vs a expanded exam of the affected body area/organ system.

    So, for example: you identify 7 exam elements for the hand and the practice defines "Expanded exam is 4 or more of these bullets." You then have that guideline noted as part of your compliance plan. In this way both you and an outside auditor would know exactly how you are defining the exam for this highly specialized provider.To achieve a "detailed exam" under the 1995 guidelines you need an "extended" exam of the affected body area/organ system, and other symptomatic or related organ systems, so you would still need at least one other system examined, but that could be vital signs or general appearance of the patient for Constitutional system.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    Thank you, that is extremely helpful.

  4. #4
    Join Date
    Apr 2007
    Jamaica, NY


    I came upon this forum while searching for an example of a comprehensive exam for a Hand Specialist and guidance. Unfortunately, our hand surgeon does not meet a 99204-5 with the '97 Musculoskeletal exam nor with the '95. You mentioned that we can develop a list of bullet points to reach a Comprehensive Hand Exam. Do you happen to have an example? There are not many where he could examine all 30 bullets of the '97 Musc exam/4 or more body areas in the musc. His exam generally consists of: Vitals and general appearance, a thorough exam of one extremity (ROM, strength, stability, inspection, palpation, etc. of digits, hand, forearm, elbow, shoulder of ULE), skin, cardio (edema, pulses), and sometimes neuro (AOx3/sensation) and psych (NAD/agitation). The only time he meets a 99204-5 is when it is based on time, which is not often.

    Thanking you in advance,


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