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Thread: 1995 dg

  1. #1
    Join Date
    Apr 2007
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    Sioux Falls, SD
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    Default 1995 dg

    Promo: Code Books
    Hello,
    I code e/m visits in several states, which includes 3 different MACs. I was wondering if anyone could guide me to what each MAC's definition of an EPF vs D exam is using the 1995 guidelines. I have tried searching their websites and don't feel I am finding the information I am looking for. I am specifically looking for WPS, Noridian and Cigna.
    Thank you so much for any guidance you can give me!

  2. #2
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    Apr 2007
    Location
    Kansas City, MO
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    Default

    WPS will only tell you that they follow the guidelines. They do not make public any coding tools they use, or even admit that they use them

    WPS does have a good Q&A section however. http://www.wpsmedicare.com/j5macpart...mngmntqa.shtml
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
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    Education Officer Loveland/Ft Collins, Colorado
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    Default 95 guidelines

    Brandi, this a grey area and none of the MAC providers will tell you the interpretation. I would recommend one of two was to view this area and have it in your compliance plan how your doctors will view and document for 95 guidelines.

    *Problem Focused -- a limited examination of the affected body area or organ system.
    * Expanded Problem Focused -- a limited examination of the affected body area or organ
    system and other symptomatic or related organ system(s). what does limited means, how many?)
    * Detailed -- an extended examination of the affected body area(s) and other symptomatic
    or related organ system(s). (what does detail mean, how many?)
    *Comprehensive -- a general multi-system examination or complete examination of a
    single organ system.


    2-7 - none in detail - Problem focused
    2-7 with one body system in detail - Detailed
    (what does detail mean? Everyone has a different view of what detail means)

    OR

    2-4 - Problem focused
    5-7 - detailed

    Much easier to define but have this spelled out in your your compliance plan of the guidelines and interpretation your physicians use.
    Melody S. Irvine,CPC, CPMA, CEMC, CFPC, CPB, CPC-I, CCS-P, CMRS
    2016 Member Education Officer, Loveland, Colorado
    2016 - 2019 AAPC Chapter Association Board of Directors
    Region 7, Montana, Idaho, WY, CO, NM
    Email: Melody.Irvine@AAPCCA.org
    Phone: (970) 222-1900

  4. #4
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    Evansville Indiana
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    Default guidelines

    NGS has recently come out with these standards that their auditors will use.
    2-5 = EPF
    6-7 = detailed

    LeeAnn

  5. #5
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    Apr 2007
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    Cincinnati, Ohio
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    Default

    Quote Originally Posted by cheermom68 View Post
    NGS has recently come out with these standards that their auditors will use.
    2-5 = EPF
    6-7 = detailed

    LeeAnn
    where did you see this Lee Ann?

  6. #6
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    Apr 2007
    Location
    Evansville Indiana
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    451

    Default Ngs

    They gave an E/M teleconference about 6 weeks ago and stated this. You might still be able to access the information on their website.
    LeeAnn

  7. #7
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    Apr 2007
    Location
    Kokomo, IN
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    Default

    This information is now on their website(NGS). they have an audit tool with it split and they have a FAQ list.
    Last edited by Anna Weaver; 06-21-2011 at 10:56 AM. Reason: left off location.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  8. #8
    Join Date
    Apr 2007
    Location
    York, Pa
    Posts
    1,899

    Default

    Quote Originally Posted by BrandiF View Post
    Hello,
    I code e/m visits in several states, which includes 3 different MACs. I was wondering if anyone could guide me to what each MAC's definition of an EPF vs D exam is using the 1995 guidelines. I have tried searching their websites and don't feel I am finding the information I am looking for. I am specifically looking for WPS, Noridian and Cigna.
    Thank you so much for any guidance you can give me!
    Hi Brandi:

    Would Highmark Medicare be one of your MAC's? If so feel free to email me at

    rthames@heritagemedgrp.com

    Thanks,
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  9. #9
    Join Date
    Apr 2007
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    Cincinnati, Ohio
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    Default

    Quote Originally Posted by Anna Weaver View Post
    This information is now on their website(NGS). they have an audit tool with it split and they have a FAQ list.
    Would you mind providing the link to the website? We are new to NGS as our Medicare Carrier and I've had no luck finding anything on their site about how the view the E/M Guidelines (both 95 and 97), nor have I been able to locate any audit worksheets on the site

    Thanks!

    Angie
    Cincinnati, OH

  10. #10
    Join Date
    Apr 2007
    Posts
    12

    Default

    I need MAC guidelines for Cahaba GBA. Specifically if they will allow Non Contributory for Family History. Can anyone help me with that?

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