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Thread: 95 rules Extremity E & M

  1. #1

    Default 95 rules Extremity E & M

    AAPC: Back to School
    Our office is in a program where the hospital codes some of the cases, and were are reimbursed by the hospital. They use the 95 rules. We were short a system for the comprehensive examination according to the hospital coders. They counted 7 systems. The doctor stated "no calf tenderness "under the extremities category. I asked why they could not count the calf tenderness under the muscskel system. They said that they could not because extremities is a body area. I was under the understanding that you could abstract the wording and use what is under this category for either the musckel system or the cardiovascular system (no edema, swelling) if their comments apply to that area, or it might even apply to the skin if they are discussing the warmth, lesions, etc. The doctors also stated no groin lymphadenopathy, and they would not give credit for the lymphatic system because it was listed under the extremities. I have always tried to look beyond the categories that the doctor quotes when coding with the 95 rules. I was wondering how others use the information that is under the extremity section to count the 95 requirements.



  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    I agree with you. I do the same thing. Extremities are definitely part of the musc skel section, and depending n what is documented about that leg or arm, it might even be marked as CV or skin! You cannot limit yourself to labels! There are no rules that I know of to say you must do this either.
    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

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