Assuming you're referring to Novitas Solutions, Inc as your MAC, there is an advanced E/M webinar coming up 2/12/13, 11am - 12:30pm ET. There you can ask questions and get a better understanding of the 4x4 rule.
In answering your question here's an example from a previous webinar.
Constitutional-1)BP 2)temp 3)pulse 4)respiration
Cardiovascular-1) Regular rate 2)and Rhythm 3)Normal S1 4) and S2
Gastrointestinal- 1) abdomen soft 2) normal bowel sounds 3) no hernia 4)abdomen flat
As per the example as long as the physician mentions ear, nose, mouth, throat he has made all 4 requirements in the organ system. Eyes is usually PERRLA (Pupils Equal, Round, Reactive To Light And Accommodation) would be appropiate for 4x4
Hope this helps
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