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Thread: Complete exam of a single organ system

  1. #1
    Join Date
    Apr 2007
    Posts
    588

    Default Complete exam of a single organ system

    My MAC is Novitas. Under the exam portion of the auditor's instruction, comprehensive exam is 8 or more systems or a complete exam of a single organ system. What constitutes a complete exam of a single organ system? Is that in reference to '97 specialty guidelines? Any assistance would be appreciated.

  2. #2

    Default Complete exam of a single organ system

    They are referencing that a provider can use the '95 or '97 guidelines.

    When using the '97 General Multi-System Guideline table it identifies the system/body area along with the elements of examination (bulleted items). In order to count the system complete each bulleted item must be completed in that particular system.


    In '95 Guidelines you typically count organ systems: constitutional, eyes, ENT, Cardio, Respiratory, GI, GU, Musculoskeletal, Integumentary, Neurological, Psychologic, and Hematologica/lymphatic/immunology.
    Monika A. Liddle, CPC, CGSC
    2016 Member Development Officer, Sailfish Chapter of the Treasure Coast
    Past Treasurer, Sailfish Chapter of the Treasure Coast
    Past Member Development Officer, Sailfish Chapter of the Treasure Coast

    Franciscan Medical Group
    Coder II
    Port St. Lucie, FL


    No act of kindness, no matter how small, is ever wasted.
    ― Aesop

  3. #3
    Join Date
    Apr 2007
    Posts
    1,716

    Default Nobody knows....

    They can't possibly be referring to 97 since none of the "single" system exams actually involve only one system. That option is in fact part of the 95 guidelines.

    I have been thru several Novitas educational sessions, as well as many other carriers, and so far none of them have ever defined the single system comprehensive exam stated as an option for 95. When I asked Novitas point blank, I was told that it would be reviewed on a case by case basis by their nurse auditors and would be based on a clinical decision. So what might meet the requirement in one case might not in another.

    My advice to providers has always been to just not go there. Use the 8 or more or one of the 97 single system exams.

    Laura, CPC, CPMA, CEMC

  4. #4
    Join Date
    Apr 2007
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    Carmel, New York
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    Default

    I tell our physicians the same thing that Laura tells hers - don't try to use the comprehensive exam of one system (we use 95 guidelines). Without clear guidance, it is left to opinions, and that can change from person to person.

    There was another discussion thread here where someone was asking about what would constitued a comprehensive exam of just the skin/integumentary system. I wasn't going to touch that one - what I say and what a government auditor would say can be very different!

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    2016 Secretary
    Ellenville, NY Local Chapter

  5. #5
    Join Date
    Apr 2007
    Posts
    588

    Default

    2017 ICD-10-CM Coding Book
    Thank you all for your responses.

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