95 guidelines- Detailed Exam

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Posts: 2
Joined: Fri Nov 10, 2017 1:46 pm

Fri Nov 10, 2017 1:58 pm

Does anyone have First Coast as their MAC? If so, what facility guidelines do you use to establish between an epf and detailed exam?
Currently, this facility does not have in-house guidelines in regards to exam requirements.
I am use to using the 2-4 5-7 systems method. All I have found on the First Coast website is that the comprehensive exam must have at least 8 systems.
Here is an example of an exam:

When I examine the patient, she does not make eye contact. She indicates the light makes her eyes sensitive. Her motor strength
is difficult to evaluate. She does have fine static tremor of her outstretched arms and no definite cerebellar tremor. Her gait
is slightly forward. There did not appear to be any Babinski.

Sometimes Pulse and BP may be documented. What would you consider this to be?

Any resources, or refreshers that you may give me would be helpful. I would prefer a resource to show the provider.
Thank you for your help
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Wed Nov 22, 2017 10:26 am

1995 Examination Guidelines
Q. Do you use the numeric conversion for the 1995 E/M guidelines (i.e., problem focused exam: one system and/or body area, expanded problem focused exam: two-four organ systems and/or body areas, detailed exam: five-seven body areas and/or organ systems, comprehensive: eight organ systems)?
A. The 1995 guidelines do not specify exact numbers -- problem focused implies one system/area, and only comprehensive has a numeric indication (eight or more of the 12 organ systems).

First Coast does not have a 95 guideline for a detailed exam beyond what is identified above. Typically a detailed exam would be depend on two things. The presenting problem, and how many elements are captured for the affected organ system/body area, out of all possible elements.

The example above would be a detailed exam (in my opinion) if the patient is being evaluated for a neurological, or suspected neurological, condition. However, if it is a patient being seen for something unrelated, like a cough, the above exam could appear to be over template/documented, without documentation identifying the condition that relates to neurological consideration.

Your question has been answered by Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC
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