1997 Exam Bullets

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coderth
Posts: 13
Joined: Fri Sep 21, 2012 2:54 pm

Fri Jun 22, 2018 3:32 pm

I audit our GYN and Neuro docs using the 1997 specialty exams. I need an opinion....I have researched this and cannot find an answer. If a "bullet" cannot be performed in the exam due to circumstances beyond provider control, should they be penalized and not allowed an otherwise comprehensive exam? For example, a GYN patient has had the uterus removed or the neuro patient that is confined to a wheelchair and the provider cannot assess gait and station? I know if a ROS is unobtainable and the reason is documented, the provider isn't penalized. But....I have not been able to find anything to support this for the 1997 exam. I agree with my physicians when they state they should not be down-coded from a justified, medically necessary 99205 to a 99203 because of something beyond their control. I would just like to have something (preferably in writing) that would hold up in case of an audit. I could not find anything on my MACs website (Novitas). The documentation definitely would not meet a comprehensive exam using the 1995 guidelines, especially Neuro, and I don't want them documenting organ systems just to get to a comprehensive exam (i.e. ENT, GI, GU for Neuro). Opinions?
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admin
Site Admin
Posts: 451
Joined: Mon Apr 09, 2012 1:54 pm

Wed Jun 27, 2018 9:16 am

I do not know of a place where this would be stated in writing, but if I were auditing and the provider stated the bullet and why it did not pertain to the patient I would give them credit. I would not count it as comprehensive if they did not mention the bullet in the exam and the reason they did not review, I think it would be hard to support in an external audit if the provider leaves it up to the coder/auditor to assume no uterus exam due to the past history showing the patient had a hysterectomy. But if they clearly state in the exam, no examination of uterus due to hysterectomy I would definitely give them credit.

What I meant to say in that answer about an external audit is that they are leaving room for the external auditor to miss that competent of the exam if provider leaves the patients past history up for assumption. I think the past history could be argued as support, but it is best practice to document the details right in the physical exam and bypass the potential to have to fight support of that exam component with an external auditor.

Your question has been answered by Stephanie Allard, CPC, CEMA, RHIT
coderth
Posts: 13
Joined: Fri Sep 21, 2012 2:54 pm

Thu Jun 28, 2018 10:02 am

Thank you Stephanie!
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