Detailed Exams

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

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kellyr
Posts: 7
Joined: Fri Jul 27, 2018 6:36 am

Mon Aug 27, 2018 11:29 am

This question, which truly resides in the grey area is for all of those that are under the CGS J15 Part B area. How do you define a detailed examination? Do you require a certain number of "bullets" to be documented for the organ system/body area that correlates to the presenting problem? Do you follow the advice of other MAC's? I want to create a policy for our providers to follow, but at the same time want to make sure that it does not put the providers at risk. I welcome all comments and/or advise!

Thanks,

KMR
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admin
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Posts: 431
Joined: Mon Apr 09, 2012 1:54 pm

Wed Aug 29, 2018 9:22 am

Good Morning-

CGS states that a detailed exam requires 2-7 organ systems with an extended exam of at lest one of the affected body region or organ systems.

Like you mentioned this does leave a gray area as they tell us what they want and give us no guidance as to how they view and "extended exam". Within our company Namas we teach that a detailed exam is supported if you have 2-7 organ systems documented with at least one of them having an extended exam. To calculate and extended you need to review the 97 guidelines for the organ system that has the extra documentation and look to see if the documentation supports 3-4 bullet points from the 97 guidelines, if it does support 3-4 bullet points than it is considered a detailed exam.

Some organ systems have fewer bullet points in the 97 guidelines (skin 2 bullets, eyes 3 bullets) in that scenario I just look to see that all the bullet points are accounted for.

https://www.cgsmedicare.com/partb/mr/pdf/99214.pdf

Your question has been answered by Stephanie Allard, CPC, CEMA, RHIT
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