EPF Detailed Exam- Noridian Jurisdiction F

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Joined: Tue Mar 27, 2018 7:25 pm

Thu Sep 13, 2018 11:36 am


Is there anyone here whose MAC is Noridian, jurisdiction F? We are trying to determine the number of elements that Noridian prefer for the expanded problem focused and detailed exam.
Currently we are completing 2-7 body areas and organ systems for both and the determination is made by how many findings are present. Although, we are seeking any guidance on if others are using 2-4 for EPF and 5-7 for detailed?
The Noridian provider reps are not very helpful on this topic.
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Thu Sep 20, 2018 11:30 am


Based on the 95 guidelines, both EPF and detailed exams are documentation of 2-7 organ systems. The difference is a detailed exam also requires more detail in the exam of the affected organ system. This is usually 3-4 findings documented. If you are unclear about what an appropriate finding is for the system, you can use the specialty specific exam in 97 as a reference tool. Here is an example:

Vital signs: BP 138/90 HR: 75 Temp: 98.2

General: Patient is normal build and stature and presents in good mood and affect.

Musculoskeletal: The left upper extremity has good range of motion, with no noted subluxation, there is no mild tenderness upon palpation around the elbow. The left hand has good perfusion, and there is no obvious rashes or scars to the area.

The organ systems noted are as follows:

Constitutional: Vital Signs and general statement of appearance
Psychiatric: Presents in good mood and affect
Musculoskeletal: 1) Extremity exam of ROM, 2) subluxation, and 3) palpation
Cardiovascular: Good perfusion
Integumentary: No rashes or scars
The exam would be Detailed as the musculoskeletal system is documented as an extended exam noting 3 bulleted findings of this organ system

Your question has been answered by Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA
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