Weekly Tip-Scoring of Exam

In this forum thread feel free to post your comments and areas for discussion that you may have based on the weekly auditing and compliance tips from NAMAS.

Moderators: NAMAS Moderator, Shannon DeConda

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Posts: 47
Joined: Fri Aug 03, 2012 10:22 am

Fri Jan 30, 2015 9:11 am

Hi. I was kinda surprised that this Exam only scored as EPF. Can you tell me how you assess whether an exam of a particular organ system is 'detailed' or not? For instance, what was the rationale behind not allowing the cardio exam (normal rate, rhythm, and sound) as 'detailed'? Thank you!
Shannon DeConda
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Posts: 53
Joined: Thu Apr 12, 2012 2:53 pm
Location: Melbourne, FL

Tue Feb 03, 2015 11:26 am

Great question! This is an area that is not truly defined by 1995 Documentation Guidelines. Some carriers have posted some guidance on the matter, and most would agree that "in detail" would be 3-4 exam findings of that organ system. These exam findings would correlate to the exam findings represented by each bullet under that specific organ system in 1997 Guidelines.
So using the example and your question about the cardio- all three of those findings related to Auscultation of heart with notation of abnormal sounds and murmurs and therefore it would not reach what we would define as a "detailed" exam.
I'm glad you posted this question as that finding was created to make auditors think about and access the exam more thoroughly.
Thank you,
Founder & President of NAMAS

Disclaimer: NAMAS cannot be held liable for any advice given that could have had a variable answer based on additional information.
Posts: 47
Joined: Fri Aug 03, 2012 10:22 am

Wed Feb 04, 2015 9:50 am

Thank you a bunch for taking the time to explain that for me. Have a great day!
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