# Detailed Exam



## dcraven (Feb 20, 2008)

Does anyone have any information where Medicare changed their stance regarding the requirements for a detailed exam?  At one time CMS required 2 systems with detail documented to have a detailed exam.  I am hearing now that CMS will accept one organ system with detail to have a detailed exam 
Thank you,
Debby


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## amjordan (Feb 20, 2008)

I have seen various audit tools that have various formulas for a detailed exam based on the 95 Guidelines.  I don't know that anything may have necessarily changed, but you could start with you Medicare carrier.  When I work with physicians I tend to go with the 2 or more systems with Detail.  If you read the guideline below literally, it should be at least 2 or more with detail.  

_Detailed -- an extended examination of the affected body area(s) and other symptomatic or related organ system(s)._


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## Cottrell (Feb 22, 2008)

I found a power point presentation done by Noridian (our local carrier) that had it broken down this way:

PF=1, EPF= 2-4, D=5-7. C=8 or more.

Hope this helps.

Wendy


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## Cottrell (May 16, 2008)

*recalled powerpoint*

According to Linda Windley at Noridian, this powerpoint presentation was requested to be taken off of their website on April 23, 2008 because they could not verify the 2-4 for the expanded exam and th 5-7 for the detailed exam. She stated to continue to use the 95 or 97 guidelines. 

So I guess it is back to the vaugeness of Medicare. Sorry guys.


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## Jagadish (May 16, 2008)

Medicare did not change its stance in regards to detailed exam as per 1995 guidelines.

Please review the following source:

http://www.empiremedicare.com/cbtcou...m Levels.pdf

Detailed. An extended examination of affected body area(s) and other
symptomatic or related organ system(s) (up to 7, at least two items per system).

Hope this helps!


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## srarick (May 21, 2008)

Debby,

Per '97 Guidelines, a detailed exam requires 12+ bulleted elements in 2+ systems.

Per '95 Guidelines, a detailed exam requires 2-7 systems - more detail.

I'm in Ohio - so the Medicare Carrier is Palmetto.

Hope this helps!
Susan


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