# count body areas and organ systems



## debaloia (Mar 11, 2009)

Hi,
I am seeing alot of physicians mix body areas such as Neck and Extremities with organ systems.  I try to make the Neck and Extremities fit into the Body Organs so that they can still be counted. 

How would you count the following:
General, HEENT,Neck, Heart, Lungs, Abdomen, Neurological exam, Extremities, Rectal Exam deferred.

I counted 1 General as Constitutional
              2 Neck as Muskular Skeletal
              3  Heart as CV
              4 Lungs as Respiratory
              5 Abdomen as GI 
              6  Neuro


I  did not count Extremities because I thought that would fall into CV and I did not count deferred Rectal exam because I thought that would fall into GI and that both organ systems have been already counted.

Please let me know what you think? and if you also get 6 

thanks!


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## ARCPC9491 (Mar 11, 2009)

The 1995 guidelines ALLOW you to use BODY AREAS and ORGAN SYSTEMS... 

The following Body Areas are recognized:
Head, including face
Neck
Chest, including breasts and axillae
Abdomen
Genitalia, groin, buttocks
Back, including spine
Each extremity

Organ Systems:
Constitutional
Eyes
Ears, nose, mouth, throat
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Skin
Neurologic
Psychiatric
Hematologic/Lymphatic/Immunologic


You documented:
General/Constitutional - Organ System
HEENT- Organ System
Neck- Body Area
Heart, CV- Organ System
Lungs, Respiratory- Organ System
Abdomen, GI- Organ System
Neurologic- Organ System
Extremities- Body Area ....... how many extremities were examined? 

You have 6 organ systems, and 2+ body areas (depending on how many extremities examined)

Either way you look at it, you have (documentation supporting of course) a detailed exam based on the 1995 guidelines.

In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam.  

It is not appropriate to "assign" body areas to organ systems.


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## debaloia (Mar 11, 2009)

Do you know if that is the same for all states?  I thought you had to use either Body Areas or Organ systems and could not mix them.  I 

We are in Pennsylvania and go by Highmark Medicare Services

To get a Detailed Exam we have to apply the 4 X4 rule which means 4 bullets in 4 different systems. 

Thanks for responding.  I want to know how everyone views this as I am getting many different answers here. 

The highmark medicare website is very vague.

thanks


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## ARCPC9491 (Mar 11, 2009)

hmm.... well the guidelines are the guidelines. The contractors can interpret them the way they like. I have a different contractor, and I'm not aware of the 4x4 rule.... sorry I couldn't help!


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## Lisa Bledsoe (Mar 11, 2009)

It has always been my understanding that you cannot mix body areas with organ systems for 95 guidelines.  It has to be either/or, not both...


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## ARCPC9491 (Mar 11, 2009)

Interesting..I've always been taught you could and that's how I apply it..I need to stop doing that then. I primarily use 1997 guidelines thankfully!


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## RebeccaWoodward* (Mar 11, 2009)

Now that's interesting.  

My auditing software has it broken 3 ways.  One template for body areas...one template for organ systems...and one template with *both*

Now I'm confused....   I'm going to check this out.


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## ARCPC9491 (Mar 11, 2009)

LOL... it's always something right Rebecca.... I'm just as confused as you... I'm going to look into it too. Let me know what you find!!


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## RebeccaWoodward* (Mar 11, 2009)

Using 95 DG's, a comprehensive exam requires 8+ organ systems.  Now...I'm ok    Whew!.........


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## ARCPC9491 (Mar 11, 2009)

Lisa-
What are you referring to when you say you can't use body areas/organ systems combined? 

I know you can't for a comprehensive exam... as per my previous statement... "In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam."


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## debaloia (Mar 11, 2009)

AR-
I asked the original question...I am going to try to clarify what I am finding when I go to the physicans practices. 
IF there were two body areas and 2 organ systems that were unrelated, lets say GI, repsiratory and then two body areas neck and extremity...I would count that as 4 by fitting the neck into the musk skeletal organ system and extremity into the cv sytem.  If however, I already had used the musk skeletal and  the cv system marked then I would only count two organ systems.  Either one would give me an Exp Problem Focused Exam but sometimes it makes a difference. 

Thanks


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## FTessaBartels (Mar 11, 2009)

*1995 guidelines*

Our 1995 audit tool allows us to count body area *and/or *organ system (i.e. you can mix them) for an EPF or detailed exam. 

For comprehensive exam you must have 8 organ systems. 

The 1995 guidelines just state that you need 2-7 body areas and/or organ systems for an EPF or detailed exam.  Some have refined this to be 2-4 BA and/or OS for EPF; 5-7 for detailed.

debaloia states: To get a Detailed Exam we have to apply the 4 X4 rule which means 4 bullets in 4 different systems. 
This sounds like a hybrid of the 1995 and 1997 guidelines to me. (Since 1995 doesn't have any "bullets," and 1997 would require 2 bullets from each of 6 areas/systems OR at least 12 bullets in 2 or more areas/systems.

Regardless, if your local carrier (Highmark or whoever) has specific guidelines then you'd be wise to follow them *for that carrier*. 


F Tessa Bartels, CPC, CEMC


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## Lisa Bledsoe (Mar 11, 2009)

Very interesting...
My audit tool states body area *OR* organ system (no _and_).
Maybe I better look into a new tool?

But I am absolutely certain that in previous E/M seminars and workshops I came away with the understanding that you could not mix body areas with organ systems for a 95 exam.  I'm working fom home today, my workshop material is at my office.  I'll have to review that...


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## kmhall (Mar 11, 2009)

This is what I get from the guidelines...  Correct me if I am wrong...please.  Just like all of you, I want to audit this correctly! 

Level of Examination
□  1 organ systems *OR* body area
*Problem Focused*
□  1 organ system or body area *AND* organ system(s) limited
*Expanded Problem Focused*
□ Affected body area(s) *AND* other organ system(s) extended
*Detailed*
□ General multi-system *OR* complete single organ system exam 
*Comprehensive*

Here is the link to CMS website

http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp


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## ylizcontreras (Jul 30, 2009)

This is an interesting thread. Tell me if the EMR templete for GI physician list abdomen can I count that as GI? they are GI physicians after all!




ARCPC9491 said:


> The 1995 guidelines ALLOW you to use BODY AREAS and ORGAN SYSTEMS...
> 
> The following Body Areas are recognized:
> Head, including face
> ...


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## jas0426 (Oct 20, 2009)

*95 Guidelines*

For a problem focused exam, expanded problem focused, or detailed, you can use areas and systems combined.  For a comprehensive exam you have to have at least 8 systems.  Think about it this way, to get that "comprehensive" they want you to exam a "system" not just and organ.  Hope that helped some!

Jeni Smith, CPC


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