# CEMC Exam - guide lines we used



## Naveen Rachagolla (Jul 22, 2013)

should we use only 95 guidelines in exam or can it be also 97, if both then how will they know which guide lines we used ?

Can someone help me on this ?


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## a.montaruli@gmail.com (Jul 22, 2013)

Each question will specifiy which guidelines to use so don't worry about not knowing which one to use for the exam. There are about 50 charts to code with 3 questions per chart. It is not hard but be aware that it is ENTIRELY E/M coding. Good Luck!

Andrew


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## Naveen Rachagolla (Jul 22, 2013)

a.montaruli@gmail.com said:


> Each question will specifiy which guidelines to use so don't worry about not knowing which one to use for the exam. There are about 50 charts to code with 3 questions per chart. It is not hard but be aware that it is ENTIRELY E/M coding. Good Luck!
> 
> Andrew



Thanks for your reply.

I need some clarification regarding consultations..

its consultation chart..

it has 3 questions

one of the questions is What category it is ? and the statement in the billing information says the provider billed 99245 to medicare.

options are given like this..
A) New patient
B) Office consultations
C) Established Patient
D) In patient consultations

and in another consultation chart it says the provider billed 99245.

options are given like this..
A) New patient
B) Office consultations
C) Established Patient
D) In patient consultations

I know that if the patient has medicare we use 99201 -99215 based on patient status.

i wrote CEMC 2 time but failed with 66% both the times.
because iam only able to do 30 charts in 5 hours 40 minutes remaining charts iam blindly choosing the answers as time is short and more over only on consultation nearly 10 charts are there which will carry nearly 45 marks but iam little confused.

And the second or the first  question for every consultations chart says what is the level of the sevice?

and the options goes like this ..

A)992X2
B)992X3
C)992X4
D)992X5

And another issue is in all the consultation charts first 2 question are inter linked to each other if iam wrong with first question ultimately the second question is going wrong and vise versa.

i need som help on these issues this time iam again writing on september 29 wihch is a third attemt so i dont want to do the same thing.


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## a.montaruli@gmail.com (Jul 23, 2013)

I will tell you exactly the way I took the test. But first to answer your questions, if it says Medicare, you will ALWAYS use 99201-05 or 99211-15 depending if the patient is new. For all other insurances I believe it will be safe to say Consult Codes are okay. That is the point of view I had taking the exam. As for the 992X1-5 codes, the main thing to look at if if the patient is new or established. It may look like they are trying to trick you but in their own little weird way, they are trying to help you by confusing you less. 

As for the linking questions, do yourself a favor and dont look into it as much as it seems that you are. I would first go through the entire test and answer any Dx questions they give you, then go back and answer all of the LOS questions. Really become familiar with that audit tool and focus on the MDM. Remember that Work Up is any planned services after the encounter itself. Remember that for a full ROS you need a positive and negative along with all systems negative. And remember a detailed exam you're looking for at eat 4 elements of detail within one system. You can pretty much eyeball that though. 

I hope this helps. If you would like to call me or email me for any more tips please do. Ive taken a ton of these tests and so far have had luck passing on the first try so if I can help I sure will. My number is 718-795-7149 and email is a.montaruli@gmail.com


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## Naveen Rachagolla (Jul 23, 2013)

I reall appreciate your response and clarification and once again thanks for extending you number and mail.

Another issue or the mistake that i did is regarding the new and established patients charts.
Bothe the times i used 95 guidelines for all the 50 charts thinking that test is purely based on 95 guidelines.

coming to est patients as only two components are required it was less confusing and able to do the charts, but iam finding dfficult to code new patient charts as 3 out of 3 components are required.

using 95 guidelines able to get Exam and MDM but coming to history there iam struck HPI because history requires 3 components like HPI, ROS and PFSH, some time the history sections mentiones 3 or 4 chronic problem without proper HPI elements though ROS and PFSH are there thinking that for extended HPI it requires 4 or more elements. in this point of thinking though Exam and MDM are level 4 because of HPI i always down coded the charts insted of choosing 97 guidelines as there are 3 or more chronic illness.

Advise me when to choose 95 and when to choose 97, should i use 97 if the HPI is less and if there are 3 or more chronic illness ? and should i used 95 guidelines if the HPI are more like 4 or more and the presenting presenting problems are 2 and less than that.


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## a.montaruli@gmail.com (Jul 23, 2013)

From what I remember, you should use the '95 GL unless advised otherwise. I remember taking the CEDC exam and a few questions on that exam stated "what level of history is this using the 1997 Guidelines". If my memory serves me right, I thought the CEMC was the same way. Also remember that the 1997 GL are really specialty based. And by specialty I really mean offices for an ENT or OB, something like that. 

It seems to me that it is taking you a lot of time using the '95s then realizing that maybe you should be using the '97s and doing the whole chart over again. I would really contact AAPC to see if you can get more clarification because I don't want to steer you in the wrong direction but I used the '95 and I passed with an 88%. 

Using the '97s, yes it may be easier to get a full history because of the chronic illnesses but the exam will suffer for sure so you actually might come out with the same code. Remember too that just stating the patient has 3 chronic conditions does not warrant a full HPI for the '97s, the status of those conditions must be stated and any medication changes (if any). So that could be an indicator too. 

But like I said, this is the way I took the test but you might want to contact AAPC and just see what they have to say about it. 

Andrew


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## Naveen Rachagolla (Jul 24, 2013)

I had sent a mail to aapc asking what guidelines has to be followed in the exam, and how will the auditor will know which guidelines are used in the exam for the charts, but i got a plain message saying (The CEMC exam will cover coding per NCCI, ICD-9-CM, CPT® Modifiers and both the 1995 and 1997 Documentation Guidelines. It is highly recommended you take Both CMS DGs (1995 & 1997) to the exam. ) where iam not satisfied with this answer.

Any suggestions.


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## a.montaruli@gmail.com (Jul 25, 2013)

I would not be satisfied with that answer either. I would go with my recommendations on how to code with the '95s unless stated otherwise. That's what I did and i passed... I wish you luck!


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## Naveen Rachagolla (Jul 25, 2013)

Thanks for your advise. Do u have any documents or material which stress more on MDM or the Risk table of MDM which might be helpful to me, incase if you have Please send it to my mail rnaveenprakash@gmail.com.

And at the same time i have question which is posted by coder.

Regarding counting additional conditions in the assessment and plan. If providers want credit for additional conditions in the assessment and plan should they document those conditions in the chief complaint along with the presenting problem or do they only need to be mentioned in the history of present illness? For example a few of our providers will document something like COPD as the presenting problem and then in the assessment and plan along with the COPD is hypertension and diabetes as the 2nd and 3rd with nothing about these conditions in the HPI. I explained to them that they need to make mention of the additional conditions in the HPI if they want credit for these conditions. A question came up as to whether those conditions also need to be documented in the chief complaint as well. I wanted to get some feedback regarding this issue.


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