# 97 exam bullet



## LLovett (Aug 20, 2009)

"Ears, nose, and throat are grossly patent."

How much credit would you give for this?

I personally don't like it at all but I do give 1 bullet. One of my co-workers gives 3 for this.

Opinions greatly appreciated.

Laura, CPC, CEMC


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## heatherwinters (Aug 20, 2009)

*Ent*

I agree, I would give him one.  He did not touch on the specific areas within the ENT that he examined.


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## ARCPC9491 (Aug 20, 2009)

Laura, it depends and I dislike this as well.

If I see HEENT: negative. Who knows what exactly they examined -- it could have ONLY been ears but they still state "HEENT". You will see that some people will give full credit because the 1997 DG's state "you may examine and state negative" for an organ system and this little bundle is an organ system. It's much easier with the 1995 DG's on this -- because they only get credit for 1, anyway.... 

However, if they list them out seperately -- such as your example, I'd be inclined to give them credit for the ones they list out.  

BUT even with that said, if you are using the 1997 guidelines, let's just say they put EARS: negative. If you look, you have 2 bullets for ears ... so which was it? I encourage them to list exactly what was negative that way it is clearer to the auditor.

Does that help a little?


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## heatherwinters (Aug 20, 2009)

*Documentation of everything*

Take a look at this link, page 12 of the book
http://books.google.com/books?id=fn...esult&ct=result&resnum=2#v=onepage&q=&f=false


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## LLovett (Aug 20, 2009)

I tell you what I encourage them til I am blue in the face and they are just plain stubborn!

This statement is sometimes the difference between a 2 in 9 comprhensive exam and a detailed. It is'nt in the note I have in front of me at the moment but it still drives me nuts!

When I look at the general multisystem exam for ENT, I don't feel comfortable give credit for more than one bullet based on this statement.


 External inspection of ears and nose (eg, overall appearance, scars, lesions, masses)
 Otoscopic examination of external auditory canals and tympanic membranes
 Assessment of hearing (eg, whispered voice, finger rub, tuning fork)
 Inspection of nasal mucosa, septum and turbinates
 Inspection of lips, teeth and gums
 Examination of oropharynx: oral mucosa, salivary glands, hard and soft palates, tongue,tonsils and posterior pharynx

When you look at throat (oropharynx), open or clear (patent) is not an option. I feel its poor documentation but that it does cover the first bullet of external inspeciton of ears and nose. 

This is something that will have to be stressed to them especially if they get rid of consults and we have to use either admits or sub care for our inpatients, and I really want be sure they get all the credit they deserve. If I am short changing them I want to know so I can change that immediately.

Thanks

Laura, CPC, CEMC


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## heatherwinters (Aug 20, 2009)

*E/M*

I'd let them know that if they want to be "audit proof", they need to touch on the areas they examined specifically.  Even if one auditor gives them credit, another may not and that kind of subjectivity could mean the difference in paying back a lot of money.  

Have you heard anything specific yet on whether Medicare is actually going to do away with consultation reimbursement?


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## LLovett (Aug 20, 2009)

Unless something changes they are going to stop paying on consults Jan 1, 2010. They are accepting comments until the end of this month then they will anounce the final rule by Nov 1.

Laura, CPC, CEMC


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## heatherwinters (Aug 20, 2009)

*Consultations*

If they stop paying consultations, will we need to start getting ABN's for them?  I mean, they arent going to do away with the code set, or I wonder if it will be statutorily excluded and become patient responsibility if one is provided.  What a mess.


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## LLovett (Aug 20, 2009)

They are saying we will have to use the other E/M codes. In the federal register it states a plan for the inpatient side to allow other providers to use the admit codes instead of consult codes. I posted the info on another thread about the 2010 proposed rule.

They got rid of all the other consult codes so I imagine they will go away in the near future if CMS goes thru with their plan.

Laura, CPC, CEMC


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## FTessaBartels (Aug 20, 2009)

*Not even one bullet*

"Ear, Nose and throat are grossly patent."

In my book, this doesn't fall ANYWHERE on the 1997 guidlines. 

* External inspection of ears and nose (e.g. overall appearance, scars, lesions, masses)
* Otoscopic examination of external auditory canals and tympanic membranes
* Assessment of hearing (e.g. whispered voice, finger rub, tuning fork)
* Inspection of nasal mucosa, septum and turbinates
* Inspection of lips, teeth and gums
* Examination of oropharynx: oral mucosa, salivary glands, hard and soft palates, tongue, tonsils and posterior pharynx

For 1995 guidelines I'd give you one system (ENMT). For 1997 I would not give any credit at all.

Just my opinion,

F Tessa Bartels, CPC, CEMC


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## andrewsbev23 (Nov 9, 2010)

*Tuning Fork*

Our physician is wanting to count the tuning fork on her E/M's.  However, can the tuning fork be deferred to the audiologist in our office to complete or does she actually have to do the tuning fork herself?


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