# E/M '97 Exam- Bullets & Elements ?



## mcarrillo (Jan 4, 2012)

Hi,

I'm confused by the 1997 E/M exam guidelines requirements of 'elements identified by a bullet'. The exams show bullets for the areas/systems, which I understand. It's the elements that confuse me. The Problem focused & Exp Problem focused seem to be easy to get, it's the Detailed and Comprehensive that is hard for me to apply. 

Example for Detailed exam: If the doctor is examining the ears as one of the systems, and is doing the _assessment of hearing_, would he/she just have to do two within the bullet (eg, whispered voice, finger rub, tuning fork) if it states 'At least two elements identified by a bullet  from each of six areas/systems'? We use the general multi-system exam.

Any help or suggestions woul be greatly appreciated.

Thanks


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## ajs (Jan 4, 2012)

mcarrillo said:


> Hi,
> 
> I'm confused by the 1997 E/M exam guidelines requirements of 'elements identified by a bullet'. The exams show bullets for the areas/systems, which I understand. It's the elements that confuse me. The Problem focused & Exp Problem focused seem to be easy to get, it's the Detailed and Comprehensive that is hard for me to apply.
> 
> ...



The "elements" are the things next to the dot or "bullet".  So for "Ears, Nose, Mouth and Throat"  you would need to examine and document two of the items in that section that are next to a bullet (not two things within the same bullet).  Examining the hearing is one element for that section regardless of how you examine the hearing.  Two elements in that section could be the otoscopic exam of the ears and the hearing check.


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## mcarrillo (Jan 5, 2012)

Thank you Arlene, this is a big help. Can you also explain the comprehensive exam? I'm confused by _performing all elements in 9 systems/areas and document at least 2 elements from each of 9 areas/systems_. 

It seems to me if the physician performs all elements in 9 systems, it's also documenting 2 elements from each 9. ??

Thanks for all your help


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## mhstrauss (Jan 5, 2012)

The performing x#/documenting x# always throws me off...If its not documented, then how can we know they did it??


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## FTessaBartels (Jan 5, 2012)

*Just worry about documenting*



mcarrillo said:


> Thank you Arlene, this is a big help. Can you also explain the comprehensive exam? I'm confused by _performing all elements in 9 systems/areas and document at least 2 elements from each of 9 areas/systems_.
> 
> It seems to me if the physician performs all elements in 9 systems, it's also documenting 2 elements from each 9. ??
> 
> Thanks for all your help



The first part of this is definiing a comprehensive exam: perform all elements in at least 9 areas/systems

The second part of this is telling you what you need to document to satisfy the requirement: codument at least 2 elements from each of 9 areas/systems.

So you'll need at LEAST 18 bullet points, 2 each from 9 different areas/systems.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## ajs (Jan 5, 2012)

mcarrillo said:


> Thank you Arlene, this is a big help. Can you also explain the comprehensive exam? I'm confused by _performing all elements in 9 systems/areas and document at least 2 elements from each of 9 areas/systems_.
> 
> It seems to me if the physician performs all elements in 9 systems, it's also documenting 2 elements from each 9. ??
> 
> Thanks for all your help



They may perform them, but they must document at least two from each of the nine.  That is the kicker...getting the documentation in the record for the specific elements identified by a bullet.


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