# Limited vs Extended Exam



## chetubig001

What is the difference between a limited vs and extended Exam?  I've looked everywhere and everything is very vague.  They both require 2-7 BA/OS. Please help.


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## jwhassjr

There is an article in the July 2009 Coding Edge which discusses exams: http://djk9qtinkh46n.cloudfront.net/5548A1AF-4C9F-49A2-BFE0-BFA7D2344700/7f7b114b-3370-4e18-9b8f-2832c59c557b/ee39303c-2f37-4e51-af05-18a5fce7cc8c.pdf

Since there is no definitive guidance provided for the terms "limited" and "extended", one has to review the documentation and apply some definition of limited (e.g., including only a part) which I interpret to be only documenting the exam for two body areas or organ systems that apply strictly to the chief complaint, or extended (e.g., drawn out) which I interpret to be documenting the exam of two body areas or organ systems that goes beyond the chief complaint.

I appreciate your dilemma, it's something that is very subjective. I would say to choose the level of exam for which you believe is defensible by what the physician documented. Best of luck to you.


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## PAMALAR

Hi,

I agree the vague difference of the EPF vs Detailed physical examination which involves 2-7 BA/OS.

I found some verbal instructions of CMS regarding numerical requirements of physical examinations (1995 guidelines). i.e

Problem Focused---------------1 body area or organ system
Expanded problem focused------2-4 body areas or organ systems
Detailed----------------------- 5-7 body areas or organ systems
Comprehensive-----------------8 or more organ systems

I am sure you know the numerical bullet systems in 1997 guidelines which are more specific.

I guess this link will be useful for more information
http://www.acep.org/practres.aspx?id=30416

Thank you,

Pamalar


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## randijelinek

I have a question as I am fairly new to coding. When the guidelines specify body areas or organ systems is that a combination? For example Expanded Problem Focused based on 1995 guidelines is 2-4 body areas or organ systems...does that mean it can be any combination?

Thanks for the help.
Randilea


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## FTessaBartels

*More specific 1995 definitions*

The 1995 guidelines are very vague.  Search the E/M Forum for more threads on this topic, because there have been many.

To give you the quick answer - YES you can mix BA and organ systems.  

*BUT* please keep reading !!!! 
The 1995 guidelines specifically state:

*Expanded Problem Focused Exam *- limited exam of affected body area or organ system, *and *other symptomatic or related organ system(s)

*Detailed Exam* - extended exam of affected body area or organ system, *and *other symptomatic or related organ system(s)
(emphasis in both added by FTB)

So an EPF exam has a *limited exam of the affected *BA or organ system  PLUS at least one other organ system examined.

And a DETAILED exam has an *expanded exam of the affected *BA or organ system PLUS at least one other organ system examined. 

Because the guidelines are so vague, however, your practice should outline in your compliance plan HOW you audit the exam.  Do you use the strictly numerical system that PAMALAR outlined in her response?  Or do you use the limited vs expanded exam of affected BA/organ system PLUS at least one other that I've outlined above?  Whatever you decide, stick to it. One of the first things any outside auditor will ask for is your complaince plan. 

Hope that was helpful.

F Tessa Bartels, CPC, CEMC


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## chetubig001

Thank you all soooo much.  This has been so helpful.


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## kfrycpc

PAMALAR said:


> Hi,
> 
> I agree the vague difference of the EPF vs Detailed physical examination which involves 2-7 BA/OS.
> 
> I found some verbal instructions of CMS regarding numerical requirements of physical examinations (1995 guidelines). i.e
> 
> Problem Focused---------------1 body area or organ system
> Expanded problem focused------2-4 body areas or organ systems
> Detailed----------------------- 5-7 body areas or organ systems
> Comprehensive-----------------8 or more organ systems
> 
> I am sure you know the numerical bullet systems in 1997 guidelines which are more specific.
> 
> I guess this link will be useful for more information
> http://www.acep.org/practres.aspx?id=30416
> 
> Thank you,
> 
> Pamalar



Pamalar,

Where did you find the information on CMS that says:

Problem Focused---------------1 body area or organ system
Expanded problem focused------2-4 body areas or organ systems
Detailed----------------------- 5-7 body areas or organ systems
Comprehensive-----------------8 or more organ systems

Thanks, Kellie


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