# 1997 guidelines- musculoskeletal elements



## sullivak (Jul 18, 2012)

I posted this in the E/M forum but got no response so I thought I'd try here-
How many "points" or bullets are possible to achieve in the musculoskeletal portion of the *General Multisystem exam *under 1997 guidelines?

Here's an example of something from a general multisystem exam document in front of me- 

Exam:
M/S: Gait normal. Good range of motion in hands, wrists, elbows, shoulders, spine, hips, knees, ankles

How many points would you give for M/S using 1997 general multisystem exam guidelines? I think two, but am not sure. 

Please respond because I have many docs to audit and I really need to be sure on this one.  
Thanks, Kim


----------



## purplescarf23 (Jul 19, 2012)

I responded to the other post as well but here are my thoughts:  I find 6 bullet points out of the musculoskeletal section of the 1997 general multi-system exam. The provider indicates hands, wrists, elbows, shoulders, spine, hips, knees, ankles in pleural which indicates to me he examined both sides of the body. So in turn that equals 1 bullet point for left upper ext, 1 bullet point for right upper ext, 1 bullet point for left lower ext, 1 bullet for right lower ext, 1 bullet point for spine, and 1 bullet point for examination of gait. Hope that helps.

Kelsey, CPC, CEMC


----------



## sullivak (Jul 20, 2012)

Thanks for the response, Kelsey.  
This is exactly what I am trying to clear up in my muddled mind! It seems unclear to me whether in general multi-system, we can count multiple areas and/or types of exams. 
Here, for instance, it would be great if we could give 4 bullets for the assessment of range of motion of the 4 body areas. Does this mean that if the doctor assessed both range of motion and stability of these four different body areas that we could give them 8 bullets?
This is an important question to me because I am seeing a number of docs like this, and it could really beef up their exam level - which is something I am not sure ought to be done. :/


----------



## maycricket (Aug 3, 2012)

That is the way I understand it as well.  Had the provider stated, "good range of motion and stability..." you could count a bullet for each extremity on motion and a bullet for each extremity on stability, as well as one for gait and one each for motion and stability on the spine/pelvis.

This is from the Musculoskeletal System Exam 1997 DG's:

NOTE: For the comprehensive level of examination, all four of the elements identified by a
bullet must be performed and documented for each of four anatomic areas. For the three lower levels of examination, each element is counted separately for each body area. For example, assessing range of motion in two extremities constitutes two elements.

Once you reach the Detailed level for the 97 DG's, that number of bullets is pointless, as you only need 2 bullets from 6 systems.  Same with Comprehensive, 2 bullets from 9 systems, unless you are trying for a complete one-system exam.  Then, he is still missing it, because inspection/palpation and strength/tone were not assessed.  

Does that help?


----------

