# general multi-system exam 1997 guidelines musculoskeletal bullets



## jpruitt114 (Jun 25, 2013)

Under the Musculoskeletal section of the *General Multi-System* exam in the 1997 Documentation Guidelines, how many bullets are possible in total for this section.  There is a descrepency in our office as to whether the total is 6 bullets or if each of the bullets can be multiplied by how many areas were examined. It is understood that for a Musculoskeletal exam specifically the wording states to count each element seperately for each body area but under the General Multi-System exam, under the musculoskeletal section it does not say this.  

Also, I have read several opinions regarding this but I am looking for someone to refer me to actual documentation that proves either interpretation of the guidelines, not opinions.


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## MikeEnos (Jun 25, 2013)

This is very clearly addressed in the 1997 Guidelines.  Check out page 32 for the musculoskeletal exam.  

Here's the relevant excerpt:


> 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.*



I'm also attaching another version of the 1997 Musculoskeletal exam that I got form EMUniversity.com that also clarifies this point:



> NOTE: Determine the *number
> of body areas* addressed within
> each bullet. Enter that number
> on the line beside each bullet.
> ...


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## jpruitt114 (Jun 25, 2013)

I am not talking about a specialty *Musculoskeletal Exam*, I am talking about a *General Multi-System Exam*.  I need to know in a General Multi-System Exam how many musculoskeletal bullets are possible.  The wording is different on the General Multi-System Exam.


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## donnalynn (Jun 25, 2013)

http://emuniversity.com/PhysicalExam.html

here is a link for a description of the 1997 General Multi-System Exam


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## MikeEnos (Jun 25, 2013)

@jkokenos, the wording is only slightly different (because obviously the Musculoskeletal exam is more detailed) but they both have the same meaning.  I don't see how anybody could argue that you wouldn't count it the same way.  For example, in the general 1997 multi-system exam why would you not count assessment of range of motion of the left knee and right knee as 2 bullets?

Look at the way it is organized:



> *Musculoskeletal*
> • Examination of gait and station
> • inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory
> conditions, petechiae, ischemia, infections, nodes)
> ...



Clearly by phrasing it that way, they are indicating that for each body area (identified by a number) you get credit for any of the findings identified by a bullet.  

If it helps you understand, _think of it this way_:



> *Musculoskeletal*
> • Examination of gait and station
> • Inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory
> conditions, petechiae, ischemia, infections, nodes)
> ...



See how all of the bullets are available under each body area?  That's the way it is layed out, but in a more concise way, in the 1997 Guidelines.


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## jpruitt114 (Jun 27, 2013)

I respectfully disagree.  You are stating that we can use what is states for the Musculoskeletal Exam and apply it to the musculoskeletal section of the General Multi-System Exam.  By this logic then could we use what it says in the Eye Exam towards the eye section of the General Multi-System Exam and get 12 bullets for eyes since under the Eye Exam there are 12 possible bullets?  

For the specialty exams such as an eye exam it makes sense that there are more possible bullets in the eye box to count because there are no other boxes besides nuerological to count bullets from.  For the General Multi System Exam you can count at least two bullets from every box from constitutional to psychiatric therefore it seems frivalous to count each musuloskeletal bullet times each area examined.


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