# 95 Musculoskeletal exam



## katelliott80 (Apr 2, 2010)

Does anyone know of any documentation anywhere that would state what would be required in order to get a comprehensive musculoskeletal exam using the 95 guidelines?

I have a Physiatrist who will never get a comprehensive exam using the 97 guidelines so this is a bit of a challenge. He does have a very large exam of all extremities, plus spine, neck, cardio, constitutional, neuro, psych, and skin. Normally I would fall to the 95 multisystem guidelines but there is not enough there for that either.

According to the auditing software we use it states that the Provider can have a written policy defining what a comprehensive exam to them means.
That just seems wrong to me so I was wanting something else to go on.

Thanks!

Katie


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## mitchellde (Apr 2, 2010)

under 95 guidelines it states for a comprehensive exam it is a complete exam of one  body system or a comphrehensive mulitsystem exam which is defined as an examination with findings of 8 out of 12 body systems.  A written policy is not going to work he must document enough in the patient's medical record.


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## katelliott80 (Apr 2, 2010)

So a comprehensive exam using 95 would mean all the requirements of the 97musculoskeletal exam?


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## 1071471 (Apr 2, 2010)

Since your physician is a psychiatrist I would imagine that he/she spends alot of time in counseling. If this is the case, I would suggest utilizing the "time caveat" (i.e. greater than 50% in counseling and/or coordinating care - CPT 2010 page 10). 

Required documentation for E/M level based on time:
- Total Time
- Percentage of Time (greater than 50%)
- What was discussed during counseling and/or what was coordinated

Just a thought


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## katelliott80 (Apr 5, 2010)

This physician is not a psychiatrist he is a physiatrist. He deals with musculoskeletal pain issues. Counseling wouldnt work for him because he spends the majority of his office time on his exam. Not in counseling/coordination of care.

There has to be someone out there that is having this situation. Unless other Drs out there are just dealing with billing for a detailed exam only.


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## mitchellde (Apr 5, 2010)

katelliott80 said:


> So a comprehensive exam using 95 would mean all the requirements of the 97musculoskeletal exam?



That is the basic premis.


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## aguelfi (Apr 7, 2010)

He doesn't qualify using the single system musculoskeletal exam for 97 guidelines?


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