# e/m comprehensive exam vs detailed exam



## Kcronin1122 (May 10, 2017)

Hello, 
I am having a hard time with one of my doctors with billing for a complete comprehensive exam. I am only counting 7 Organ systems in their exam. Can anyone else look at the exam below and tell me how many organ systems they are finding?

General appearance: alert, cooperative, no distress
Head: Normocephalic, without obvious abnormality
Eyes: negative findings: No redness or drainage
Neck: supple, symmetrical, trachea midline, no carotid bruit and no JVD
Back: no skin lesions, erythema, or scars, no tenderness to percussion or palpation
Lungs: clear to auscultation bilaterally, no crackles, no wheezes, chest expansion normal
Chest wall: left sided chest wall tenderness at times, not consistent
Heart:  RRR, normal S1 and S2, no murmur, no S3 or S4, no rub
Abdomen:  soft, present bowel sounds, tender to palpation at left upper quadrant which patient states is chronic
Extremities: extremities normal, atraumatic, no cyanosis or edema
Pulses: 2+ and symmetric
Skin: Skin color, texture, turgor normal. No rashes or lesions
Neurologic:  Alert and oriented X 3

Thanks


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## Kcronin1122 (May 10, 2017)

Also, would this be considered Musculoskeletal----
Extremities: No edema, pedal pulses 2+ bilaterally, no ulcers or lesions noted, no skin breakdown noted


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## OhioMB (May 10, 2017)

It would depend on the Guidelines you are billing with, either 95 or 97?  
97 Guidelines - Detailed 
95 Organ Systems - Comprehensive

_Also, would this be considered Musculoskeletal----
Extremities: No edema, pedal pulses 2+ bilaterally, no ulcers or lesions noted, no skin breakdown noted_  <--no you're in cardiovascular & skin


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## Kcronin1122 (May 10, 2017)

If I'm billing with the 95 guidelines how are you getting 8 organ systems. I am only counting 7
Constitutional
Eyes
Lungs (resp)
Heart (Cardio/vasc)
Abdomen (GI)
Skin
Neuro

Please help me understand what I am missing.


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## bforr (May 10, 2017)

I'm getting the same seven systems you are. I don't see an eighth.


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## avhadvidya@gmail.com (Jul 13, 2017)

8th one is alert which we can consider from constitutional as a psych...hence according to 95 guidelines 8 systems are there i.e com.


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## krishrndz@gmail.com (Jul 24, 2017)

I came out with 8 also! 

Constitutional
Eyes
Cardio
Resp
Gastro
Musc
Skin
Psych


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## NishaJ (Jul 26, 2017)

Im also agree with 8 exams..
I have read in one Medicare E&M  FAQ.they suggest to count "Head: Normocephalic"    and Atramautic under Musculoskeletol...


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