# Exam detailed 5 to 7 systems



## medicalsec (Aug 19, 2009)

I have always used the 5 to 7 systems guidelines for a detailed visit for an examination.  Apparently, Palmetto Medicare (I am in California) had a Webinar seminar on E & M charges in July. I did not attend the seminar, but I saw the reference material that said that you had to have at least 6 systems to qualify for a detailed visit. I am using the 95 rules. I was wondering if anyone read that information?

Here Is the info copied from the reference material:

Detailed: Include at least six organ systems or body
areas. For each system/area selected, performance and
documentation of at least two elements is expected.
Alternatively, can include performance and
documentation of at least 12 elements, two or more
organ systems or body areas.
 Comprehensive:1997 Documentation Guidelines for
Evaluation and Management Services: Include at least
nine organ systems or body areas. For each
system/area selected, all elements of the examination
should be performed, unless specific directions limit the
content of the examination. For each area/system,
documentation of at least two elements is expected.
 1995 Documentation Guidelines for Evaluation and
Management Services: Eight organ systems must be
examined. If body areas are examined and counted, they
must be over and above the eight organ systems.



Thanks,

DEE


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## RebeccaWoodward* (Aug 19, 2009)

I've seen various guidelines.  Some allow 2-7 for detailed--others allow 2-7 with more detail---others only allow 5-7 for detail.  I often refer to Palmetto for information and found this.  


*Jurisdiction 1 Part B *

General: 1995 vs 1997 Guidelines

You may follow either the 1995 or 1997 guidelines in determining the appropriate level of service. In comparing the guidelines, changes to 1997 are as follows: 

History - In 1997, an extended HPI includes the status of at least three chronic or inactive conditions. This is the only change. 

Examination - In 1995, only the multi-system examination was defined. In 1997, the documentation requirements for the multi-system exam have changed (see chart below) and ten single organ system examinations have been developed. 

Decision Making - No changes 

*General Multi-System Examination Type of Examination *

95=Detailed Two to seven systems (more detail)

97=At least two bullets from each of the six areas or at least 12 bullets in two or more areas 



1995 - For purposes of examination, the following body areas are recognized:
Head, including the face 
Neck 
Chest, including breasts and axillae 
Abdomen 
Genitalia, groin, buttocks 
Back, including spine 
Each extremity 
1995 and 1997 - For purposes of examination, the following organ systems are recognized:
Constitutional (e.g., vital signs, general appearance) 
Eyes 
Ears, nose, mouth and throat 
Cardiovascular 
Respiratory 
Gastrointestinal 
Genitourinary 
Musculoskeletal 
Skin 
Neurologic 
Psychiatric 
Hematologic/lymphatic/immunologic 

last updated on 03/23/2009




http://www.palmettogba.com/palmetto...t Guidelines~11E801D8060DD94D852575C900596184


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## Love Coding! (Aug 19, 2009)

rebeccawoodward said:


> I've seen various guidelines.  Some allow 2-7 for detailed--others allow 2-7 with more detail---others only allow 5-7 for detail.  I often refer to Palmetto for information and found this.
> 
> 
> *Jurisdiction 1 Part B *
> ...



Hi Rebecca,

I am having an awful time figuring this out.  It was taught to me that 95' guidelines give you a choice between body areas or organs as they are sometimes called and body systems.  I work for a dermatology practice and I have always coded by pertintent body areas example:

S:  A new patient is being seen today for a rash, that has been itchy for the last 2 weeks.  The rash has covered the head, neck, back, chest and arms. The patient has tried several over the counter anti itch medications with no relief.  

Past History:  Eczema as a young child.
Family History:  Father had malignant melanoma in 1992.
Social History:  Patient smokes a pack of cigarettes a day.

ROS:  Asthma controlled with medication.  Hypertension controlled with medication.  

Exam:  The patient appears to be well oriented.  Apearance is good.  I examined the head, neck, back, upper extremities, abdomen, chest, buttocks and lower extremeties all positive for erythema and pustule like bumps.

A/P:  Rash of unknown cause.  Patient was prescribed XYZ medication and to followup in one week to see if this medication will help. I went through the instructions on how to use it and the importance of not overusing as prescribed.

I would code this scenario out as a new patient 99204.  Can anyone please tell me what they get?  Remember this is based on 95' guidelines.

Thanks to all that respond.


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## dclark7 (Aug 20, 2009)

99204 requires a "comprehensive" exam, a comprehensive History and moderate MDM. According to CMS 1995 DG for E/M a comprehensive exam inclused "a general multi-system examination or a complete examination of a single organ system"., the DG also states "The medical record for a genreal multi-system examination should include findings about 8 or more of the 12 organ systems."  Body areas cannot be used in a comprehensive exam.

Using 95 guidelines, I get 99203, HPI= comprehensive, ROS=Detailed (2 systems), PMFSH=comprehensive.
Exam=detailed orgain systems 1)psych, 2) constititutional & then body areas
MDM=mod

Doreen, CPC


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## Love Coding! (Aug 20, 2009)

dclark7 said:


> 99204 requires a "comprehensive" exam, a comprehensive History and moderate MDM. According to CMS 1995 DG for E/M a comprehensive exam inclused "a general multi-system examination or a complete examination of a single organ system"., the DG also states "The medical record for a genreal multi-system examination should include findings about 8 or more of the 12 organ systems."  Body areas cannot be used in a comprehensive exam.
> 
> Using 95 guidelines, I get 99203, HPI= comprehensive, ROS=Detailed (2 systems), PMFSH=comprehensive.
> Exam=detailed orgain systems 1)psych, 2) constititutional & then body areas
> ...




Hi Doreen,

Thank you very much for you speedy reply!


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## medicalsec (Aug 20, 2009)

*Detailed Examination*

http://www.palmettogba.com/palmetto/Providers.nsf/vMasterDID/7THMEF3256?opendocument


This is the recent Palmetto training material site. It seems to discount the 2-7 system idea for a detailed examination.

Thanks,

Dee


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