# E/M Audit tool



## solocoder (May 10, 2011)

Does anyone know a website where I can find an audit tool that uses the 2-4 and 5-7 guidelines for exams?  I have one,but it does not say on it where it came from and I can't remember.  If I am going to use it, I want to be able to back it up with a reference (in case my supervisor or doctors ask).
I appreciate any help.


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## Lassal423 (May 11, 2011)

*Audit Guide*

We have Trailblazer as our intermediary, and they have the CMS tool on their website:

http://www.trailblazerhealth.com/Publications/Job Aid/coding pocket reference.pdf

I hope that helps!

Lora


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## solocoder (May 12, 2011)

Thanks for the reply, but the Trailblazer audit tool uses 2-7 EPF and 2-7 Detailed.  The one I am looking for  breaks that down into 2-4 EPF and 5-7 Detailed. 
So if anyone knows where I can find that one, I'd appreciate a link.


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## Mojo (May 12, 2011)

I couldn't find a link for you but Intelicode that offers The Art of E/M Auditing has a table with the 2-4 or 2-7 EPF and 5-7 or 2-7 Detailed exam elements for the 95 General Multi-System with a note that some carriers adhere to strictly numeric counting (2-7, 5-7). Other carriers look for detail in the systems...



ACEP offers this in its FAQ:
FAQ 10.  Are there differences between the CMS and CPT requirements for Physical Exam?  
A. Yes, as you see in the table below CMS has specific numeric requirements for the Physical Exam.

CPT                                    1995 CMS  
Problem Focused                 1 body area or organ system 
Expanded Problem Focused  2-4 body areas or organ systems* 
Detailed                              5-7 body areas or organ systems* 
Comprehensive                    8 or more organ systems 

* The numerical requirements for the Expanded Problem Focused Exam and the Detailed Exam were verbal instructions from CMS officials but never officially included in the CMS E&M Guidelines. Carrier policies vary regarding the definitions of Expanded Problem Focused and Detailed Exams.


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## solocoder (May 13, 2011)

Thanks for the tip, Mojo.  Do you think that book would be a good investment for a new-ish coder?


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## Mojo (May 13, 2011)

I won the book during a raffle at a local chapter seminar, 2 years ago.  $149 is a bit pricey but the website states 4 CEUs are offered. I would verify that it is updated and current (for example CMS no longer reimbursing the consultation codes and the new subsequent Observation codes). I have the 12th edition. I do like having auditing information in one reference book and I refer to it often.

HIPAA is listed as HIPPA in the Table of Contents. Hopefully, Intelicode has corrected that as well as the other typos.  I would post on the Auditing forum asking for recommendations on auditing references before making a purchase. Keep us posted on what you decide.


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## Jagadish (May 15, 2011)

The following are the excerpts from the webinar "Assessing Your Evaluation & Management Services Documentation" by NGS Medicare on Apr 26 2011. You can find the information from the "attachments for this event" area on their website.



Q3. What exactly is required for an expanded problem focused exam using the 1995 E/M guidelines? Can I use body areas and/or organ systems? How many are needed? 

A: According to the documentation guidelines, an expanded problem focused exam is a limited examination of the affected body area or organ system and other symptomatic or related organ system(s). At this level, using the '95 Guidelines 2-5 body areas or organ systems must be documented. You may use either body areas or organ systems in all levels except the comprehensive. At the comprehensive level, only organ systems are accepted 


Q4. What exactly is required in terms of the number of body areas and/or organ systems to qualify for a detailed exam using the 1995 E/M guidelines? 

A: According to the documentation guidelines, a detailed exam is an extended examination of the affected body area(s) and other symptomatic or related organ system(s).At this level, using the '95 Guidelines, 6-7 body areas or organ systems must be documented. You may use either body areas or organ systems in all levels except the comprehensive. At the comprehensive level, only organ systems are accepted.


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