# E/m !asap!



## rcbaker (Jan 20, 2011)

Hello,

Please with me understand the Exam and MDM 

First question: On the audit tool for the ortho under the 1997 guidelines, it states to 2 from each 9. What does this mean and please give me an example?


Second question:

If a provider order surgery for a pt does this go under level of risk moderate?? because in the note he states he recommend CTR and he explains the risk to the patient.

third question:  How would arrive at an exam level,please explain to me so I can understand?
Examination:
Physical examiniation; psy patient is alert and oriented x3, NAD. Skin: healthy, normal color, temp and texture, no lesions. Subjective sensation decreased r thumb, decreaed R IF, decreased R MF. Cardiovascular bilat wrist with palpable pulses, digits with cap refil<3 sec. Neuro RUE+tinel at wrist,+ phalens. Neuro LUE+tinel at wrist,+phalens. muscle strength/tone R thenar atrophy-mild, L thenar atrophy-mild. palpation, tenderness no obvious masses, crepitations or tenderness bilat wrists. A1 pulley tenderness no tenderness. randge of motion able to oppose thumb bilat. stability UE no obvious dislocation, subluxation or laxity to either UE. xrays bilat wrist/hands without carpal masses, fractures or dislocations.

Hand examination
A1 pulley tenderness--interosseous muscle--thumb oppostion--phalen's test--tinel's test--carpal tunnel compression test--thenar atrophy-- finkelstein test--thumb cmc joint--grind test--epicondylar tenderness--scapolunate tenderness--DRUJ tenderness--Snuffbox tenderness--weak abduction--long finger extension test--subjective sensation--range of motion--APB strength.


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## FTessaBartels (Jan 20, 2011)

*1997 guidelines - Exam*

I'm sorry, but I don't fully understand your question.

The 1997 guidelines allow you to follow EITHER the General Multi-system Exam -OR- one of the specialty exams.

If you are following a specialty exam for Musculoskeletal (there is no "ORTHO exam") then the guidelines specify how many bullets you need for each level of exam. 
The bullets are listed by system and some systems are shaded.
Problem focused exam = 1-5 bullets
EPF exam = at least 6 bullets
Detailed exam = at least 12 bullets
Comprehensive exam = Perform ALL elements identified by a bullet / and document EVERY element in each shaded box, and at least ONE bullet from each unshaded box. (By the way, there are only two unshaded boxes and they only have one element each.)

If you are following the General Multi-System exam there are NO shaded boxes.
Problem focused = 1-5 bullets
EPF = at least 6 bullets
Detailed  = at least 2 elements from each of 6 areas/systems   -OR-  at least 12 bullets from two or more systems.   (in both cases you need at least 12 bullets)
Comprehensive = at least 2 bullets from each of nine areas/systems (i.e. at least 18 bullets, but you must have covered at least 9 areas/systems)


I highly recommend www.emuniversity.com for help in understanding E/M auditing and coding. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## rcbaker (Jan 20, 2011)

*E/M help*

What would the exam be for my scenairo?


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## FTessaBartels (Jan 20, 2011)

*Learn by doing*

I'm not trying to be mean, but the best way for you to learn this, is for you to do it. 

So take out your guidelines and FIRST, decide which exam you are following. Then go down the list of bullet points and see if your exam documents each one.

For example: the first bullet on both the Musculoskeletal Specialty Exam AND the General Multi-System Exam is:
Constitutional:  *Any three of the following seven *: 1) sitting or standing BP, 2) supine BP, 3) pulse rate and regularity, 4) respiration, 5) temperature, 6) height, 7) weight.

So you have to have at least 3 vitals of the 7 vital signs listed to get ONE bullet point.

Check your exam documentation to see if this criteria is met. If YES, they you have one bullet; if NOT, then you don't get credit for that. 

*If you are using the specialty exam*, this is one of the shaded boxes. So if you are missing that bullet, then you know right away you will never get a comprehensive exam (because you have to document EVERY bullet in the shaded boxes to get a Musculoskeletal Specialty comprehensive exam). 

Then keep going down your list of bullet points.

Report back what you think you found and then I'll be happy to let you know if you're right or if you missed something. 

This is a great exercise for anyone wanting to improve their E/M coding.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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