# 1995 Exam Elements



## dballard2004 (Jun 29, 2009)

Per the 1995 Exam elements, 2-4 body areas or organ systems are required for an expanded problem focused exam. Does this mean that it has to be 2-4 oragan systems, 2-4 body areas, or can it be both? 

For example, if the documentation shows head and abdomen and cardio and ENT, is this considered four or just two?


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## ARCPC9491 (Jun 29, 2009)

It can be body areas *and/or *organ systems for problem focused, expanded problem focused and detailed.

For the comprehensive exam, it can *only be 8 (or more) organ systems*. No body areas.


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## coder25 (Jun 29, 2009)

Is true for all insurances??? I just came back from a Highmark Medicare Advance office and outpatient E/M Workshop where they said that Medicare does not allow you to mix or match for any level of exam.  Were they given out wrong info??


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## ARCPC9491 (Jun 29, 2009)

hmm .... that is what the guidelines say!

now, each Medicare contractor can interpret the guidelines in whatever way they would like.

So it seems to me, they are going with *OR* instead of *AND/OR*

"Expanded Problem Focused: 2-7 systems and/or body areas"

May want to contact them to clarify.


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## dballard2004 (Jun 29, 2009)

Thanks so much for the replies.


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## hthompson (Jun 29, 2009)

I think that it's and/or as long as you aren't counting one exam in more than one area.  So, you can't count head and ENT if they just looked at ears, nose, throat, you'd only count ENT.  If they had a bump on their head and that was examined and they also did an ENT exam, that'd count as 2.


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## cwcieri@yahoo.com (Nov 1, 2009)

*DG for 1995 state systems, not body area*

We count  only one body area for expanded problem focused and detailed exams. All the rest have to be organ systems. Per 1995 DG, "other symptomatic or related ORGAN systems" Ingenix also states, in their E/M book, only one body area may be counted, the rest are ORGAN systems.


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