# Lymph nodes



## dballard2004 (Mar 7, 2012)

I need clarification around the 1997 general multi-system E/M guidelines around the lymphatic system, please.  The 1997 general multi-system guidelines from CMS state that in order to get credit for this organ system, the provider must examine the lymph nodes in *two or more* areas.  They then list the neck, axillae, groin, and other.  

Now, how exactly is this intrepreted?  Does this mean the literal that the two or more areas have to be either the neck or axillae, or the groin and axillae  or groin and other, etc. as listed?

or

Is this intrepereted to mean you have to examine the lymph nodes in two or more areas of the body system you are examining?  For example if examining the neck and you examine the lymph nodes on both the left side and the right side, is that two or more areas?

The 1997 guidelines are pretty vague when it comes to this and there seems to be confusion among some of my providers as they are looking at this from the clinical standpoint and  examining the lymph nodes on the left and right side of the neck is how they are intrepreting the two or more areas guidance.

I  am curious how others are intrepreting this.


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## dballard2004 (Mar 8, 2012)

Any takers?


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## MnTwins29 (Mar 8, 2012)

*one person's opinion*

While we use the 95 guidelines so I don't have any policies to use, I read the "two or more areas" as your first suggestion - meaning it has to be neck and groin, groin and axilla, etc.   I would consider left and right side of the neck as still only being one area - the neck.  

Just my $0.02 - since you posted again looking for some opinions!


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## dballard2004 (Mar 8, 2012)

Lance,

Thanks so much!  That is the standard that we have always used at our clinics, but I had a provider who was questioning this.


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## FTessaBartels (Mar 9, 2012)

*1997 is pretty clear, I think*

I agree with Lance, and I think the 1997 guidelines are pretty clear.  

So to get 1 bullet under 1997 guidelines, they would have to documentation examination of lymph nodes in two distinct body area ... neck and groin, or neck and axillae, or ...

Hope that helps.

F Tessa Bartels, CPC, CEMC


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