ED Coding and Reimbursement Alert

Question: Our practice is debating how many vital signs we need documented to count as a -constitutional- exam. The 1997 documentation guidelines indicate that we need three out of seven. Does this apply to the 1995 guidelines as well?

For example, the physician indicates blood pressure only in his physical examination, and he did not document whether he reviewed the nursing notes (which contained documentation of three vital signs). In this case, I said that we couldn't count the vital signs. Was I correct?


Massachusetts Subscriber

Answer: For Medicare carriers using the 1995 guidelines, you are correct. But because the answer may vary by payer, your best bet is to ask about each payer's criteria for the number of vital signs necessary.

The 1995 guidelines don't specify how much the physician needs to do during the physical examination to count a body area or organ system. In light of this ambiguity, you could certainly make an argument that a lone vital sign--such as blood pressure reading--could count as a constitutional exam under these guidelines.

You-re right, though, that the 1997 guidelines specify that the documentation needs to list at least three of the seven vital signs for a constitutional exam.