Oncology & Hematology Coding Alert

Question: I have a old audit sheet that states for 1995 guidelines, and it states:

Problem Focused exam - we need 1-5 elements
Expanded - 6--11 elements
Detailed exam - 12+ elements
Comprehensive exam - 2 elements in 9 systems

Is this still correct?

Oregon Subscriber

Answer: No, these are the guidelines for the 1997 E/M exam documentation. The 1995 guidelines listed only body areas and organ systems, not elements. If using 1995 the exam would be judged as follows:

Problem Focused: Limited exam of one body area or organ system

Expanded Problem Focused: Limited exam of the affected body area or organ system plus any other symptomatic or related organ system(s) - commonly interpreted by CMS auditors to mean 2-4 systems total.

Detailed: Extended exam of the affected body area(s) and other symptomatic or related organ system(s) - commonly interpreted by HCFA auditors to mean 5-7 systems total.

Comprehensive General Multisystem: Documentation of 8 or more findings about the 12 organ systems, or a
Single Organ System: Not formally defined and left up to the discretion of the auditor, but CMS-defined as a complete exam of a single organ system.