Primary Care Coding Alert

Question: The September Family Practice Coding Alert, mentioned that you could count the phrase "Neck is supple" as part of the musculoskeletal exam or the lymph or neurological system. But the Merriam-Webster Medical Dictionary states, "Musculoskeletal - Head and neck - Assessment of range of motion ... The normal neck is supple, meaning limber: easy and fluent without stiffness ..." My clinic doctors agree with the definition and think that we should count the phrase only as "range of motion" under musculoskeletal. Could you explain the discrepancy?

Alabama Subscriber

Answer: Part of the problem stems from the fact that "supple" is not a true medical term.

Because supple means "able to bend," you can always count the phrase "Neck is supple" as part of an orthopedic exam. In this case, you could give your physician credit for the statement as range of motion under the musculoskeletal section.

Some FPs may use the phrase to refer to the lymph system. The phrase "Neck is supple" has also come to mean the physician checked the patient's node and found no swelling, meaning the patient doesn't have enlarged lymph nodes. Not all physicians like using the phrase this way.

Regardless of which way your FPs feel, be careful that you don't double-count the phrase. You can use the note under either the musculoskeletal system or the lymph system, but you shouldn't count it under both exams at the same time.

Exception: You can consider the term part of both systems if the note states, "The neck is supple without adenopathy." That means the neck is bendable and the nodes aren't swollen.