Wiki 1995 dg

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BrandiF

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Hello,
I code e/m visits in several states, which includes 3 different MACs. I was wondering if anyone could guide me to what each MAC's definition of an EPF vs D exam is using the 1995 guidelines. I have tried searching their websites and don't feel I am finding the information I am looking for. I am specifically looking for WPS, Noridian and Cigna.
Thank you so much for any guidance you can give me!
 
95 guidelines

Brandi, this a grey area and none of the MAC providers will tell you the interpretation. I would recommend one of two was to view this area and have it in your compliance plan how your doctors will view and document for 95 guidelines.

*Problem Focused -- a limited examination of the affected body area or organ system.
* Expanded Problem Focused -- a limited examination of the affected body area or organ
system and other symptomatic or related organ system(s). what does limited means, how many?)
* Detailed -- an extended examination of the affected body area(s) and other symptomatic
or related organ system(s). (what does detail mean, how many?)
*Comprehensive -- a general multi-system examination or complete examination of a
single organ system.


2-7 - none in detail - Problem focused
2-7 with one body system in detail - Detailed
(what does detail mean? Everyone has a different view of what detail means)

OR

2-4 - Problem focused
5-7 - detailed

Much easier to define but have this spelled out in your your compliance plan of the guidelines and interpretation your physicians use.
 
This information is now on their website(NGS). they have an audit tool with it split and they have a FAQ list.
 
Last edited:
BrandiF said:
Hello,
I code e/m visits in several states, which includes 3 different MACs. I was wondering if anyone could guide me to what each MAC's definition of an EPF vs D exam is using the 1995 guidelines. I have tried searching their websites and don't feel I am finding the information I am looking for. I am specifically looking for WPS, Noridian and Cigna.
Thank you so much for any guidance you can give me!
Click to expand...

Hi Brandi:

Would Highmark Medicare be one of your MAC's? If so feel free to email me at

rthames@heritagemedgrp.com

Thanks,
 
Anna Weaver said:
This information is now on their website(NGS). they have an audit tool with it split and they have a FAQ list.
Click to expand...

Would you mind providing the link to the website? We are new to NGS as our Medicare Carrier and I've had no luck finding anything on their site about how the view the E/M Guidelines (both 95 and 97), nor have I been able to locate any audit worksheets on the site

Thanks!

Angie
Cincinnati, OH
 
Just went to NGS site again, they still don't have their audit tool listed, but I got it off their webinar from April. They said it would be listed under resources, then tools and materials. That's where the 95 and 97 guidelines live, but can't find the audit tool. sorry, these sites are not user friendly. will see if I can access it through their archives.
 
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