Wiki Body parts and organ systems

Create Wiki
G

grandmacora

Guest
Messages
127
Best answers
0
I have a question can i count 3 organ systems and 2 body areas for a expanded focused exam?

Constitutional
cardivascular
musculosketal

and the 2 body areas are rle and lle

thank you
 
Yes, you can. The only level of exam that doesn't allow you to count body areas and/or organ systems is Comprehensive.... for that level you need organ systems only, body areas don't count.
 
That depends on your MAC and if they have any particular guidelines. Where I live, NHIC is our MAC and they define a detailed exam as 5-7 body areas and/or organ systems. NGS defines detailed as 6-7, so you will have to check with your local carrier.
 
I am understanding that we can combine the organ and body parts for all the level of exams except the comprehensive is that correct? We were told that it had to be one or the other and you could not combine I took a webinar on AAPC and she said you could count both. This is so confusing no where is all this documented!!!!!!!! I really appreciate the help. Cora
 
Hi Cora,
From the 1995 guidelines (page 32 of the CMS Evaluation and Management Services Guide) -

The levels of E/M services are based on four types of examination that are defined as
follows:
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).
Detailed -- an extended examination of the affected body area(s) and other
symptomatic or related organ system(s).
Comprehensive -- a general multi-system examination or complete examination
of a single organ system.
.
.
.
DG: The medical record for a general multi-system examination should include
findings about 8 or more of the 12 organ systems.

Also, on page 14 of the guide -
* The 1995 documentation guidelines state that the medical record for a general multi-system
examination should include findings about eight or more organ systems.

I hope this helps! :)
 
body area vs organ system

Sorry, but I'm going to reopen this discussion :)

The 1995 and 1997 guidelines also state: "For purposes of examination, the following body areas are recognized:" (page 31), followed by a listing or organ systems also recognized. No where does it state they are recognized ONLY for problem focused thru detailed exams.

And the 1997 guidelines on page 50 under Comprehensive state: "Comprehensive – a general multi-system examination, or complete examination of a single organ system and other symptomatic or related body area(s) or organ system(s)."

The 1997 criteria do specifically list body areas as acceptable under the comprehensive exam.

I was also "taught" that only organ systems count toward a comprehensive exam. When recently questioned about this by a physician, I tried to find clear documentation to support this and I could not. In fact, what I found was clear documentation of the opposite.

Tracy Helget, CPC
 
I saw this post a few days ago, and it was very intriguing. Thanks for the response.

I think the problem is the difference between the CMS description of a comprehensive exam, and the local MAC definition. As you know, the CMS definition of an Expanded Problem Focused exam and a Detailed exam is very similar. There is no real definition. The local MACs have clearly defined them by assigning a number of body areas and/or organ systems that must be reviewed.

Looking at the CMS definition of the 1995 guidelines, a Comprehensive exam is defined as a general multi-system examination or complete examination of a single organ system. That would seem to indicate that a complete skin exam could be considered a type of Comprehensive exam. Sadly, there is no further definition in the 1995 exam guidelines as to what is a 'complete' skin exam. That's one reason dermatologists, psychiatrists, neurologists, and other specialists complained and prompted the development of the 1997 exam guidelines. The 1997 guidelines describe in detail what the requirements are for a single organ system examination recognized by CPT.

So what's wrong with going by the 1995 guidelines, and examining the skin in 10 different body areas? Why doesn't that count as a Comprehensive exam? Well, depending on your MAC you will have a different auditing tool. Where I live, NHIC is our MAC and their auditing tool is like most others in how it scores the 1995 physical exam. Here's how they spell it out:

  • Problem Focused - Limited exam of the affected body area or organ system
    1 (BA) or (OS)
  • Expanded Problem Focused - Limited exam of the affected body area or organ system and other symptomatic or related organ systems
    2-4 (OS) and/or (BA)
  • Detailed - Extended exam of affected body area(s) and other or related organ systems.
    5-7 (OS) and/or (BA)
  • Comprehensive - A general multisystem exam or complete exam of a single organ system
    8 or more (OS)
Notice how on the first 3 levels they count body areas (BA) or organ systems (OS) but for some reason on the comprehensive level they only count organ systems? I'm not sure why that is, but it isn't a typo. They even include the definition that says "a complete exam of a single organ system" but define it as 8 or more organ systems. Crazy.

Perhaps your local carrier will allow body areas for a 1995 comprehensive exam, but I have yet to find one that will. The reason isn't exactly clear, as the CMS and CPT definitions both would seem to allow for a complete single organ system exam to be counted as Comprehensive, but no MACs seem to have a way of defining "complete" except for the 1997 exam definition.
 
Last edited:
You must log in or register to reply here.
Top