Wiki Counting Systems and Body Areas 1995

[medicalsec]

If doctor mentions under the neck category that he checks the thyroid, my understanding is that this is counted as a body area. Sometimes he only uses the one word "Supple" is that enough to put in a the MS system.

Also, I have read different things regarding using the 95 guidelines. Some people seem to try to convert the body areas to a system and only count systems, and others combine the body areas and systems for the other areas that are not comprehensive (expanded/detailed). For example, lets say that you have a credit for (1) Cardio, (2) Respiratory, (3) (GI), (4). Musc, could you use A. neck/thyroid or B. (head, face) to give you the 5th item to meet the 5 to 7 requirement for a 99203. This would give you 4 systems and 1 body area.

Also, if he used the subheading Head: atraumatic/Does that only count as a body area or could it be in the MS system.

I run into so many gray areas in the 95 guidlines because the doctors are borderline to take them to the next level.

Thanks,

Dee

 

[cknittle]

We don't combine body area and organ system in Exam

We don't combine body area and organ system in Exam. I need rationale for this method versus combining both. Does anyone have information on this?

 

[jdibble]

I'm confused too!

Too add to this confusion...

Our Medicare carrier, Highmark, states you cannot combine body areas and organ systems - however, if the documentation states for example, Abdomen non-tender to palp they say they check off Abdomen under Body areas and also consider a check under GI for systems. Then, when you total your checks, you must either have the total number under areas or systems - but you can not "combine" the checks together. Hopefully, that makes sense!

Now, the part that is really confusing - I "attended" the AAPC webinar on Ortho E/M and the presenter stated that you can combine both body areas and organ systems for Expanded Problem Focused and Detailed levels, but not for Comprehensive. I had never heard of this before - and I hesitate to go with this as again, our Medicare MAC states not to combine!

I look forward to others interpretations on this question!

Jodi Dibble, CPC

 

[RebeccaWoodward*]

I have always been told/trained that you can combine the organ systems and body areas for the 95 guidelines but you can't use both for the same exam bullet. (With the exception of the Comp. exam-this requires 8 organ systems) Do you think it's a of matter "wording/interpretation, etc?


Under the Examination Section of the 1995 Scoresheet, can we combine the body areas and organ systems?

No. The examination section of the 1995 scoresheet is divided into body areas and organ systems. The Current Procedural Terminology (CPT) manual recognizes 7 body areas and 12 organ systems. Depending on the documentation in the patient's medical record you can use either the body areas or the organ systems. There is a dotted line between the body areas and organ systems indicating you must choose one or the other. If you combined the body areas and organ systems you would be giving credit twice which would be incorrect when determining the final score for the examination section of the scoresheet. An example could be: the documentation in the patient's medical record stated, abdomen soft, credit can only be given in the body areas under abdomen or in the organ systems under GI which ever area benefited the physician the most.

Highmark allows one or the other but not both...which I agree with.


https://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html


When utilizing the 95 documentation guidelines can you combine body areas with organ systems?

It is appropriate to combine body areas and organ systems for all level of service except the comprehensive multi-system examination. The comprehensive multisystem examination must consist of 8 organ systems. Any body areas used must be above and beyond the 8 organ systems.

http://www.wisconsinmedicalsociety.org/education/faq

Taken from the 95 Guidelines:

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.

 

[Kocur1]

Question on Consults with HD patient

I was asked whether we can do an initial visit for a question other than ESRD, in an ESRD patient, the following day after an HD visit on the first day we see the patient? i.e. we were called with a new inpatient ESRD patient who needs an emergent HD. HD was done in the same day without an initial visit note/consult note that day as we can bill for only one. The following day a new development occurred in the patient status for example hypotension or sepsis that needs our feedback. May we write an initial consult note and bill for it the second day as a new consult?

Thanks.

 

[RebeccaWoodward*]

Too add to this confusion...

Our Medicare carrier, Highmark, states you cannot combine body areas and organ systems - however, if the documentation states for example, Abdomen non-tender to palp they say they check off Abdomen under Body areas and also consider a check under GI for systems. Then, when you total your checks, you must either have the total number under areas or systems - but you can not "combine" the checks together. Hopefully, that makes sense!

Now, the part that is really confusing - I "attended" the AAPC webinar on Ortho E/M and the presenter stated that you can combine both body areas and organ systems for Expanded Problem Focused and Detailed levels, but not for Comprehensive. I had never heard of this before - and I hesitate to go with this as again, our Medicare MAC states not to combine!

I look forward to others interpretations on this question!

Jodi Dibble, CPC

Jodi,

I'm in the same predicament now. Our new carrier, Palmetto GBA, doesn't allow the combination of organ systems and body areas for the 95 exam....(sigh...)

 

[Love Coding!]

Jodi,

I'm in the same predicament now. Our new carrier, Palmetto GBA, doesn't allow the combination of organ systems and body areas for the 95 exam....(sigh...)

Is that Palmetto GBA Nevada? Is there anything on their website that states this? I have never heard of this before. In Arizona we have Noridian they say you can combine the two up to a detailed exam. Comprehensive 8+organ systems. I train physicians on E/M for both states..

Thanks!

 

[RebeccaWoodward*]

I'm in NC...

Jurisdiction 11 Part B

Can we consider both body areas and organ systems together if we are using the 1995 E/M guidelines for the examination component?

Answer:No. For the exam component, you may either use body areas or organ systems, not a combination.

Resources:

•CMS 1995 & 1997 E/M Guidelines

http://www.palmettogba.com/palmetto...Asked Questions~EM~7RHQXJ7836?open&navmenu=||

Hope the link works. Sometimes they get routed somewhere else.

 

[Love Coding!]

I'm in NC...

Jurisdiction 11 Part B

Can we consider both body areas and organ systems together if we are using the 1995 E/M guidelines for the examination component?

Answer:No. For the exam component, you may either use body areas or organ systems, not a combination.

Resources:

•CMS 1995 & 1997 E/M Guidelines

http://www.palmettogba.com/palmetto...Asked Questions~EM~7RHQXJ7836?open&navmenu=||

Hope the link works. Sometimes they get routed somewhere else.

Thank you I am going to take a closer look at Palmetto in Nevada. Thanks!

 

[jdibble]

Jodi,

I'm in the same predicament now. Our new carrier, Palmetto GBA, doesn't allow the combination of organ systems and body areas for the 95 exam....(sigh...)

Rebecca,

For us, Highmark has always looked at it this way. We really don't have an issue getting the Exam to the right level though as long as the doctors say the "right" things in their documentation. Such as if they mention the neck, but state no adenopathy or mention the thyroid rather than just supple, that will fall under the lymph system. If they state HEENT and then mention the eyes and nose, rather than just getting head in the body area they get 2 systems covered there. Extremities are the only body area where sometimes we cannot capture it under systems unless they mention something about the Musculo system - otherwise they usually say something about edema or the skin, which would be cardio and skin and they have usually already mentioned those systems.

It is just a different way of looking at things and may take more effort to find the systems - but we try and teach our physicians to just mention their findings a little differently to meet the requirements for the systems.

Good luck!