Wiki Exam: Detailed vs exp prob focused

[decembercap@hotmail.com]

Confusion about exam portion:

Expanded problem focused vs detailed.

How does CPT define the difference when considering which one to choose?

Taking the CEMC exam soon & Im desperate for some clarification ..

Thanks !!

 

[CatchTheWind]

EPF requires at least six bullet points, while detailed requires at least 12 (except eye and psych, which only require 9).

 

[jdibble]

EPF requires at least six bullet points, while detailed requires at least 12 (except eye and psych, which only require 9).

This would be for the 1997 guidelines. Which guidelines are you questioning - 1997 or 1995?

For the 1995 guidelines the difference between the 2 levels is a gray area and could depend on who you are billing and your company's policy! Some places consider documentation of 2-4 organ systems as expanded problem focused and 5-7 as detailed. Novitas goes by what they call the 4X4 rule. They look for at least 4 statements in 4 different organ systems to qualify as a detailed exam, however they do state that it can also be upto the discretion of their auditor. I usually look for the amount of documentation for each organ system. If there is only one thing in each of seven systems, I would call that expanded problem focused. If the physician goes into more detail for some of the systems, then I could consider it as detailed.

Maybe someone else can explain it better! Hope I helped a little!

 

[decembercap@hotmail.com]

Thank you for your reply and yes its such a grey area ! 1995 DG is what I am referring to.
I am familiar with Medicare's 4X4 rule, but the CEMC exam I am taking has me following CPT guidelines ... there isn't a lot that pertains to medicare on this exam.

I can never find a definite answer