Highmark is entitled to their interpretation, but I don't agree with it.
Just remember that this is the carrier that says this on the same page:
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.
Does the body areas of the examination section of the 1995 score sheet work exactly as the organ systems?
You may count up to 7 body areas or 7 organ systems for an expanded problem focused or detailed examination, and you may count 8 body areas or 8 organ systems for a comprehensive examination. However, you may not add body areas and organ systems together to determine the level of the examination.
The above answers are obviously incorrect. You can use both body areas and organ systems in all levels of the exam except for the comprehensive level. In the comprehensive level you cannot use either 8 systems or 8 body areas. It must be at least 8 systems, with any body areas examined being over and above the 8 systems.
The point is that specific carriers do comment on these issues, but in most cases they are throwing in their interpretation which is often as flawed as that of many coders. If there is a cite at the FEDERAL level (CMS manual or quote from a CMS rep), that will carry much more weight.