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kfrycpc

kfrycpc

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I have a seemingly easy question. I dont understand the exam section on the Medicare audit sheet below. They have up to 7 systems as a choice TWICE - one is detailed and one is expanded problem focused so if I had up to 7 systems I didn't know which one to pick. Can anyone explain WHEN you pick which one? I feel the answer is so simple but I just do not get it.
 

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The difference is between what constitutes "detailed" and what constitutes "expanded problem focused". Medicare has been vague on a definition of this for years but it is expected that a "detailed" exam of an organ system or body area will contain more information than that of an "expanded problem focused exam".
 
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I'm about a year into my first coding job, and when a coworker gave me this audit sheet when I started, she said 1-4 systems is expanded and 5-7 systems would fit into detailed, so that is how we interpret that at my workplace. I also have found some will say if there are 2 or more bullet points addressed in a system, that shows more detail, so that is something to consider. Therefore, if 5 systems are examined minimally (1 bullet point addressed), I might consider that an expanded exam, but if 5 systems are examined in more detail, I might go with the detailed exam. Other factors may come into play in my decision as well when it's a fine line between an expanded or detailed exam, such as reason for visit and whether the systems examined fit with that reason. (Some of my providers occasionally document detailed exams that go well beyond what is needed to address the chief complaint.)
 
Peter Davidyock said:
The difference is between what constitutes "detailed" and what constitutes "expanded problem focused". Medicare has been vague on a definition of this for years but it is expected that a "detailed" exam of an organ system or body area will contain more information than that of an "expanded problem focused exam".
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That being said I guess it just takes the experience of reading enough charts to recognize what is one or the other. But thank you...Atleast I know the difference :)
 
tag60 said:
I'm about a year into my first coding job, and when a coworker gave me this audit sheet when I started, she said 1-4 systems is expanded and 5-7 systems would fit into detailed, so that is how we interpret that at my workplace. I also have found some will say if there are 2 or more bullet points addressed in a system, that shows more detail, so that is something to consider. Therefore, if 5 systems are examined minimally (1 bullet point addressed), I might consider that an expanded exam, but if 5 systems are examined in more detail, I might go with the detailed exam. Other factors may come into play in my decision as well when it's a fine line between an expanded or detailed exam, such as reason for visit and whether the systems examined fit with that reason. (Some of my providers occasionally document detailed exams that go well beyond what is needed to address the chief complaint.)
Click to expand...
Thank you for your reply. Atleast I have a better idea now of what to look for. Thank you :)
 
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