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Exam Elements

Jamie Posted Thu 12th of January, 2017 15:11:20 PM
Both 95 and 97 guidelines have exam 2-7(areas) for 99213 & 99214(w/one area being more detailed). Can we split the exam elements into 2-4 for 99213 and 5-7 for 99214 when using 1995 guidelines? If not, what is considered a "detailed" organ system?
SuperCoder Answered Fri 13th of January, 2017 09:56:29 AM

In 97 exam guideline, both organ system and body parts can be calculated to make the exam level, whereas in 95 guideline only organ system can be considered. Therefore 2-7 body organs and body areas can be counted in 97 guideline and one area examined in detailed counted to make the higher exam level. You can bill the same in 95 guidelines to make the level up of the chart, if your billing entity accept the 95 guidelines. So, 5-7 organ system can be counted for “detailed” exam for 99214. Make sure you are using either 95 or 97 guidelines, both cannot be used together.

Jamie Posted Fri 13th of January, 2017 13:13:51 PM
So just to clarify... if we are using the 95 guidelines and coding organ systems it is okay to split the exam 2-4(99213) and 5-7(99214)? But...does the 5-7 have to have 1 organ system still "detailed" to be a 99214?
SuperCoder Answered Mon 16th of January, 2017 06:10:30 AM

 

According to general coding guidelines by CMS, there should be 5-7 elements selected with “One or more areas and/or organ systems is documented in DETAILED" to make the level of exam as "detailed", otherwise it will be EPF level of exam. On the other hand, if you are using some other guidelines, like Noridian coding guidelines, in this system of selecting exam elements, 5-7 elements are enough without one "DETAILED" examination of areas and/or organ systems for detailed exam.

There is a tool SuperCoder named as “E/M Auditor” for all the automated calculations of E/M. For details you can reach at-www.supercoder.com or Phone: (866)-228-9252 or E-Mail: customerservice@supercoder.com

Hope it helps.

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