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Guest
#1 Posted : Friday, May 1, 2020 11:13:48 AM(UTC)
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Guest

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Hello!

I would like to confirm we have all systems/documentation in place to accurately code an exam as 99214 and have a question regarding the criteria surrounding the detailed exam portion.

A detailed exam per coding guidelines is such when includes the outlined:
12-17 bullet points or 5-7 body systems checked

The body systems listed are such:

1. Ears, Nose, Mouth and Throat
2. neck- palpitation of muscles, look for lymph nodes
3. Constitutional
4. Head
5. Neurologic
6. Psychiatric

What is the 7th body system referring to?

Ears, Nose, Mouth, Throat (1 of 5 minimally) is a no brainer, as is neck (2), head (3) and constitutional (4). Neurologic and Psychiatric checks will most likely be guided by the patient's responses to a through questionnaire. Would the very action of the patient filling out the questionnaire and the Dr. reviewing responses with the patient satisfy this requirement? If not, can you provide guidance on satisfaction of meeting requirements for these two body systems?

Thank you!
Jill

courtneydsnow
#2 Posted : Thursday, May 7, 2020 12:07:37 PM(UTC)
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courtneydsnow

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Hi Jill!

Great question.

The 1997 E/M guidelines recognize the following organ systems:

Constitutional
Eyes
Ears, nose, mouth and throat
Neck
Respiratory
Cardiovascular
Chest (breasts)
Gastrointestinal (abdomen)
Genitourinary (male)
Genitourinary (female)
Lymphatic
Musculoskeletal
Skin
Neurologic
Psychiatric

The 1995 E/M guidelines recognize the following body areas and organ systems:

Body Areas:
Head, including the face
Neck
Chest, including breasts and axillae
Abdomen
Genitalia, groin, buttocks
Back, including spine
Each extremity

Organ Systems:

Constitutional (e.g., vital signs, general appearance)
Eyes
Ears, nose, mouth and throat
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Skin
Neurologic
Psychiatric
Hematologic/lymphatic/immunologic



The 6 you listed are ones that have been identified as commonly performed in the dental practice setting. Of course certain ones listed above such as genitourinary will never happen in the dental practice setting :)

And no, in my opinion the patient completing the questionnaire and the doctor reviewing the it with the patient would fall under the level of history, these body systems are specific to the examination portion of the E&M code.


Here is a link to CMS's E&M guide which gives detailed information on exam requirements (starting on page 12):
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf


Hope this helps!
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