Mixing Exam Types?

December 8, 2010

Can this provider choose elements from both a multisystem and single organ system exam?

Question: Can I mix and match bullet points from the general multisystem and single organ system examinations in the 1997 Documentation Guidelines for Evaluation and Management Services?

Answer: This would depend on the carrier. To be on the conservative side I would say no. Although the 1997 guidelines themselves only call for a certain number of points or elements to qualify for a certain level, the general theory is that you are using one of the exam formats.

The specialty exams were set up to accommodate concentration or interest in specific organs systems and related systems. The general multisystem exam was just that - general. If that doesn’t get you what you need, you likely need a specialty one.

Or, can you use the 1995 guidelines? Sometimes people lock themselves into the 1997 set of rules because they think they are newer, or a higher standard. They are newer, but they simply allow for specificity - they are no more valid than the 1995 guidelines. The 1995 set actually allow less specificity. Maybe you don’t need to cross between exam types.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or physicianspractice@cmpmedica.com.

This question originally appeared in the April 2010 issue of Physicians Practice.