Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Detailed Exam 4 x 4 Method for 95 Coding Guidelines

Certain local Medicare carriers require that you document the physical exam using the 4 x 4 Detailed Exam method. This method requires four or more body areas or four or more organ systems to have four or more elements documented to meet a detailed exam. If your local carrier requires this method, you can select the 4 Body Areas/Organ Systems equals detailed exam checkbox on the Practice Configuration template. If the required number of body area and organ system elements have been documented, the application calculates a detailed exam. E&M Coding 4 x 4 Detailed Exam section Note: If you select the 4 Body Areas/Organ Systems equals detailed exam checkbox, the 95 Coding Thresholds are not used to determine if an exam is detailed. Parent topic: Physical Exam Calculation for 95 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Single-Organ System Exam Thresholds for 95 Coding Guidelines

Both the Detailed Numeric and the Strict Numeric calculations use the 95 Complete Exam levels for calculating a comprehensive, single-organ system exam. The official Centers for Medicare and Medicaid Services (CMS) guidelines allow for two separate calculations for a complete or comprehensive examination. The guidelines state that a comprehensive examination is a general multi-system exam or a complete examination of a single-organ system. The guidelines do not define what a complete examination of a single-organ system means. Although NextGen® Adaptive Content Engine is packaged with a default set of thresholds, your practice must determine how many documentation elements equal a complete exam. For the system to make this calculation, review and/or customize the thresholds for each organ system in the 95 Single System Complete Exam Thresholds section on the Practice Configuration template. Review and Configure the 95 Single-Organ System Complete Exam Thresholds You can configure singl

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Strict Numeric Exam Method for 95 Coding Guidelines

The Strict Numeric exam method for the 95 Coding Guidelines includes the following calculations: Problem Focus - One body area or organ system Expanded Problem Focus - Two to four body areas or organ systems Detailed - Five to seven body areas or organ systems Comprehensive - Eight or more organ systems Two configuration options are available: 95 Complete Exam - Configure the coding thresholds for a 95 Single System Complete Exam to be used by all payers. 95 Exam Payer Configuration - Customize the coding thresholds for all exam levels for specific payers. Configure 95 Strict Numeric Exam Levels by Payer You can configure payer exam levels under the 95 coding guidelines strict numeric method. Parent topic: Physical Exam Calculation for 95 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Show Information for the 95 Physical Exam Calculation Methods

You can display information comparing the physical exam level calculations under the 95 coding guidelines using detailed numeric and Strict numeric methods. For guidance on the 95 physical exam calculations, in the E&M Coding section of the Practice Configuration template, select the information icon next to 95 PE Exam Calculation Method.An information window opens, listing the physical exam levels and the body areas or systems included in each calculation method. 95 Physical exam calculation methods Parent topic: Physical Exam Calculation for 95 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Review and Configure 95 Detailed Numeric Exam Coding Thresholds

You can configure coding thresholds for body areas and organ systems under the 95 coding guidelines detailed numeric method. Open the Practice Configuration template. In the E&M Coding section, select the 95 Coding Guidelines option. For the 95 PE Exam Calculation Method, select the Detailed Numeric option. 95 Details in E&M Coding section Select 95 Coding Thresholds.The 95 Detailed Exam Coding Thresholds section appears. 95 Detailed Exam Coding Thresholds Review the default number of documented elements. To change the coding thresholds, select to enter a new number for an item under Body Areas or Organ Systems. Parent topic: Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Physical Exam Calculation for 95 Coding Guidelines

If your practice chooses the 95 Coding Guidelines option in the E&M Coding section of the Practice Configuration template, you must select one of two physical exam calculation methods associated with the guidelines. Detailed Numeric Strict Numeric Show Information for the 95 Physical Exam Calculation Methods You can display information comparing the physical exam level calculations under the 95 coding guidelines using detailed numeric and Strict numeric methods. Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines Thresholds that must be configured under the 95 coding guidelines detailed numeric method. Strict Numeric Exam Method for 95 Coding Guidelines Types of calculations and methods under the 95 coding guidelines strict numeric method. Single-Organ System Exam Thresholds for 95 Coding Guidelines Overview of single-organ system exams. Detailed Exam 4 x 4 Method for 95 Coding Guidelines Overview of the 4 x 4 detailed exam method under the 95 coding guidelines. Parent top

Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines

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