Show Information for the 95 Physical Exam Calculation Methods

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines

The Centers for Medicare and Medicaid Services (CMS) 95 Coding Guidelines do not define a detailed exam. It is up to your practice to determine how many documentation elements equal a detailed exam. Your practice must configure the thresholds for each body area and organ system to allow the application to calculate a detailed exam. The application is packaged with thresholds based on common coding practices. Review these values to make sure that they meet your practice’s documentation patterns and specialty needs. Your practice can customize the number of elements required in each of the fields for Body Areas and Organ Systems. 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. Parent topic: Physical Exam Calculation for 95 Coding Guidelines

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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

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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

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

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Physical Exam Calculation for 97 Guidelines

If your practice selects the 97 Coding Guidelines option in the E&M Coding section of the Practice Configuration template, the exam calculations are based on the Multi- or Single-system exams. The application determines which calculation to use based on the template set that is selected for the encounter. In the General panel of the Finalize template, the PE Type defaults to Multi system or Single system based on the Specialty selected for the encounter. The specific Single-system exam type appears in the field to the right of the option. You can select a different Single-system exam type. PE Type and Speciality on General panel of Finalize template Parent topic: Evaluation and Management Coding See also Select Evaluation and Management Coding Guidelines

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Select Evaluation and Management Coding Guidelines

You can select the Evaluation and Management (E&M) coding guidelines to use for your practice on the Practice Configuration template. Open the Practice Configuration template. In the E&M Coding section, do one of the following: Select in the 2021 Coding Effective Date. Then, select either the 95 Coding Guidelines or 97 Coding Guidelines option to use for visit types unaffected by the 2021 Coding Guidelines or for encounters before the effective date. Select the 95 Coding Guidelines option, and then select the physical exam calculation method. Parent topic: Best Practices for Evaluation and Management Coding Calculations See also Physical Exam Calculation for 95 Coding Guidelines Physical Exam Calculation for 97 Guidelines

Show Information for the 95 Physical Exam Calculation Methods

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