Strict Numeric Exam Method for 95 Coding Guidelines

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

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

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

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

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

Configure 95 Strict Numeric Exam Levels by Payer

When you select the Strict Numeric option for 95 Coding Guidelines, you can configure all exam levels for each payer on the 95 Exam Payer Configuration template. Note: Payer configurations on the 95 Exam Payer Configuration template supersede all other coding configurations. 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 Strict Numeric option.The 95 Exam Payer Configuration link becomes active. Select 95 Exam Payer Configuration.The 95 Exam Payer Configuration template opens. 95 Exam Payer Configuration template To review the 95 Exam payer information, select the information icon. In the Payer(s) Available section, select a payer and then select the right arrow to move the payer to the Payer(s) Selected section. Enter the number for each Physical exam level in the fields for Body areas/organ systems. Note: The defaults are 1 as the lowest possible value and 12 as the highest

Strict Numeric Exam Method for 95 Coding Guidelines

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Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines

Single-Organ System Exam Thresholds for 95 Coding Guidelines

Detailed Exam 4 x 4 Method for 95 Coding Guidelines

Show Information for the 95 Physical Exam Calculation Methods

Physical Exam Calculation for 95 Coding Guidelines

Configure 95 Strict Numeric Exam Levels by Payer

Strict Numeric Exam Method for 95 Coding Guidelines

Detailed Numeric Exam Coding Thresholds for 95 Coding Guidelines

Single-Organ System Exam Thresholds for 95 Coding Guidelines

Detailed Exam 4 x 4 Method for 95 Coding Guidelines

Show Information for the 95 Physical Exam Calculation Methods

Physical Exam Calculation for 95 Coding Guidelines

Configure 95 Strict Numeric Exam Levels by Payer