Physical Exam Calculation for 95 Coding Guidelines

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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

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Components of E&M Coding

The calculation of evaluation and management (E&M) code is based on following components. E&M Coding Component Description New Patient or Established Patient Required. This component identifies which patient type is used for the overall E&M calculation. A new patient has not received any professional services from any physician in the same specialty within a group over the last three years. Visit Type Required. The visit type identifies the E&M code category, for example, Office Visit, Consultation Visit, or Preventive Visit. The visit type factors into all coding guidelines. Reason for Visit (RFV) or Chief Complaint (CC) Required. The RFV describes the symptom, problem, condition, or diagnosis that indicates why the patient has come for services. The RFV factors into the calculations under the 95 or 97 Coding Guidelines. History of Present Illness (HPI) The HPI factors into the calculations under the 95 or 97 Coding Guidelines and documents any of the following elements: Location Dura

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Evaluation and Management Coding

NextGen® Adaptive Content Engine uses Evaluation and Management (E&M) coding guidelines from the Centers for Medicare and Medicaid Services (CMS) for the documentation and billing of E&M services because these protocols are the most stringent. CMS provides three sets of guidelines to calculate E&M codes: 1995 (95) Coding Guidelines 1997 (97) Coding Guidelines 2021 Coding Guidelines (effective January 1, 2021) The Cardiology template set does not use these calculation methods described. For information on E&M coding for the Cardiology specialty, go to NextGen Healthcare Success Community, and download the latest Cardiology User Guide for NextGen® Adaptive Content Engine. The 95 and 97 Coding Guidelines calculate E&M codes based on one of the following: Documented history and physical exam elements and the selected Medical Decision Making (MDM) level Total visit time if more than 50 percent of the time was spent counseling or coordinating care You can use either the 95 or 97 Coding Guide

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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

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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 enable 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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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 sin

Physical Exam Calculation for 95 Coding Guidelines

Recommendations

Physical Exam Calculation for 97 Guidelines

Components of E&M Coding

Evaluation and Management Coding

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

Physical Exam Calculation for 95 Coding Guidelines

Physical Exam Calculation for 97 Guidelines

Components of E&M Coding

Evaluation and Management Coding

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