Review and Configure 95 Detailed Numeric Exam Coding Thresholds
- For the 95 PE Exam Calculation Method, select the Detailed Numeric option.
- Click 95 Coding Thresholds.
The 95 Detailed Exam Coding Thresholds section appears.
Recommendations
NextGen® Adaptive Content Engine Help Enterprise 8
Open the Practice Configuration template. In the E&M Coding section, select 95 Coding Guidelines. For the 95 PE Exam Calculation Method, select either the Detailed Numeric or Strict Numeric option. 95 Details in E&M Coding section Click the 95 Complete Exam link. The 95 Single System Complete Exam Thresholds section appears. 95 Single System Complete Exam Thresholds section Review the default number of documentation elements for each organ system. To change the coding thresholds, click to enter a new number for an item under Organ Systems. Parent topic: Single-organ System Exam Thresholds for 95 Coding GuidelinesReview and Configure the 95 Single-organ System Complete Exam Thresholds
NextGen® Adaptive Content Engine Help Enterprise 8
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. Click 95 Exam Payer Configuration. The 95 Exam Payer Configuration template opens. 95 Exam Payer Configuration template To review the 95 Exam payer information, click the Information icon. In the Payer(s) Available section, select a payer and click 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 possibConfigure 95 Strict Numeric Exam Levels by Payer
NextGen® Adaptive Content Engine Help Enterprise 8
Open the Practice Configuration template. In the E&M Coding section, do one of the following: Click 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. For more information, refer to Physical Exam Calculation for 95 Coding Guidelines section. Select the 97 Coding Guidelines option (default). For more information, refer to Physical Exam Calculation for 97 Guidelines section. Parent topic: Best Practices for E&M Coding CalculationsSelect E&M Coding Guidelines
NextGen® Adaptive Content Engine Help Enterprise 8
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 GuidelinesDetailed Numeric Exam Coding Thresholds for 95 Coding Guidelines
NextGen® Adaptive Content Engine Help Enterprise 8
If you are using the 95 or 97 Coding Guidelines, you can choose not to use the MDM level as one of the three components for the overall E&M level. You can mark the MDM level as not required on the Practice Configuration template. This option is not applicable to the 2021 Coding Guidelines. Open the Practice Configuration template and then scroll to the E&M Coding, Medical Decision Making section. Select the MDM not a required component check box. MDM not a required component check box in E&M, Medical Decision Making section Click Save and Close. Parent topic: Medical Decision MakingMark the MDM Level as Not Required
NextGen® Adaptive Content Engine Help Enterprise 8
Open the Practice Configuration template, and scroll down to the E&M Coding, ROS Calculation Method section. For guidance on the ROS calculation method, click the information icon. Select one of the following calculation methods: HPI and ROS credit is given when symptoms are entered on HPI templates Note: The ROS coding credit is not given when symptoms have been entered on the dynamic HPI templates. ROS is assigned when symptoms are documented on ROS templates Click Save and Close. Parent topic: Review of Systems (ROS) Calculation for E&M Coding