Review and Configure the 95 Single-organ System Complete Exam Thresholds

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Review and Configure 95 Detailed Numeric Exam Coding Thresholds

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 Click 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, click 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

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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. 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 possib

NextGen® Adaptive Content Engine Help Enterprise 8

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

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Select the ROS Calculation Method

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

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Mark the MDM Level as Not Required

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 Making

NextGen® Adaptive Content Engine Help Enterprise 8

Select E&M Coding Guidelines

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 Calculations

Review and Configure the 95 Single-organ System Complete Exam Thresholds

Recommendations

Review and Configure 95 Detailed Numeric Exam Coding Thresholds

Configure 95 Strict Numeric Exam Levels by Payer

Single-organ System Exam Thresholds for 95 Coding Guidelines

Select the ROS Calculation Method

Mark the MDM Level as Not Required

Select E&M Coding Guidelines