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Show Information for the 95 Physical Exam Calculation Methods

Show Information for the 95 Physical Exam Calculation Methods

For guidance on the 95 physical exam calculations, in the E&M Coding section of the Practice Configuration template, click 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

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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 check box 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 check box, 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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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 topic:

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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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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

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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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Evaluation and Management Guidelines on Finalize

You can view different coding guidelines on the Finalize template. The guidelines are available as the following panels in the template. 95 Physical Exam Details displays the calculated E&M points for each listed component. 95 Physical Exam Details on Finalize 97 Multi System Physical Exam Details displays detailed information on calculating points for multi system physical exam items to calculate a total E&M service code. 97 Multi System Physical Exam Details on Finalize 97 Single System Physical Exam Details displays detailed information on calculating points for single system physical exam items to calculate a total E&M service code. You can only use one of these guidelines at a time. You need to configure the guidelines in the E&M Coding section on the Practice Configuration template. Note: With the 97 Coding Guidelines, you can select the Multi system or Single system physical exam type in the General panel on the Finalize template. Based on the selection, either the 97 Multi Syst