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.