Forum - Questions & Answers
1995 Detailed Exam
Does anyone know if NY Medicare has documented guidelines for what they consider a detailed exam using 1995 guidelines? I just started working in NY and am having trouble auditing a specialist. When I use the 1997 guidelines, they barely make it to an expanded focus exam, so I want to try 1995 (they do very limited and specific exams). I have been told at least 3 different ways to get to a detailed exam, but wasn't sure which NY Medicare followed. I learned the 4x4 method, I heard about the 1-focused, 2-4 expanded focused, 5-7 detailed, and 8+ comprehensive. The latest I have heard about is for every 1 pertinent positive, 4 observations need to be made about another; the example I was given says if provider documents "vitals", he needs to make 4 observations about "musculoskeletal" and this is a detailed exam. This doesn't seem very detailed to me, but maybe I am reading it wrong.
Anyone have any advice/help?
Thanks!