Physician

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System/Body Area Genitourinary (Cont’d) FEMALE: Elements of Examination Includes at least seven of the following eleven elements identified by bullets: Inspection and palpation of breasts (eg, masses or lumps, tenderness, symmetry, nipple discharge) Digital rectal examination including sphincter tone, presence of hemorrhoids, rectal masses Pelvic examination (with or without specimen collection for smears and cultures) including: External genitalia (eg, general appearance, hair distribution, lesions) Urethral meatus (eg, size, location, lesions, prolapse) Urethra (eg, masses, tenderness, scarring) Bladder (eg, fullness, masses, tenderness) Vagina (eg, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, rectocele) Cervix (eg, general appearance, lesions, discharge) Uterus (eg, size, contour, position, mobility, tenderness, consistency, descent or support) Adnexa/parametria (eg, masses, tenderness, organomegaly, nodularity) Anus and perineum Lymphatic Palpation of lymph nodes in neck, axillae, groin and/or other location Musculoskeletal Extremities Skin Neurological/ Psychiatric Inspection and/or palpation of skin and subcutaneous tissue (eg, rashes, lesions, ulcers) Brief assessment of mental status including Orientation (eg, time, place and person) and Mood and affect (eg, depression, anxiety, agitation) 27 Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 141
Content and Documentation Requirements Level of Exam Problem Focused Expanded Problem Focused Detailed Perform and Document: One to five elements identified by a bullet. At least six elements identified by a bullet. At least twelve elements identified by a bullet. Comprehensive Perform all elements identified by a bullet; document every element in each box with a shaded border and at least one element in each box with an unshaded border. 28 Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 142
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Medicare Physician Guide A Resource
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ICD-9-CM Notice The International C
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MEDICARE PHYSICIAN FEE SCHEDULE ...
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CHAPTER ONE INTRODUCTION TO THE MED
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THE MEDICARE PROGRAM The Medicare P
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worker must have a specified number
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Part B - Medical Insurance Some of
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Where to Find Additional Informatio
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CMS contracts with one Quality Impr
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This chapter discusses Medicare pro
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staff or faculty appointments, part
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The following forms are often requi
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Accept the Medicare allowed amount
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Below is an illustration of the pay
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cultural background, or ability to
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This chapter provides information a
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suppliers can obtain a list of elec
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Insurer information (name, group nu
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Coordination of Benefits Contractor
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In these situations, the physician
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Where to Find Additional Informatio
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OTHER HEALTH INSURANCE PLANS Medica
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Part B Railroad Retirement Benefits
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This chapter discusses Medicare cov
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2) Renal dialysis treatments Renal
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2) Furnished by the physician or au
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Services that are considered not me
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This chapter discusses common sets
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International Classification of Dis
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CHAPTER SIX PROTECTING THE MEDICARE
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codes that describe what is and is
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Consistently using billing or reven
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Investigations A Program Safeguard
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Sanctioned and Reinstated Provider
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CHAPTER SEVEN INQUIRIES, OVERPAYMEN
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If Medicare pays more than the corr
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It contains the name, telephone num
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filed), the time limit will be exte
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Liability and Appeal Decisions Liab
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REFERENCE SECTION Medicare Physicia
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Coinsurance Under the Original Medi
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Medically Necessary Services or sup
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Participating Provider or Supplier
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ACRONYMS AA ABN AEP AIC ALJ ASC CAH
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HIC HIPAA HPSA ICD-9-CM ICD-10-CM/P
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Page 99 and 100: 1995 DOCUMENTATION GUIDELINES FOR E
Page 101 and 102: II. DOCUMENTATION OF E/M SERVICES T
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Page 117 and 118: I. INTRODUCTION WHAT IS DOCUMENTATI
Page 119 and 120: III. DOCUMENTATION OF E/M SERVICES
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Page 123 and 124: REVIEW OF SYSTEMS (ROS) A ROS is an
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Page 129 and 130: System/Body Area Respiratory Elemen
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Page 133 and 134: Cardiovascular Examination System/B
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Page 137 and 138: Content and Documentation Requireme
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Page 157 and 158: System/Body Area Skin Elements of E
Page 159 and 160: NUMBER OF DIAGNOSES OR MANAGEMENT O
Page 161 and 162: RISK OF SIGNIFICANT COMPLICATIONS,
Page 163: D. DOCUMENTATION OF AN ENCOUNTER DO
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Physician

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