1601 N. Tucson Blvd. Suite 9
Tucson, AZ 85716-3450
Phone: (800) 635-1196
Hotline: (800) 419-4777
Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

R. Arthur N. Lurvey, M.D.
Medical Director
Medicare Carrier Medical Director
Transamerica Occidental life Insurance Company
1150 South Olive
Los Angeles, California 90015-2211

Date: 3/21/98

Dear Dr. Lurvey,

I have been studying the E&M guidelines for my specialty for 3 hours so far today. Here are my questions regarding a comprehensive physical examination:

1. Do I still get credit for documenting a required element if the patient refuses this part of the exam or is uncooperative for this type of exam as long as I document that this is the case?

2. I am supposed to document at least one element in each unshaded box, but for some organ systems, no elements are identified: i.e. Genitourinary, Musculoskeletal. What do I do here?

3. Can I get credit if I perform and document more elements in one unshaded box as substitution for documenting fewer required elements in another unshaded box, if it is more clinically relevant for a given patient?

4. If there is already a specialist examining the patient in another organ system, say cardiology, can I defer to this specialist's expertise as long as I agree with their exam and document that I agree?

5. I realize after all my study, that previously, I have performed enough elements to qualify for a comprehensive exam, but have not documented to this level since it is so irrelevant to do so. This type of documentation also clutters up the medical record. Therefore, I was actually undercoding. When I typed up my comprehensive hospital note it came out to be 6-12 pages long depending on the patient. Should I include a Table of Contents?

I have enclosed copies of my other 4 letters to which you have not yet responded so that you can respond more easily, all at once. I there is a specific person at HCFA that you recommend, please let me know and I will address my many questions and problems with Medicare to them.


Linda Wilson, M.D.

CC. Jane Orient AAPS
Dianne Feinstein and Sharon Burgess, HCFA