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Specialty Exam Score Sheets

Print and Fill Score Sheets

The score sheets are designed to assist only with identifying the appropriate level of service defined by the work documented as rendered using the Centers for Medicare & Medicaid Services (CMS) Documentation Guidelines for Evaluation and Management Services.

There is only one score sheet based on the 1995 guidelines which includes the three key components and time. This score sheet is referred to as the E/M (1995) score sheet. The 1997 guidelines were an enhancement to the 1995 guidelines to include status of chronic conditions, one general multisystem exam scorecard and 11 single organ system exam scorecards. The other components remained unchanged. These guidelines were developed by the American Medical Association (AMA), CMS, and various specialty societies. These guidelines focus only on the way the examination component is reviewed.

The score sheets must be used in conjunction with the CMS Evaluation and Management Guidelines for 1995 and 1997. Other factors must be considered before arriving at the final code reported to Medicare, including but not limited to, medical necessity and removing from the scoring any documented services reflective of separately reported preventive services and non-relevant documentation.

To view the complete guidelines published by CMS and the AMA, please refer to the following:

Specialty Exam Score Sheets

For most cases, we recommend using the PDF format for printing or screen viewing. The HTML format is provided for special accessibility needs.

Title

PDF Format

HTML Format

E&M (1995)

PDF

HTML

Cardiovascular (1997)

PDF

HTML

Dermatology (1997)

PDF

HTML

Ears, Nose and Throat (1997)

PDF

HTML

Eyes (1997)

PDF

HTML

General Multi-System (1997)

PDF

HTML

Genitourinary (Female) (1997)

PDF

HTML

Genitourinary (Male) (1997)

PDF

HTML

Hematologic/Lymphatic/Immunologic Examination (1997)

PDF

HTML

Musculoskeletal (1997)

PDF

HTML

Neurology (1997)

PDF

HTML

Psychiatry (1997)

PDF

HTML

Respiratory (1997)

PDF

HTML

Note: To provide the highest quality scans on PDF versions, these sheets have been scanned at a high resolution. If you are printing hard copies of the PDF versions to your printer, be sure to select the "Shrink to Fit" option from Adobe Acrobat's Print screen for a clear, compressed copy.


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Last modified:  09/19/2017