I audit our GYN and Neuro docs using the 1997 specialty exams. I need an opinion….I have researched this and cannot find an answer. If a "bullet" cannot be performed in the exam due to circumstances beyond provider control, should they be penalized and not allowed an otherwise comprehensive exam? For example, a GYN patient has had the uterus removed or the neuro patient that is confined to a wheelchair and the provider cannot assess gait and station? I know if a ROS is unobtainable and the reason is documented, the provider isn’t penalized. But….I have not been able to find anything to support this for the 1997 exam. I agree with my physicians when they state they should not be down-coded from a justified, medically necessary 99205 to a 99203 because of something beyond their control. I would just like to have something (preferably in writing) that would hold up in case of an audit. I could not find anything on my MACs website (Novitas). The documentation definitely would not meet a comprehensive exam using the 1995 guidelines, especially Neuro, and I don’t want them documenting organ systems just to get to a comprehensive exam (i.e. ENT, GI, GU for Neuro). Opinions? Would it be sufficient to document "uterus surgically absent" or "patient confined to wheelchair – unable to assess gait and station"?