what does the below really mean? is it 4 exams within the same body area or organ area?

The 4 x 4 method applies to the exam only and is a way to ensure you have 4 exam items in 4 body areas or 4 exam items in 4 organ systems; thus, reducing reviewer variability.

When reviewing a medical record and scoring the exam, our medical staff will automatically score a detailed exam if 4 or more exam items are noted in the medical record for 4 or more body areas or organ systems. However, less than such can still be a detailed exam based on the reviewer’s clinical judgment, which is considered clinical inference.

Our nurse reviewers also use their clinical knowledge while reviewing medical record documentation to determine the correct and appropriate level of care. It provides for an individual consideration, and makes the review of all services (including E/M examinations) fairer to the physician.