ICE portion is graded on physical exam, differential, and how you support it. Physical exam is actually graded twice. Once how you perform and then how its documented in the note. So anything vital physical exam wise is counted against you twice in ICE. Not doing a good physical exam can basically fail you for that case even if you write a good note. Also with your differential you get a few points by a listing diagnosis but you also get points for supporting it. If you just a list a diagnosis without support, you gets points taken off. Say you list the correct diagnosis and support it, you get the full 30% (hypothetical number). However if you list three differentials, and only the first is right, the other two are wrong or badly supported, you only get 10%. The other diagnosis's count as 10% each and so the 30% gets spread out thin. So only list differentials that are most likely and supported and you can get full 30% since it might be accepted as a alternative diagnosis. Basically listing two or three diagnosises, is kinda like hedging your bet if your primary diagnosis isnt the most likely on the exam. Also, how you support the diagnosis is formulaic. There is a way you are suppose to fill in those date entries lines under the diagnoses. Step 2 cs book has is all wrong. They don't tell you this. The test is very very poorly understood. Probably one of the most if not the most poorly understood exam out there. Its really crazy.
