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ED Coding and Reimbursement Alert

Reader Questions:

Count Systems, Not Symptoms, On ROS Levels

Published on Sat Jun 05, 2010

Question:

What do you think the review of systems (ROS) level would be for the following encounter, and what diagnosis code should I use?

"Px symptoms fever, weight loss, sharp stomach pain and cramping, trouble breathing. No def dx. Proscribed OTC antacids, rest. Told px follow up with PCP if symptoms do no abate."

North Carolina Subscriber

Answer:

This is an extended ROS, as the physician reviewed three systems:

Constitutional (fever, weight loss)

Respiratory (breathing trouble)

Gastrointestinal (cramping, sharp stomach pain).

When the physician performs ROS on two to nine systems, it is an extended ROS. While ROS level is no guarantee as you should always code according to the notes, an extended ROS can support up to a level-four ED E/M service (99284, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; medical decisions making of moderate complexity ...).

Dx coding: Since the physician did not reach a definitive diagnosis, you should include a diagnosis code for each of the patient's presenting symptoms:

780.60 (Fever, unspecified) to represent the patient's fever

783.21 (Abnormal loss of weight and underweight; loss of weight) to represent the patient's weight loss

789.00 (Other symptoms involving abdomen and pelvis; abdominal pain; unspecified site) to represent the patient's stomach pain and cramping

786.05 (Dyspnea and respiratory abnormalities; shortness of breath) to represent the patient's breathing trouble.

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