Medicare Compliance & Reimbursement

Differentiate brief history of present illness from extended with these tips. Question: Our coding staff has a disagreement about how to differentiate a brief history of present illness (HPI) from an extended HPI. Our office manager feels that our practice has had to downcode some claims from a higher E/M level to a lower one simply because the physician either isn't documenting the HPI completely, or because our coding staff downgrades the HPI. We'd love some advice on what the difference is. Answer: You can distinguish between brief and extended HPIs based on the detail the physician needs to accurately characterize the clinical problem(s). Specifically, a brief HPI consists of one to three elements, but an extended HPI consists of four or more elements, according to the CMS "1995 Documentation Guidelines for Evaluation & Management Services" (www.cms.gov/MLNProducts/Downloads/1995dg.pdf). Important: Remember when choosing an E/M code that history is only one [...]