Primary Care Coding Alert

Question: What is the difference between problem-pertinent, extended and complete review of systems (ROS) on an E/M service?


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Answer: You-ll need to know the difference between the three ROS levels because ROS is a vital component to determining your level of history, which, in turn, determines the level of E/M service. Problem-pertinent: The physician performs a problem-pertinent ROS when he reviews a single system for the patient during the encounter. A problem-pertinent ROS can support up to an expanded problem-focused level of history, which can support up to a level-three established patient E/M service (99213) or level-two new patient E/M service (99202) -- but be sure to choose your E/M code based on your FP's entire set of encounter notes, not just the ROS level. Extended: When the physician conducts an extended ROS, there must be evidence that he checked the system directly related to the patient's problem and a -limited- number of additional systems. According to Medicare, -limited- can be anywhere from two to nine systems, depending on the service your physician provides. An extended ROS can support up to a detailed level of history, which can support a level-four established patient E/M service (99214) or level-three new patient E/M service (99203). Complete: The physician must review 10 or more systems to qualify for a complete ROS and must individually document those systems with positive or pertinent negative responses. For the remaining systems, a notation that all other systems are negative is permissible. In the absence of such a notation, the physician must individually document at least 10 systems. A complete ROS can support a comprehensive level of history, which can support a level-five established patient E/M service (99215) or a level-four or -five new patient E/M service (99204 or 99205). Answers to You Be the Coder and Reader Questions reviewed by Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.