Primary Care Coding Alert

Question: I have found information and heard at seminars conflicting information regarding the Associated Signs and Symptoms in the HPI section of the 1997 audit guidelines. Does a negative response count toward the HPI points? For example, say a patient presents with complaint of sinus pain. The note states that the patient has no fever. Because the provider asked about the symptom and the response was negative, should I check the associated signs and symptoms box, or should I assign no credit?Colorado Subscriber Answer: The lack of fever represents a pertinent negative in this example, but not under the history element you think it does. The 1997 "Documentation Guidelines for E/M Services" does not reference pertinent negatives in the context of the history of present illness (HPI). Instead, it references pertinent negatives in the context of the review of systems (ROS). Impact: When the note contains a pertinent negative, such [...]