3 chronic illness = automatic 4 HPI

DeniseDenise

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3 chronic illnesses = an automatic 4 HPI, is this the standard for 95 and 97 guidelines?

Thanks!
 

valleycoder

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Per 97 guidelines: an extended HPI consists of at least 4 elements of the HPI or the status of at least 3 chronic or inactive conditions.
Per 95 guidelines: an extended HPI consists of 4 or more elements of the HPI. The medical record should describe four or more elements of the present illness (HPI) or associated comorbidities.
 
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Status

"Status" is the key to this. Make sure it is more than a list of 3 ccs. This link to the CMS-approved Highmark Medicare audit form allows for either or. Though I have seen the argument that if you use the 3 cc to support a comprehensive HPI you must adhere to the 97 DGs (bulleted) examinations, I don't know that to be 100% true. It makes sense, but currently it's an either/or situation and, I think, open to interpretation.

http://www.highmarkmedicareservices.com/partb/reference/pdf/scoresheets/8985.pdf
 
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