Allergy clarification under the ros

1formissy

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Recently, a fellow colleague and myself were having a discussion regarding the Allergy section of the ROS.
We had a record where the provider reported the patient has a allergy to a medication causing facial swelling.
I took that as part of the MDM (Under Medication Management). I did not count it as a ROS because my understanding of the allergy ROS is pertaining to hay fever, pollen, ect.
I know the E/M guidelines front to back, but there is some grey between myself and my colleague. Since we audit for a payer, I want to make sure we are consistent on our decision making on these types of claims.
Any input would be most helpful.
 

thomas7331

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I haven't seen any 'official' guidance that addresses this question directly. My personal feeling has always been that a listing of a drug allergy in the history is part of PFSH, since it is historical information. I agree with you that it's not really ROS because it's not a case of the provider asking about particular allergy symptoms that the patient might be having as part of their present illness. That said, I do know that a lot of coders/auditors will allow it as a system under ROS, and when I studied for the CEMC exam it was specifically stated in the study materials that it could be used as an ROS system point.

I could see how you might count it toward MDM, but only if it somehow figured in the provider's plan of care, for example, if the provider documented that the allergy influenced the course of treatment, that the allergy prevented the use of a drug that normally would have been used to treat the problem, or if the reaction is new or ongoing. I don't think I'd count it toward MDM if it's simply listed in the history alone.

Hope that makes sense or helps some.
 

1formissy

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Hi Thomas,

Sorry I did not respond earlier. Something was wrong with my Log In. I appreciate your response, you are always most helpful.
I think I may begin to write up a guideline for myself and my colleague so when we audit these claims, we can pretty much be on the same level. I know audits sometimes produce a variation depending on that persons interpretation.
Your input is greatly appreciated!
 
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