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I have always understood that elements within ROS can not count in the exam, even if there is no double dipping going on of the elements. But recently, I was told by several other certified coders that you can. I have always understood history to be provided by the patient and the exam provided by the doctor's observation during the encounter. That they would have to be documentated separately within in the note. My understooding is that the only place where elements can count in different sections is within the history (HPI, ROS, PFSH) as long as you are not double dipping.