Determining level of HPI

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I understand about the 8 criteria (location, quality, severity, etc.) and how to apply it when the patient comes in with a new problem, i.e., The patient comes in complaining of RIGHT ARM pain that has been going on for A WEEK and is EXACERBATED BY any twisting motion and MADE BETTER by Tylenol.

However, when the patient is coming in to be evaluated for an older problem with really no current symptoms and only chronic history of that problem, how do you apply the criteria? i.e.,

The patient comes in with a history of ureteral obstruction a few years ago. CT scan done prior revealed hydronephosis. She has had ureteroscopy and stent placement. An ultrasound done recently showed mild to moderate left-sided hydronephrosis, similar to the CT scan. The patient does have flank pain. The patient reports that she has a remote history of pyelonephritis in high school. She doesn't recall any other imaging studies of the kidneys.

The only criteria I see above are location (ureter) and maybe duration (a few years) and associated symptoms (flank pain).

From this note, it would be a brief (1-3) level HPI....correct?

Thanks for your help!
 

CatchTheWind

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First, a question: Are you getting three HPI elements or four on the example in your first paragraph? You list four items, but I think that "EXACERBATED BY any twisting motion" and "MADE BETTER by Tylenol" are duplicates of "modifying factors."

For the chronic problem, I get the same three as you, plus one more: severity (mild to moderate).
 
Messages
142
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First, a question: Are you getting three HPI elements or four on the example in your first paragraph? You list four items, but I think that "EXACERBATED BY any twisting motion" and "MADE BETTER by Tylenol" are duplicates of "modifying factors."
Oops, that one is my fault. I had intended to include a fourth item and forgot the next part of that sentence.

For the chronic problem, I get the same three as you, plus one more: severity (mild to moderate).
I don't think I would have pulled the "mild to moderate" as being associated with the patient's complaint because it was the result of an ultrasound and not subjectively given by the patient, whereas the "mild to moderate" pertains to an objective finding (radiology result).
 
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