Wiki NKDA - How are others counting?

KurtRego

New
Messages
3
Location
Stoughton, WI
Best answers
0
I would be interested in finding out how fellow coders are currently counting the NKDA? Is this a ROS or counted as a PFSH?

Any input would be appreciated along with the rationale for the choice.

Kurt Rego, CPC
Corporate Compliance
 
I was told at a Medicare seminar by the nurse reviewers that NKDA should be counted under PFSH. What do others do.

roxanne
 
I think it depends on how your medicare carrier views it. We use it under ROS or PFSH but not both places.
 
I generally count this as an element of the ROS. If you look under medicare E/M guidelines it shows "allergic/immunologic" as a system - I perceive this as a general statement that can apply to any allergy reviewed. Allergies (unless otherwise stated) are a current issue for the patient - and can potentially affect the doc's treatment options.
 
CMS has made documentation guidelines for this relatively clear--where I (personally) find dissent is in the interpretation of presenters, auditors and educators.

According to CMS, it may be counted as either Past Med. Hx. or as a ROS (All/Imm), but only one of those. It is pretty standard for auditors/coders to just automatically slam it into PFSH, although it may be needed elsewhere (e.g., ROS). Since the allowance is permitted by CMS, I would say it needs to be counted where it is needed in the document.

If specific FIs have rules outside those of CMS, they should place those in writing. I would also pay heed to what the Medical Reviewers (not Clinical Reviewers) are stating from those FIs; these are the people reviewing your documentation, after all.

Hope this helps.
 
Ros

I, personally, consider NKDA a ROS (allergy). Typically, past history is easy to get anywhere else and it's another point in the provider's favor to use it as a system.
 
NKDA stands for no known DRUG allergies. My outside consultant said that it should be counted as PFSH over ROS for 2 reasons: 1: it is documented (in my clinic) by the MA's not the provider and 2: it is not generally specific to the particular problem the patient is coming in for.
 
I always count it in ROS. In the ED, where I code, I feel it is always pertinent to nature of the presenting problem.

JG
 
Nkda

This is part of the past medical history.

If a patient is asked about other allergies such as environmental allergies like hay fever, this would be part of the ROS.
 
This is part of the past medical history.

If a patient is asked about other allergies such as environmental allergies like hay fever, this would be part of the ROS.

I agree with you Khaspert... thats what I was taught by the auditors at Medicare.

Roxanne Thames, CPC
 
Top