Wiki Other Auditiors opinions on HPI status of Chronic conditions

[ivygirl18@hotmail.com]

Hello,

I was doing a nursing home audit for two providers and there was differences of opinion as to what qualifies as a status of the chronic conditions. There documentation in the HPI is the patient is being seen for their monthly visit. Chronic problems being followed are diabetes, HTN, Hyperlipidemia, dementia, and Parkinson's disease. Nursing reports no new questions or concerns at this time. There have been no new interval complaints from last seen. They are saying when the document "no new interval complaints" that is the status of the patient's chronic conditions. To me that does not seem like a status--it is they have not had any acute issues since last time. Maybe I am thinking wrong???

Any help would be appreciated!!

 

[thomas7331]

I have not seen any official guidance from CMS or my local contractor on what specifically they look for to support the status of chronic conditions in an HPI. Personally I would not accept 'no new interval complaints' as a status of 3 chronic conditions because I don't see that it provides any information about the either the conditions or their status. After all, the fact that a patient has no complaints does not give you any information about how well or whether their hypertension is being managed, does it? I might accept it as a 'brief' HPI, but not as 'extended'.

As understand the background of this, the status of chronic conditions was added to the HPI portion of the E&M documentation guidelines in the 1997 revision because under the original guidelines the HPI required elements which specifically described symptoms. In cases where the purposes of the visits were to follow and monitor chronic conditions, it did not make sense to document things like location, quality, severity, etc. in the record, so a 'status' of the condition was determined to be acceptable in place of this. So in the case of a condition such as hypertension or diabetes, where there aren't always symptoms to gauge the progress of the illness, the physician could instead document the status with information such as how the condition is being managed, and whether or not it is stable or improving or worsening. Saying there are 'no interval complaints' is basically going back to symptoms again, and it gives no information about the 'status' of the condition itself. In my experience with E&M coding, coders and auditor typically look for a provider to document these things in order to count a status, and E&M education materials usually give examples such as 'hypertension is currently stable on metoprolol' or that 'diabetes is poorly controlled based on reported blood glucose results since the last visit'.

Just my thoughts. If you're not able to reach a consensus with your providers on this, a good solution is to have a few notes reviewed by an independent auditor to get additional input.

 

[kdlberg]

I agree with Thomas on this. "No new symptoms" only means "no new symptoms." Are any previous ones getting worse, showing she is on a steady decline? Is she stable? In the case of a condition that could improve, have any symptoms disappeared?

One thing I would remind the providers is that don't assume an auditor will have access to previous encounters. When I'm doing an audit, I only get a record for that date of service. So "no new interval symptoms" wouldn't do me any good, because I have no way of knowing what the previous encounter found.

 

[ivygirl18@hotmail.com]

I have not seen any official guidance from CMS or my local contractor on what specifically they look for to support the status of chronic conditions in an HPI. Personally I would not accept 'no new interval complaints' as a status of 3 chronic conditions because I don't see that it provides any information about the either the conditions or their status. After all, the fact that a patient has no complaints does not give you any information about how well or whether their hypertension is being managed, does it? I might accept it as a 'brief' HPI, but not as 'extended'.

As understand the background of this, the status of chronic conditions was added to the HPI portion of the E&M documentation guidelines in the 1997 revision because under the original guidelines the HPI required elements which specifically described symptoms. In cases where the purposes of the visits were to follow and monitor chronic conditions, it did not make sense to document things like location, quality, severity, etc. in the record, so a 'status' of the condition was determined to be acceptable in place of this. So in the case of a condition such as hypertension or diabetes, where there aren't always symptoms to gauge the progress of the illness, the physician could instead document the status with information such as how the condition is being managed, and whether or not it is stable or improving or worsening. Saying there are 'no interval complaints' is basically going back to symptoms again, and it gives no information about the 'status' of the condition itself. In my experience with E&M coding, coders and auditor typically look for a provider to document these things in order to count a status, and E&M education materials usually give examples such as 'hypertension is currently stable on metoprolol' or that 'diabetes is poorly controlled based on reported blood glucose results since the last visit'.

Just my thoughts. If you're not able to reach a consensus with your providers on this, a good solution is to have a few notes reviewed by an independent auditor to get additional input.

Thomas,

Im glad you agree! Thank you very much for your response. Great explanation! I agree with everything you said.

 

[ivygirl18@hotmail.com]

I agree with Thomas on this. "No new symptoms" only means "no new symptoms." Are any previous ones getting worse, showing she is on a steady decline? Is she stable? In the case of a condition that could improve, have any symptoms disappeared?

One thing I would remind the providers is that don't assume an auditor will have access to previous encounters. When I'm doing an audit, I only get a record for that date of service. So "no new interval symptoms" wouldn't do me any good, because I have no way of knowing what the previous encounter found.

Great! I'm glad I'm on the right path! Thank you very much for your response! Even if an auditor has access to previous encounters they still can't be used if they didn't refer to them in the note or include the documentation in the note.