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Wiki ROS for inpatient E/M

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Bellaboo

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A physician in the group is stating that a ROS is not necessary in a
inpatient consult or inpatient revisit note. Anyone have any comments?
Also any supporting documents?
Thanks
 
He does not have to have a review of systems but he will only be able to code the lowest level code - 99251.
Mary
 
Referring to chart

Perhaps your MD is thinking that if the complete ROS is already a part of the medical record (e.g. in the H&P) for the patient. HOWEVER, in order to get credit for this, the consulting MD must document something along lines of "For ROS and PMFSH, I have reviewed the H&P done by Dr Admitting on mm/dd/yy"

As for the "revisit" ... this would be a subsequent hospital visit and only two of the three elements need to be met ... Exam and MDM would suffice.

F Tessa Bartels, CPC, CPC-E/M
 
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