ROS from previous visit - how to count it

betsycpcp

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I've searched here for previous answers on this but never seem to find exactly what I'm looking for-- if a provider indicates that they reviewed a previous Review of Systems and they give the date that it was done and where it's on file, I know guidelines say that is acceptable rather than doing a new ROS as long as they update or say there are no changes. All I want to know is how to determine what level to assign to the ROS if they don't say how many systems were reviewed or that it was a "complete" ROS.
I saw on previous answer in a forum that says since the previous ROS is listed with a date, that creates an audit trail so the level can be verified if necessary. However, what if that information is not available? Example- I work for a payer for workers' comp. The note refers back to ROS done on a date prior to the work injury. We would not have access to any records prior to or unrelated to the injury. So I don't know if it was a complete ROS or not since the note doesn't specify.
Also I always wonder about medical necessity. If the previous ROS was 10 or more systems because of the patient's complaint(s) at that time, but now they have a specific, straightforward complaint, why should the previous complete ROS count?

Just interested in any guidelines, references or opinions on this topic-- thanks!
 

HarrisburgLPN

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When auditing, we don't give credit for the ROS if they don't include some THING - how hard is it to ask if they have a headache etc.? That said, if they refer to a past ROS, when requesting documentation we will always request the DOS that is being referenced - if it's not sent it, they don't get credit. If the provider documents, "ROS reviewed and all are negative" - we give full credit for that .. begrudgingly .. but we do it.

THAT SAID --- if you're reviewing medical records, look at the patient's HPI - you can *most times* eek out at least ONE system from the description of the problem.



 

betsycpcp

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Thank you---I agree with what you've said- in the example I have, the provider is billing 99215, so in order to get to a comprehensive history they have to have a complete ROS. So if they only get credit for the ROS elements that could be pulled from the HPI, they might not have enough to support 99215 (unless there is enough in the exam and MDM to get 2 out of 3). I have always found the guideline confusing since it should be based on medical necessity for the current visit, and yet providers can use a previous complete ROS that may not be necessary for the current problem.
 
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