Wiki ROS question - Does anyone know CGS Medicare's

[jtb57chevy]

Does anyone know CGS Medicare's stance on the use of "all other systems reviewed and are negative"? I've looked extensively on their website and not finding a definitely yes answer or a definitely no answer. I will greatly appreciate any supporting documentation links.

Thanks for any and all help!

 

[LLovett]

http://www.cgsmedicare.com/kyb/coverage/mr/PDF/99205.pdf


This audit tool seems to support use of the "all others negative" type documentation, which is supported by the official guidelines. The next link just has some nice info.

http://www.cgsmedicare.com/ohb/claims/cert/Articles/056.html

Hope this helps,

Laura, CPC, CPMA, CEMC

 

[ivorytofu@hotmail.com]

Trailblazer does not accept the "all others negative"

 

[thelton]

Our MAC, Novitas, does accept "all others reviewed and are negative" for the review of systems.

Tammy, CPC, CPMA, CEMC

 

[mdoyle53]

First off, most do not get the wording correct - "all other systems negative". There is no need to indicate reviewed as most of the time they are not reviewed. Medicare guidelines indicate that you must review all positive and negative pertinent systems and then it can be stated "all other systems negative"

When I see a note that indicates 'all other systems reviewed and negative', i immediately ask to see the documentation of the review. Generally not there so therefore I would not accept the statement as they were not reviewed. If they were reviewed, they would be documented.

 

[Annette]

Validated Source

I always look to a validated source to answer these types of questions. The most recent update of the MLN; "Evaluation and Management Services Guide" states the following under the Documentation Guidelines symbol (DG):

"At least ten organ systems must be reviewed. Those systems with positive or pertinent negative responses must be individually documented. For the remaining systems, a notation indicating all other systems are negative is permissible."

 

[ilenefla]

I have a dr who states gives info in the hpi about pertinent positives, but for ros, he states: 12 systems were reviewed and unremarkable, other than what is stated above.

I don't feel this is enough to be a complete ros. Does anyone have any thoughts on this?

 

[AmandaW]

thelton (Tammy), my MAC is also Novitas and I'm aware of them accepting the statement but the part I am confused about is the required documentation for the "pertinent positives and negatives." When I have asked in webinars about it, they say they "expect" to see a statement about "pertenent positves and negatives" in addition to the statement "all other ROS negative" but then they say that it is NOT "double-dipping" to pull that date from the HPI so if it is already stated in the HPI does the physician have to state it again in the ROS portion??