Hi Jenny. I audit Pediatric Geneticists and sometimes it is difficult to reach an extended HPI. If you use CMS 1997 E/M documentation guidelines, you could use the status of at least three chronic or inactive conditions (if so documented by the physician) for an extended HPI.
Because of the nature of the specialty, the physicians often spend a lot of time in counseling and coordination of care (for example, 2 hours counseling parents of newly-diagnosed infant with Down syndrome). Correctly documented counseling and coordination of care time can be used as the determining factor when selecting E/M levels of service.
Hope this helps and good luck!
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