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E/M university case of the week

  1. #1
    Default E/M university case of the week
    Exam Training Packages
    http://www.emuniversity.com/COW/case072809.pdf

    I am a little confused on the explanation he gives for the ROS. ROS: No chest pain or shortness of breath. He states that 2 systems were reviewed which i agree but he states it was Gastro and Cardio/Pulmonary. I think it should be gastro and respiratory. Does anyone else agree with him and if so where do i find documention stating that those statements should fall under the cardio ROS ?

    Thanks in advance !!
    Last edited by cpccoder2008; 07-28-2009 at 09:40 AM.

  2. #2
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    The complete ROS states: Positive for intermitent nausea and vomiting (GI) No chest pain or shortness of breath (CV).

    I do these too and have learned a lot. This is how I intrepret it.

  3. #3
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    I thought the statement No chest pain or sob was a Respiratory ROS. According the this handout it would be counted as Resp.
    http://medinfo.ufl.edu/year1/epc97/handouts/ros.html
    But in the case review he states it's cardio/pulmonary. I am just really confused on what system it should be associated with.

  4. #4
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    CMS provides an example in the DG's.....

    Extended, which inquires about the system directly related to the problem(s) identified in the HPI and a limited number (two to nine) of additional systems. In the following example, two systems – cardiovascular and respiratory – are reviewed:

    CC: Follow up visit in office after cardiac catheterization. Patient states “I feel great.” ROS: Patient states he feels great and denies chest pain, syncope, palpitations, and shortness of breath. Relates occasional unilateral, asymptomatic edema of left leg.

    http://www.cms.hhs.gov/MLNProducts/d...serv_guide.pdf

    Page 11 of first link

  5. #5
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    So would the Chest pain be a ROS for Cardio and the SOB for Resp ? Then that would make 3 ROS instead of 2 like stated in his explanation. The paragraph under that statement says

    3) Complete, which inquires about the system(s) directly related to the problem(s) identified in the HPI plus all additional (minimum of 10) body systems. In the following example, 10 signs and symptoms are reviewed: CC: Patient complains of “fainting spell.” ROS:
    o Constitutional: weight stable, + fatigue.
    o Eyes: + loss of peripheral vision.
    o Ear, Nose, Mouth, Throat: no complaints.
    o Cardiovascular: + palpitations; denies chest pain; denies calf pain, pressure, or edema.
    o Respiratory: + shortness of breath on exertion.
    o Gastrointestinal: appetite good, denies heartburn and indigestion. + episodes of nausea. Bowel movement daily; denies constipation or loose stools.
    o Urinary: denies incontinence, frequency, urgency, nocturia, pain, or discomfort.
    o Skin: + clammy, moist skin.
    o Neurological: + fainting; denies numbness, tingling, and tremors.
    o Psychiatric: denies memory loss or depression. Mood pleasant.

  6. #6
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    In the case study it states :
    ROS: Positive for intermittent nausea and vomiting. Negative for melena or hematemesis. No chest pain or shortness of breath.

  7. #7
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    Personally, I scored 3 ROS. Not sure how/why he mentioned 2 (statement copied from his assessment...."Two systems are reviewed: gastrointestinal, cardiovascular and pulmonary.")

    ROS: Positive for intermittent nausea and vomiting (GI). Negative for melena or hematemesis (GI) . No chest pain (Cardio) or shortness of breath (Respiratory).

  8. #8
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    Quote Originally Posted by cpccoder2008 View Post
    I thought the statement No chest pain or sob was a Respiratory ROS. According the this handout it would be counted as Resp.
    http://medinfo.ufl.edu/year1/epc97/handouts/ros.html
    But in the case review he states it's cardio/pulmonary. I am just really confused on what system it should be associated with.
    Chest pain stated by itself is usually considered as cardiovascular. If the note stated painful respiration that would qualify as respiratory. Look at the definitions in the hand out you provided the link for; under Respiratory it provides examples of what kind of pain would be considered under the respiratory ROS. (I hope that made sense...)
    Lisa Bledsoe, CPC, CPMA

  9. #9
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    I first scored 2 because i didn't know that chest pain was considered cardio so i was adding 1 for chest pain and sob for Resp and 1 for gastro but after reviewing the documents you sent me i am counting three, the same as you. I just want to make sure i am understanding this right.

  10. #10
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    Quote Originally Posted by Lisa Curtis View Post
    Chest pain stated by itself is usually considered as cardiovascular. If the note stated painful respiration that would qualify as respiratory. Look at the definitions in the hand out you provided the link for; under Respiratory it provides examples of what kind of pain would be considered under the respiratory ROS. (I hope that made sense...)
    Yes i understand now, after reading all the documents it started to be clearer. But am i right to say that there are 3 systems being reviewed instead of 2 ?

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