Page 1 of 2 12 LastLast
Results 1 to 10 of 13

HPI and 1995 guidelines-Can anyone clairify

  1. Default HPI and 1995 guidelines-Can anyone clairify
    Exam Training Packages
    Hello,

    Can anyone clairify for me what Medicare means by this statement? How do you use the co-morbids if you cannot come up with an extended HPI under 95 guidelines?

    Per the Medicare 1995 documentation guidelines:

    An extended HPI consists of four or more elements of the HPI.

    !DG: The medical record should describe four or more elements of the present
    illness (HPI) or associated comorbidities.

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Are you referring to the 3 Chronic Conditions?

    If the patient has 3 chonic conditions, you can use those conditions in place of the HPI elements. The provider needs to document those 3 chronic conditions and their status....Example:

    Patient has history of HTN, DM, and Hyperlipidemia. Patient monitors BP weekly. Her typical BP reading is 120/85. Her Blood pressure is adequatley controlled with Toprol. Patient also checks insulin level daily. Patient's takes glucophage as directed. Patient is on a weight maintance plan and takes Crestor as directed. Patient does not experience any negative effects of this medication.

    Now...I noticed you mentioned the 95 guidelines. I assume that your carrier allows you to use the 3 chronic conditions for the 95 DG. The 3 chronic conditions guidelines are referenced in the 97 DG. Recently, I wrote my local carrier and they indicated that they recommend using the 3 chronics for the 97 only.

  3. Default
    Thank you so much for your quick reply! My providers use the 95 guidelines. I was confused because I know that the 97 guidelines allow you to use 3 chronic or inactive conditions, however, the 95 guidelines state the use of 4 elements needed for an extended HPI or co-morbidities(that is what is throwing me off) why would they state that if we cannot use them?

    Thanks :0)

  4. Default
    http://www.cms.hhs.gov/MLNProducts/Downloads/1995dg.pdf

    Page 6 in regards to HPI and 95 guidelines

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    95=An extended HPI consists of four or more elements of the HPI.

    !DG: The medical record should describe four or more elements of the present illness (HPI) or associated comorbidities.

    97=An extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions.

    !DG: The medical record should describe at least four elements of the present illness (HPI), or the status of at least three chronic or inactive conditions.


    Now...

    What are the differences between the 1995 and the 1997 E/M guidelines?

    Answer: Unfortunately, this is a complicated question and the answer may depend upon who you ask.

    The best way to consider this question is to take apart the key components of documentation.

    HISTORY: The rules for documenting the PAST MEDICAL, FAMILY and SOCIAL HISTORY and REVIEW OF SYSTEMS are identical for both the 1995 amnd 1997 E/M guidelines. The sole difference lies in the documentation of the HPI. The 1995 rules state that you must use the HPI elements to complete the HPI. A BRIEF HPI requires one to three of the HPI elements while an EXTENDED HPI requires at least four HPI elements. But, there is some language in the 1995 rules that also leaves the door open to documenting an EXTENDED HPI by commenting on four "associated co-morbidities." To be honest, it's not really clear if you can use the co-morbidities or if you have to use the HPI elements when completing the HPI using the 1995 rules. On the other hand, the 1997 E/M guidelines clearly state that you can qualify for an EXTENDED HPI by documenting four HPI elements OR by commenting on "the status of three chronic or inactive conditions."

    http://emuniversity.com/FAQ/EMFAQ3.html


    95's are vague as indicated above...That's why I wrote my carrier for their view.

  6. Default
    Thank you Rebecca for that answer, my providers are using 95 guidelines and always have. It just gets so frustrating when there are so many shades of gray...

    I appreciate your time, happy holidays!

    dscoder74

  7. #7
    Location
    North Carolina
    Posts
    3,126
    Default
    I agree. As CMS continues to make "changes", maybe this will be crystal clear one day. Below are some Q/A from other carrier sites. There are several that do allow the 3 Chronic Conditions with '95.

    ~Happy Thanksgiving to you as well~


    Can one utilize the status of 3 chronic conditions when using the 95' DG?

    Per CMS, yes. Although this information is physically present in the 97' DG it is also implied in the 95'DG.

    http://www.wisconsinmedicalsociety.o...cation/faq#q22

    What is meant by "Status of chronic conditions"?
    In 1997 the Evaluation and Management (E/M) Guidelines were enhanced under the History of Present Illness (HPI) section of the 1995 score sheet to include patient's chronic conditions in which an exacerbation may have occurred resulting in the chief complaint and the reason for the patient encounter. The documentation in the patient's medical record must state a status of the chronic condition in order to meet the requirement under the History: HPI Status of 1, 2, or 3 Chronic Conditions on the 1995 scoresheet. An example could be: hypertension - stable on Atenolol.


    https://www.highmarkmedicareservices...ervices.html#7


    Where can I get CMS' documentation stating three chronic or inactive conditions apply to both 95 and 97 guidelines?

    A 7. The 1997 DG state an extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions. The 1995 DG do not have this statement. However, WPS Medicare received clarification from CMS indicating this statement applies to both 1995 and 1997

    http://www.wpsic.com/medicare/part_b...ahistory.shtml

  8. Default
    Hi Rebecca,

    That is my hope to thank you so much for your feedback, you have been very helpful. :0)

    dscoder74

  9. #9
    Location
    Kansas City, MO
    Posts
    431
    Default
    What if all the doctro writes is "visit for diabetes follow up"? Does this count as any HPI?

  10. #10
    Location
    North Carolina
    Posts
    3,126
    Default
    This almost sounds like a chief complaint

Page 1 of 2 12 LastLast

Similar Threads

  1. PLEASE HELP, 1995 guidelines
    By mpl5btx in forum E/M
    Replies: 2
    Last Post: 02-28-2012, 04:08 PM
  2. 1995 guidelines
    By drsunitha in forum E/M
    Replies: 2
    Last Post: 11-21-2011, 10:06 AM
  3. HPI, Chronic, and the 1995 Guidelines
    By fredcpc in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 12-29-2010, 12:23 PM
  4. HPI and 1995 guidelines
    By Love Coding! in forum E/M
    Replies: 4
    Last Post: 02-10-2009, 11:33 AM
  5. using the 1995 guidelines.
    By daniel in forum E/M
    Replies: 3
    Last Post: 04-30-2008, 10:25 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.