It would help to divide this into three separate threads.
My responses, as always, are specifically applied to coding for the professional fees ONLY.
ER ADMIT CODES - there is no such thing. Are you talking about ER codes or Initial Hospital Visit codes? If service is provided in the ER to a patient who is then admitted to the hospital by the same physician who provided the ER service, then only the Initial Hospital Visit should be coded - The documentation will determine the level of the code.
ROS vs HPI - If the ROS documentation reads: Full 14-system ROS performed and negative other than HPI - then I would count it. BUT beware -- you need to check with your local carrier as to what language they will accept on the ROS. More and more are requiring that each system be outlined individually. If it just says "ROS as per HPI" then I will count only what I don't need for HPI elements from the HPI paragraph as ROS. A lot of doctors lump everything in the history section into one big paragraph and the coder needs to sift through to find and apply the information where needed.
CRITICAL CARE - if the documentation says "40 minutes minus procedures" then you CANNOT tell how much time was spent in critical care, so you cannot code critical care. If the documentation says "40 minutes exclusive of procedures" then you know that 40 minutes was spent in critical care.
Hope that helps.
F Tessa Bartels, CPC, CEMC
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