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Ros -physician documents

  1. #11
    Default Ros
    Exam Training Packages
    If you have ROS in the HPI you can use that for ROS, also, the rules for double dipping have changed. You are now allowed to double dip. If the physician states that 10 review of systems were reviewed and negative, that does not count you have to have at least one pertinent or negative ROS and the statement must say all other ROS were negative (or whatever his findings were). The key words are "all other". I hope this helps.

  2. #12
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    Milwaukee WI
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    cfullum writes: the rules for double dipping have changed. You are now allowed to double dip. What?! Please tell us where you saw that in writing because it is news to me.

    Leslie: I am not familiar with the t-system you are referring to so I cannot answer your specific questions about that. I would be tempted to NOT allow a blanket "all others negative except where marked" if NOTHING ELSE was marked. I mean SOMETHING has to be positive - why is the patient here?

    Sorry I can't be more specifc. I gave it my best shot with my previous answer.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    The T-System is designed to include the system(s) pertinent to the chief complaint in the HPI. The HPI also contains other associated systems. This documentation may be counted for both elements within the HPI and the ROS. This is not double dipping. Dr. Barton C. McCann, the Executive Director of the Department of Health and Human Services, wrote in April of 1998 that "it is not necessary to mention an item of history twice in order to meet the Documentation Guidelines requirement for the ROS". A copy of this letter can be found on the American College of Emergency Physicians website (ACEP.org).

    Regarding the "all systems negative except as marked box". Both the 1995 and 1997 Documentation Guidelines contain the following statement:

    "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. In the absence of such a notation, at least ten systems must be individually documented."

    The "all systems negative except as marked" box is is not a performance shortcut. It is a documentation shortcut that is compliant with the CMS Documentation Guidelines. The "all" is the operative word. It should be marked only after the provider has performed a complete ROS and documented those systems with pertinent positives and negatives.

    David Gardner, RN, CPHQ

  4. #14
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    Greeley, Colorado
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    Quote Originally Posted by FTessaBartels View Post
    cfullum writes: the rules for double dipping have changed. You are now allowed to double dip. What?! Please tell us where you saw that in writing because it is news to me.

    Leslie: I am not familiar with the t-system you are referring to so I cannot answer your specific questions about that. I would be tempted to NOT allow a blanket "all others negative except where marked" if NOTHING ELSE was marked. I mean SOMETHING has to be positive - why is the patient here?

    Sorry I can't be more specifc. I gave it my best shot with my previous answer.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    I am in complete agreement with what Tessa has said in this post. If you have enough documentation in the HPI to crossover to the ROS (NOT DOUBLE DIPPING) then you can use those "extra" systems in the ROS to go along with the "all other" statement. Anyone who has Trailblazer as their carrier cannot use the "all other" statement. And to my knowledge, double dipping is NEVER ALLOWED.
    Lisa Bledsoe, CPC, CPMA

  5. #15
    Default
    Thanks Lisa and Tessa. That is basically what I needed to know. And Tessa, by the t-system, I only meant the t-sheets the providers use for ER visits. These have created quite a stir between the providers and HIM and I have brought this specific issue to them regarding the "all others negative" box without checking off anything else and all to no avail so this process of sharing the ROS and HPI notations (without double dipping) is what I needed to assure myself that I was still practicing properly according to the DG's, so thank again everyone

  6. Default
    I spent years using the T-System for an ER physicians group. We always operated under the premise that the 'gimme box' was only valid IF pertinent +/- were marked in the ROS section (regardless of what was included in the HPI). When our charts were audited by an outside auditing company, they supported our practice.

  7. Default
    I sent in a question about this to my local Medicare carrier, First Coast (FL). The specific question was:
    What is the acceptable verbage for documenting the remaining ROS that were checked but negative?
    Answer: All other systems negative.

    There is no mention that the number of systems reviewed has to be mentioned.
    adrianne, cpc

  8. #18
    Default
    Quote Originally Posted by abenson View Post
    I sent in a question about this to my local Medicare carrier, First Coast (FL). The specific question was:
    What is the acceptable verbage for documenting the remaining ROS that were checked but negative?
    Answer: All other systems negative.

    There is no mention that the number of systems reviewed has to be mentioned.

    I, too, asked the representative at an E/M conference sponsered by Highmark Medicare (Pennsylvania). They also said that it is was totally acceptable to mention positive ROS with the remainder of the 10-point ROS being negative. They also stated that I could use items from the HPI for my ROS and that they do not consider this double dipping. This last sentence is actually printed in the booklet that they gave out at the conference.

    Peggy

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