Page 1 of 2 12 LastLast
Results 1 to 10 of 18

Ros -physician documents

  1. #1
    Default Ros -physician documents
    Exam Training Packages
    If a physician documents that he did a 10 point review of systems, otherwise negative...... and did not document which ROS he reviewed. Would you count a complete ROS? I don't think so, but would like some feedback.

    Thanks,
    Kristen
    Kristen Richard, CPC

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I wouldn't count it. There has to be some pertinent positives/negatives noted prior to using the freebie statement (that's what I call it). Also, since there are 14 systems, we need to know which 10 are reviewed...
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default
    Lisa (or anyone else for that matter), I am not sure if you can help me with this but I have a provider here that does that same thing on all of his ER t-sheets in the ROS section and he is driving me crazy. I was told by someone in this forum a while back that if there is no ROS other than the box being checked for the all systems reviewed, otherwise negative, that we could use some of the symptoms in the HPI section if needed (ex: if 10 things are reviewed in HPI, use 3-4 for the HPI and the rest for the ROS). Is that true, or did I misunderstand?

  4. #4
    Location
    Kansas City, MO
    Posts
    431
    Default
    If they are coming in for a problem...say chest pain, which is described in the HPI...isn"t it assumed that you can count this for ROS without having to redocument? So...if he then later, under a heading of "ROS", checks only a box that says "all systems reviewed, otherwise negative", he'd get full credit??
    I have a letter on CMS letterhead that says you do not have to document twice for the same system in HPI and ROS, that if the documentation is good, it is easily inferred that this sytem was reviewed.
    Seems logical to me...but I'd love to hear others thoughts on this.
    http://www.donself.com/documents/HPI.pdf

  5. #5
    Default
    I have always been told that counting a system within the HPI and also in the ROS is considered to be double dipping. I had posted a question a while back that questioned that exact same thing, and the answer that I got was counting an element in the HPI, for ex: Abdominal Pain, and then counting it as the Gastrointestinal system reveiwed in ROS, without documentation stating GI: Negative/Postive, is double dipping. I myself do not count it twice. If I count it in the HPI, then I do not count it in ROS, unless it is documented twice.

    As for the ROS (evil box). I do not utilize the T-system, so my physicians dictate and it is transcribed into a typed dictation. My initial question would construde as the same as the "evil box". The physician dictates ex: ROS: 10 systems reveiwed, otherwise negative.... Why cant that be counted the same as the "evil box"?
    Kristen Richard, CPC

  6. #6
    Default
    I am inclined to agree, Kristen, which is why the confusion I do think that it would be considered double dipping. I will read over that CMS document anyway and see what it has to say, but when it comes to E&M, I want to know about what multiple carriers think, not always just medicare, you know? I was taught to follow the audit tools but I also have been doing a lot of E&M training and I just can't seem to find difinitive answers on some of this stuff and I am finding that some of it is open to interpretation by different carriers and different coders.

    I don't see why I couldn't use 3 elements of the HPI for the actual HPI and the rest of the elements covered in the HPI for the ROS. It wouldn't be double dipping, as each one is only being used once, right? I can't seem to find anything in writing that says that I can't do it that way. The person in this forum that told me that I can do that is someone that I respect, admire and trust very much and I am inclined to just go with her on faith. I just wanted to get others' opinions on it.

  7. #7
    Default
    Quote Originally Posted by LTibbetts View Post
    I am inclined to agree, Kristen, which is why the confusion I do think that it would be considered double dipping. I will read over that CMS document anyway and see what it has to say, but when it comes to E&M, I want to know about what multiple carriers think, not always just medicare, you know? I was taught to follow the audit tools but I also have been doing a lot of E&M training and I just can't seem to find difinitive answers on some of this stuff and I am finding that some of it is open to interpretation by different carriers and different coders.

    I don't see why I couldn't use 3 elements of the HPI for the actual HPI and the rest of the elements covered in the HPI for the ROS. It wouldn't be double dipping, as each one is only being used once, right? I can't seem to find anything in writing that says that I can't do it that way. The person in this forum that told me that I can do that is someone that I respect, admire and trust very much and I am inclined to just go with her on faith. I just wanted to get others' opinions on it.

    That is correct. If I dont count it in the HPI, then most definetly, I will count it in the ROS. The only thing that I was stating is that if I do count it in the HPI, then unless it is documented twice, then you cannot count it. Its just so confusing, because you have 2 different out looks on the issue, and it makes it so your not sure. My initial question has kinda turned into a different question, which is ok, I like to get all kinds of feedback from fellow coders out there. As for the CMS guidelines, they are not specific to the ROS. So its hard to come up with a plan and stick to it. I appreciate your feedback, and would appreciate if you could send me anything you may find reg this issue. Thank you so much.
    Kristen Richard, CPC

  8. #8
    Location
    Milwaukee WI
    Posts
    4,466
    Default HPI vs ROS
    The fact that different carriers have different "rules" doesn't help this at all! (e.g. some do not allow the "all others reviewed and negative" statement AT ALL).

    HPI vs ROS ... a lot of providers lump everything in history into one big paragraph when they document.

    For illustration purposes let's all assume for a minute that we have a NEW patiient.

    You have to have 4+ HPI elements in order to get to the comprehensive or detailed history. Let's pretend that you have an HPI that read:
    Patient has had vascular malformation at the right axila since birth; large maroon-colored lesion is 3cm x 5cm and has been growing over last six months. Occasional pain and swelling of RUE, particularly after exercise. Had previous sclerotherapy in 2007 with minimal improvement; but lesion has grown back. Patient thinks it is now worse than it was before.

    You have more than 4 elements here. You can stop counting when you get to 4. IF you need more info for your ROS or past medical history you can take it from the parts of the above paragraph you didn't count as HPI. (e.g. pain and swelling could be counted as associated symptom, or used as ROS // sclerotherapy could be counted as a modifiying factor for HPI or could be counted as past medical history)

    Let's move on to ROS. The defnition of "double dipping" is somewhat nebulous. The most conservative would be that you can not count the same system in your ROS as in your HPI. So - for example - if your complaint is vomiting you can not count GI at all in ROS.

    Another interpretation is that you can count the same system, but not the exact same verbage. So if you have a complaint of vomiting, and your HPI mentions nausea and vomiting for 3 days you would need some other item applicable to the GI system to count for ROS (for example: tenderness, masses, constipation, diarrhea, etc).

    The most liberal interpretation is that you can count it if it is actually stated multiple times. So you could have: chief complaint vomiting / HPI vomited twice this morning; had nausea for past 3 days without fever or abdominal tenderness / ROS: GI: vomiting and nausea.

    Now back to the original post which was can you give credit for the statement "10 systems reviewed and negative." I say "no" - because there are 14 systems and this statement doesn't tell me WHICH of the systems the provider reviewed. Best to list them all individually -or- (if your provider allows) list the pertinent positive/negatives and state "all other systems reviewed and are negative." (Of course, you have to have actually reviewed all the systems.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  9. #9
    Default
    Thank you F Tessa. I really appreciate you taking the time to respond. This has always been a question for me, never really sure how to treat that statement. Thank you so much for clearing that up for. Have a wonderful day

    Kristen
    Kristen Richard, CPC

  10. #10
    Default
    Tessa, that does help clear up Kristens problem with the 10 systems reviewed question and it explains a lot for me as well about the different documentation, but in the matter of us using the t-system where I work, the box located in our ROS box simply states "all systems negative except those as marked" and they are checking this with nothing else whatsoever marked in the box. This is the case where I would like to use the leftover HPI elements for use in the ROS section, and am unsure. I believe that this is how it was initially explained to me, but I just want to make sure. We are having many dilemnas over this t-system and I would just like to have some back up for my case for future arguments, if possible.

Page 1 of 2 12 LastLast

Similar Threads

  1. Ros
    By valerie2424 in forum E/M
    Replies: 0
    Last Post: 04-08-2015, 08:45 AM
  2. Ros
    By selsal in forum E/M
    Replies: 1
    Last Post: 09-07-2011, 01:09 PM
  3. Ros?
    By ktden in forum E/M
    Replies: 1
    Last Post: 12-03-2009, 08:54 AM
  4. ROS: see ROS from (other document)
    By renifejn in forum E/M
    Replies: 3
    Last Post: 07-13-2009, 04:59 PM
  5. ROS Help!! What is proper language for ROS?
    By jvalntine in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 07-10-2009, 07:07 AM

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.