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Can you get 4 in this HPI??

  1. #1
    Default Can you get 4 in this HPI??
    Medical Coding Books
    68 Y/O female presents with abdominal pain since 4:00 am yesterday afternoon. She complains of pain located in the periumbilical area with localization to the RLQ. She reports a normal bowel movement but has been dealing with constipation for several weeks. She denies any nausea or vomiting, but does complain of some belching, which is new for her. She has no fevers/chills/sweats. She does have a history of similar symptoms last week, which have resolved spontaneously.

    This is what I can come up with, any additional help is greatly appreciated!

    location--abdominal pain

    timing--yesterday afternoon

    associated S&S--belching/constipation

    Could I use belching or the constipation as a location, or just keep it with signs and symptoms?

    I am not sure what else I could use.

    Thanks again for your help!

    Peggy

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Hpi
    Location - "Where is it" - site, diffuse, localized
    Quality - "What kind is it" - sharp, dull, constant
    Severity - "How bad is it" - pain scale 1-10, mild, severe, worsening
    Duration - "How long" - length of time it has been present
    Timing - "Is there a pattern" - continuous, repetitive, relation to something else.
    Context - "What brings it on" - does it occur with a specific activity
    Modifying Factors - "What makes it better or worse" - treatments tried
    Assoc. Signs/Symptoms - "What comes with it" - other symptoms that accompany the main complaint.

    In your example you have Location (abdomen), Duration (yesterday), Assoc signs/symtpoms (belching /constipation).

    I'd be willing to listen to arguments that would give credit for Modifying Factors since a previous episode "spontaneously resolved." I am conflicted about giving credit for that.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default
    Thanks for responding Tessa! That is what I thought that I could only get 3 HPI. She is a Medicare patient, guess this now a subsequent hospital code.

    Peggy

  4. #4
    Default
    I agree, I only see 3

    Location - abdomen
    duration - since yesterday
    ass. signs and symptoms - belching and constipation

    too bad the provider didn't mention the severity or quality of the symptoms...

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Hospital admission?
    Quote Originally Posted by coder25 View Post
    Thanks for responding Tessa! That is what I thought that I could only get 3 HPI. She is a Medicare patient, guess this now a subsequent hospital code.

    Peggy
    So this is an H&P? I would use the 99499 unlisted E/M code and base my price on 99221. This is the specific guidance given by our Medicare carrier in Wisconsin - WPS.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Default
    Yes Tessa,

    This is an H&P, however, by our webinar conference with Highmark Medicare Services, they do not want us to use the unlisted code. They stated that we had to use the subsequent hospital codes, even for the admissions and for consultations.


    Peggy

  7. #7
    Default Additional HPI
    Why wouldn't anyone count constipation as context - what 'may' cause the problem?

    Location - abdomen
    Duration - since yesterday
    Context - constipation
    Associated S/S - belching

    Schawn Pedersen, CPC, CEMC

  8. #8
    Location
    Dover Seacoast New Hampshire
    Posts
    1,970
    Default
    I would give 'quality' for normal BM, and 'duration' for several weeks of constipation. With abdominal pain for the location, and 4:00 for timing, you have four histories. ROS: GI and Constitutional.


    I would argue a level four, with a clear conscience!
    Last edited by Pam Brooks; 04-12-2010 at 09:31 AM.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  9. #9
    Location
    Garden State Chapter, Cherry Hill, NJ
    Posts
    23
    Default HPI elements
    68 Y/O female presents with abdominal LOCATION pain since 4:00 am yesterday afternoon DURATION.
    She complains of pain located in the periumbilical area with localization to the RLQ LOCAITON.
    She reports a normal bowel movement but has been dealing with constipation ASSOC'D SIGNS/SYMPT for several weeks DURATION.
    She denies any nausea or vomiting ASSOC'D SIGNS/SYMPT, but does complain of some QUALITY belching ASSOC'D SIGNS/SYMPT, which is new for her.
    She has no fevers/chills/sweats. ASSOC'D SIGNS/SYMPT
    She does have a history of similar symptoms last week, which have resolved spontaneously. TIMING (pattern of wirsening/imporving)

    Y - LOCATION
    Y - QUALITY
    N - SEVERITY
    Y - DURATION
    Y - TIMING
    N - CONTEXT
    N - MODIFYING FACTORS
    Y - ASSOC'D SIGNS/SYPT

    This is just my opinion... hope it helps!

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