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3 chronic illness = automatic 4 HPI

  1. #1
    Default 3 chronic illness = automatic 4 HPI
    Medical Coding Books
    3 chronic illnesses = an automatic 4 HPI, is this the standard for 95 and 97 guidelines?


  2. #2
    Per 97 guidelines: an extended HPI consists of at least 4 elements of the HPI or the status of at least 3 chronic or inactive conditions.
    Per 95 guidelines: an extended HPI consists of 4 or more elements of the HPI. The medical record should describe four or more elements of the present illness (HPI) or associated comorbidities.
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  3. #3
    It also depends on the carrier.

    Mine has said you can count the status of 3 chronic conditions whether you are using 1995 or 1997 guidelines.

  4. #4
    Smile Status
    "Status" is the key to this. Make sure it is more than a list of 3 ccs. This link to the CMS-approved Highmark Medicare audit form allows for either or. Though I have seen the argument that if you use the 3 cc to support a comprehensive HPI you must adhere to the 97 DGs (bulleted) examinations, I don't know that to be 100% true. It makes sense, but currently it's an either/or situation and, I think, open to interpretation.

    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

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