AAPC - Back to school
Results 1 to 4 of 4

Thread: 3 chronic illness = automatic 4 HPI

  1. #1

    Default 3 chronic illness = automatic 4 HPI

    AAPC: Back to School
    3 chronic illnesses = an automatic 4 HPI, is this the standard for 95 and 97 guidelines?


  2. #2
    Join Date
    Apr 2007


    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

  3. #3
    Join Date
    Apr 2007
    Chicopee, MA


    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
    Join Date
    Apr 2007
    Albany, NY

    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.


Similar Threads

  1. HPI Elements for Chronic Conditions
    By karlam in forum E/M
    Replies: 1
    Last Post: 08-05-2013, 01:10 PM
  2. Replies: 3
    Last Post: 07-28-2011, 01:09 PM
  3. HPI status of chronic conditions
    By crberman in forum E/M
    Replies: 4
    Last Post: 09-07-2010, 07:43 AM
  4. HPI 1 chronic stable 95 guidlines
    By mpfaff in forum Auditing General Discussion
    Replies: 1
    Last Post: 06-22-2010, 01:17 PM

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?


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.