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Dx coding for Gastroparesis and Anorexia

  1. #21
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    Quote Originally Posted by fredcpc View Post
    Thank you for the workup. Nice. The ROS is Comp; and the PFSH is also Comp. So we have a detailed History.

    The DM and HTN are actually on follow up, but it may not make a difference in the MDM. But this leads to my real question.

    1) Which of the guidelines did you use to grade the HPI?

    2) What is your take on HPI as it relates to chronic problems and the 1995 guidelines? I feel good about some of my codes, but this is a shady area.
    I think that the doctor should have listed hip pain in his Impression statement, since it was part of the chief complaint; the same can be said about erectile dysfunction. That would have made their significance to this visit more obvious.
    I'm using whichever one has the # of elements (Location, Quality, Severity, etc.) - I count 4 that I'm confident about, which adds up to extended HPI. (I have an audit tool that doesn't specify 95 or 97 - either are acceptable) But I also think you've got 3+ chronic conditions - diabetes, ED, and HTN. Depending on how long ago surgery was, it may be chronic hip pain as well.

  2. #22
    Smile dx coding for gastroparesis
    Yeah, I like those audit tools. Wish I had one. But do the 1995 allow you to count chronic conditions or status on HPI? this is a really key area and will make difference in my EM levels. What is your take on this?

  3. #23
    Default
    Why does it have to be one or the other? Either rule is acceptable. But, apparently, I used 1995 guidelines:
    The HPI is a chronological description of the development of the patient's present illness from
    the first sign and/or symptom or from the previous encounter to the present. It includes the
    following elements:
    • location,
    • quality,
    • severity,
    • duration,
    • timing,
    • context,
    • modifying factors, and
    • associated signs and symptoms.
    Brief and extended HPIs are distinguished by the amount of detail needed to accurately
    characterize the clinical problem(s).
    A brief HPI consists of one to three elements of the HPI.
    !DG: The medical record should describe one to three elements of the present
    illness (HPI).
    An extended HPI consists of four or more elements of the HPI.
    !DG: The medical record should describe four or more elements of the present
    illness (HPI) or associated comorbidities.
    - 1995 Guidelines

    Mine is from Trailblazer, but I'm sure your local carriers have their own available online.
    (This is what mine looks like, in case you were curious.) http://www.e-medtools.com/Aqua_Medic...Worksheet.html

  4. #24
    Smile dx coding for gastroparesis
    Which guidelines you use does make a difference on your EM level. Here is something I just found on E/M university....

    Both the 1995 and 1997 E/M guidelines allow the HPI to be completed by using the so-called HPI elements which are used to further describe a specific somatic complaint (e.g. chest pain). In clinical settings where there is no such complaint from the patient, the 1997 E/M guidelines (but not the 1995 rules!) offer the option of completing the HPI by commenting on the status of chronic or inactive problems.

    Unless I am being overly analytical, we don't count the chronic histories with the 1995 Guidelines. Thoughts?

  5. #25
    Default
    No, I don't believe so, but the point is, you don't have to use only 1995 or 1997 guidelines specifically - either one is acceptable. I tend to use the 1995 guidelines, because they're just easier for me - it's a matter of personal preference, and the policies you have to follow. The 1997 guidelines added the status of 3 chronic conditions for situations like the one you mentioned. As long as you know how you got your code selection, you should be fine.

  6. #26
    Smile 1995 Guidelines
    The medical record should describe elements of the present illness (HPI) or associated morbilities (1995 guidlines)

    The medical record should describe elements of the present illness (HPI) or the status of atleast 3 chronic or inactive consitions (1997 guidlines).

    Like you, I started with a 1995 preference, the exams seem more realistic. But I am working my way back to 1997.

    Mahalo,
    Fred

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