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ROS-all systems negative

  1. Default ROS-all systems negative
    Medical Coding Books
    How are you supposed to calculate the ros when the doctor only check marks the all systems negative box and there is nothing that we can take from the HPI section? It this calculated to as no ROS ?

  2. Default
    That would be counted as a complete review of systems, you would take the statement "all systems negative" to mean that all systems were reviewed and they are all negative. I hope this helps.

    Christine Cruz, CPC
    Professional Billing
    Last edited by cmcruz; 03-22-2011 at 05:52 PM.

  3. Default
    from what i was taught you cant consider this to be a complete ros when the box is the only thing checked marked. I have read other posts within aapc and that is what everyone else says along with the aapc book on E&M coding that there has to be at least positive and negative system checked. I am just not sure how to calculate this when the physician has not marked any positive or negative systems that he reviewed. Only the box is checked marked......??? any help would be appreciated.

  4. Default
    Quote Originally Posted by littlebit29 View Post
    from what i was taught you cant consider this to be a complete ros when the box is the only thing checked marked. I have read other posts within aapc and that is what everyone else says along with the aapc book on E&M coding that there has to be at least positive and negative system checked. I am just not sure how to calculate this when the physician has not marked any positive or negative systems that he reviewed. Only the box is checked marked......??? any help would be appreciated.
    It is a counted as a full review of systems. You said there had to be at least one positive and negative system checked. Well, if ALL SYSTEMS reviewed and are NEGATIVE, how do you think there is going to be a positive if all are negative?

  5. #5
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    Quote Originally Posted by littlebit29 View Post
    How are you supposed to calculate the ros when the doctor only check marks the all systems negative box and there is nothing that we can take from the HPI section? It this calculated to as no ROS ?
    Is this a complete PE? No complaints? If this was a problem oriented visit, it seems that there would be a least one positive or is this mgmt of chronic conditions? What's the CC?

  6. Default
    According to the other posts in the forums alot of ppl are saying that this is not a complete ros when the only thing that is checked marked is the box. I looked online at other sites and I also looked in the AAPC study guide and it all states :
    E/M University Coding Tip: When documenting the ROS , it is not necessary to list each system individually. It is acceptable to document a few pertinent positive or negative findings and then say: “All other systems were reviewed and are negative.” in the aapc book its states that a complete ros is the positive and negative responses for all additional body systems related to the problem at least 10 systems must be noted.

    </EM>So now i am getting confused because alot of the other posts say you cant count the box as complete ROS and now i am being told it is a complete ros??? So how do i calculate this when it is just the box that is checked marked and i cant pull any information from the hpi??oh and this is for the ER E&M codes 99281-99285.

  7. Default
    The other posts on here say that checking the box is not enough for a complete because what systems were reviewed and negative.????

  8. #8
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    North Carolina
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    I understand your concern and it's a valid one. I have an issue with simply checking a box notating "all systems negative" when there must be a reason they are presenting to the ER. If there isn't any information in the HPI to work with, I would not allow this statment...but that's just me.

  9. Default
    It is a complete review of systems. When I was preparing for the CEMC exam last fall the practicum exam had this same scenario and the rationale was if it is documented all system are negative then it is counted as a complete ROS.

    Diane Bazuin, CPC, CEMC

  10. #10
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    Quote Originally Posted by littlebit29 View Post
    According to the other posts in the forums alot of ppl are saying that this is not a complete ros when the only thing that is checked marked is the box. I looked online at other sites and I also looked in the AAPC study guide and it all states :
    E/M University Coding Tip: When documenting the ROS , it is not necessary to list each system individually. It is acceptable to document a few pertinent positive or negative findings and then say: “All other systems were reviewed and are negative.” in the aapc book its states that a complete ros is the positive and negative responses for all additional body systems related to the problem at least 10 systems must be noted.

    </EM>So now i am getting confused because alot of the other posts say you cant count the box as complete ROS and now i am being told it is a complete ros??? So how do i calculate this when it is just the box that is checked marked and i cant pull any information from the hpi??oh and this is for the ER E&M codes 99281-99285.
    There are many talented and experienced coders who post on this board, and I have off-line discussions with several of them quite frequently. That having been said, there are a number of posts from coders who tell us, "this is what I do". As a professional coder, it is your reponsibility to research the documentation guidelines and use them as the basis for your standardized coding process. Consultants and other coders may certainly give their opinions, but the DGs really must take precedence. E&M University (Peter Jensen...and I talk to him all the time) is a consultant who provides recommendations. The AAPC study guide is just that....a guide. And even years ago, when I took the CPC exam, it was a known fact that CMS and the AAPC coding guides didn't necessarily agree...but the AAPC won't fine you if you make a coding error. I recommend you use only regulatory guidance to support your coding policy, not just comments from this board. The best responses you'll get from this discussion board are the ones that point you directly to the regulatory guidance. This is from the 1995 CMS guidelines:

    A complete ROS inquires about the system(s) directly related to the problem(s) identified in theHPI plus all additional body systems.
    DG: At least ten organ systems must be reviewed. Those systems with positive or
    pertinent negative responses must be individually documented.
    For the
    remaining systems, a notation indicating all other systems are negative is
    permissible. In the absence of such a notation, at least ten systems must be
    individually documented.

    What this tells us that simply checking off 'all others negative' is inappropriate, because CMS requires us to document pertinent positives and negatives. Exclusion of this documentation constitutes no system review.
    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

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