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ROS vs HPI

  1. #1
    Exclamation ROS vs HPI
    Exam Training Packages
    I am confused regarding HPI. Last year during an E&M webinar the instructor stated that "HPI is not a negative finding. Remember that HPI is a symptom - so how can it be a negative finding." Last week I attended another webinar and that instructor stated that HPI can be a negative or positive. Which way is correct?

  2. #2
    Location
    Kansas City, MO
    Posts
    431
    Default
    I'm with you. I was always taught the same thing. The HPI is what the patient says about their illness "my left leg hurts when I run, and motrin is not helping". When I see "no right leg pain, no swelling, no warmth, no redness" then I know these are responses to what the doc is asking.

    The same thing came up in a seminar I was in (given my our local Medicare carrier) and I questioned it. To my suprise, I seemed to be in the minority in the room.

    I'd like some better examples of negative responses for an HPI.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Negative HPI
    I DO give credit for negatives for associated signs/symptoms.

    I recently saw my physician due to recurring headache. I described my problem as a "typical sinus mask headache, mostly around the right eye/cheek, since last Tuesday, but without any sinus drainage or post nasal drip, no fever, or other symptoms of usual sinus infection. Have taken some Tylenol when the pain gets to where I can't just ignore it; that works for a few hours, but the headache comes back."

    This was exactly how I myself (the patient) described it to the physician. I described the typical "associated signs/symptoms" as negative without any prompting from the physician.
    So I'd give credit for 4 HPI elements for the above: location, duration, assoc signs, modifying factors. But I would have given credit even if she had had to ask me about this to elicit the information.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Kansas City, MO
    Posts
    431
    Default
    I have this history dictation guide hanging on my wall. I don't know where I got it, but it says under assoc. signs and symptoms that this should be "other things or issues associated with or accompanying the problem." and then at the end of the example statements it says "if patient is responding to Physician questions mark ROS, if the patient offers the information mark HPI"

    Most patients are NOT in the medical field, and would not offer up the clear HPI like you did. Who gives the best HPI's? Well E/M coders of course.

    I still don't agree.
    Guidelines say:
    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.


    Iif something is non-existent...how is it a symptom?
    I am not trying to argue with you...I really want to understand...like I said before, I realize many people give negative responses credit. There's a good possibilty I may be wrong...I'm just not convinced yet.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  5. #5
    Default
    CC. Chest pain

    HPI. Pt complains of chest pain for 2 hours, crushing in nature and pt feels short of breath.

    Location, Duration, Quality, Associated Signs and Symptoms

    CC. Chest pain

    HPI. Pt complains of chest pain for 2 hours, crushing in nature but pt denies shortness of breath.

    Location, Duration, Quality, Associated Signs and Symptoms.

    As long as it is a pertinent negative response WPS Medicare says it is correct to count it for HPI.

    Another example.

    CC. Leg pain

    HPI. Pt complains of Rt leg pain that is throbbing in nature for 2 days, fell down the stairs.

    Location, Quality, Duration, Context

    CC. Leg pain

    HPI. Pt complains of Rt leg pain that is throbbing in nature for 2 days, no known injury.

    Location, Quality, Duration, Context.

    Hope this is helpful,

    Laura, CPC , CPMA, CEMC

  6. #6
    Default
    Laura,
    Can you please tell me where you found the information from WPS? I was unable to find that.
    Thanks,
    Ann

  7. #7
    Default Pertinent negative response is the key!!!
    Quote Originally Posted by LLovett View Post
    CC. Chest pain

    HPI. Pt complains of chest pain for 2 hours, crushing in nature and pt feels short of breath.

    Location, Duration, Quality, Associated Signs and Symptoms

    CC. Chest pain

    HPI. Pt complains of chest pain for 2 hours, crushing in nature but pt denies shortness of breath.

    Location, Duration, Quality, Associated Signs and Symptoms.

    As long as it is a pertinent negative response WPS Medicare says it is correct to count it for HPI.
    Another example.

    CC. Leg pain

    HPI. Pt complains of Rt leg pain that is throbbing in nature for 2 days, fell down the stairs.

    Location, Quality, Duration, Context

    CC. Leg pain

    HPI. Pt complains of Rt leg pain that is throbbing in nature for 2 days, no known injury.

    Location, Quality, Duration, Context.

    Hope this is helpful,

    Laura, CPC , CPMA, CEMC

    I agree with Laura and with Tessa. The key here is "pertinent" negative responses. There are times when a person has CC but doesn't have all the symptoms that normally go "hand in hand" with the condition.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  8. #8
    Default
    http://wps.mediasite.com/mediasite/V...6b6fa17fe2771d

    This is an education. Info you want is on slide 29 but she says it at approx 01:05. So if you skip forward to slide 29 you just have to listen for about a minute. I have been thru this education 2 times on the phone conference and once in person. This is always the response.

    Laura, CPC, CPMA, CEMC

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