I tend to count each element only once, however I have heard that certain payers will recognize each location as a separate element of HPI.
I'd be inclined to do this if there were SEPARATE problems. For example a rash on the arm, and a sprained ankle (then I could be persuaded to count TWO bullets for location).
I would count the example you give as 3 HPI elements: Location, duration, modifying factors
Hope that helps.
F Tessa Bartels, CPC, CEMC
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