AAPC - Back to school
Results 1 to 4 of 4

Thread: Double Dipping with ROS?

  1. #1
    Join Date
    Apr 2007
    New Port Richey & Gulf to Bay

    Question Double Dipping with ROS?

    AAPC: Back to School
    I have confusion regarding the review of systems. I am a new coder, having almost a year of actual coding experience. Let me say the real world is nothing what school had pictured! My manager had saw my proficiency with E&M coding, and has been grooming me for our current system wide audit.

    I was originally taught that a symptom being used in the HPI, can not be used in review of systems. This example is from an actual case.

    "Patient is here with a skin infection." Then in the ROS, the physician only states "Generally feeling well, no other skin complaints." That statement only has me giving credit for for constitutional.

    We currently have a consultant come on board to help provide physician education. The consultant has cited me for not selecting the "No other skin complaints." I told him my reasoning was that I was instructed it was double dipping. I understand his side, that the skin is our largest organ, and multiple concerns can errupt.

    Another incident, the physician stated "No drug allergies". The consultant said I should use that for ROS, if there aren't any ROS available. I consider that a part PFS history, and another EM coder has agreed.

    Can anyone give me some insight on this situation? I am confused that I could be undercoding or potentially overcoding. Is the consultant's view double dipping, or should I get some more of that dip? Thank you all for your time!

    Respectfully Yours,
    Kevin P. Honig, CPC-A

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default NOT double dipping

    You ask good questions. That's how you will learn.
    "Double dipping" refers to using the exact same words for more than one bullet.
    Example from your scenario has skin mentioned TWO times. Once in the HPI, and again when there is the statement "no other skin complaints." So this is NOT double dipping to count these two separate statements, one for HPI and one for ROS.
    However, I hope you have yet another statement for the chief complaint, because if you don't then the "patient here for a skin infection" is your CC and I wouldn't count that as HPI.
    As for "no drug allergies" - one of the systems is Immunologic/Allergic, so, yes, I would count that as ROS. But you could count it as Past Medical History. The important thing is where do you need the check mark?
    You are, indeed, lucky if you have a provider who clearly defines each area of history and hits all the bullet points. In reality many providers lump all this information together without clear "headings" so we coders are left to decipher what is HPI, what is ROS, what is PFS. Fortunately the guidelines allow us leeway in counting the bullet points based on the words in front of us, as long as we don't count any specific word (or phrase) in satisfying more than one bullet.
    If you haven't already signed up for emuniversity.com that might be a great resource for you.
    Good luck, Kevin, you seem to be on a path to success.
    F Tessa Bartels, CPC, CPC-E/M

  3. #3
    Join Date
    Apr 2007
    New Port Richey & Gulf to Bay

    Red face Thank you!

    Thank you for the quick response. So we can use the body system that is related to the HPI and Cheif complaint? Just as long as it is documented twice in the encounter?

    Respectfully Yours,

  4. #4
    Join Date
    Apr 2007
    Greeley, Colorado


    Yes - as lont as it is noted twice...
    I totally agree with everything FTessaBartels said!
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. Double Dipping or not?
    By tony1sue in forum E/M
    Replies: 0
    Last Post: 03-29-2013, 11:53 AM
  2. HPI and ROS Double Dipping
    By mony94803 in forum Auditing General Discussion
    Replies: 4
    Last Post: 01-23-2013, 05:02 PM
  3. Double Dipping HPI/ROS
    By Love Coding! in forum E/M
    Replies: 6
    Last Post: 02-15-2012, 11:54 AM
  4. double dipping?
    By solocoder in forum E/M
    Replies: 1
    Last Post: 11-01-2011, 09:50 AM
  5. HPI-ROS "double dipping" question
    By MnTwins29 in forum E/M
    Replies: 1
    Last Post: 05-17-2010, 04:42 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.