# E&M



## ktden (Oct 15, 2009)

I have just started coding E&M services and need help with some definitions.
Within the HPI, could someone give me a description of the terms:

1) location
2) quality
3) severity
4) duration
5) timing
6) context
7) modifying factors
8) associated signs and symptoms


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## RebeccaWoodward* (Oct 15, 2009)

B. History of Present Illness
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. HPI elements are:

Location. For example, pain in left leg;■■
Quality. For example, aching, burning, radiating;■■
Severity. For example, 10 on a scale of 1 to 10;■■
Duration. For example, it started three days ago;■■
Timing. For example, it is constant or it comes and goes;■■
Context. For example, lifted large object at work;■■
Modifying factors. For example, it is better when heat is applied; and■■
Associated signs and symptoms. For example, numbness.


http://www.cms.hhs.gov/MLNEdwebGuide/25_EMDOC.asp


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## mitchellde (Oct 15, 2009)

Good job Rebecca!  I like it.


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## ktden (Oct 15, 2009)

Great,
Thank you so much!!!!


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## FTessaBartels (Oct 15, 2009)

*Each element defined with a question*

*Location* - _Where_ - the site, is it diffuse, localized?

*Quality *- _What kind_ - sharp, dull, constant, intermittent

*Severity* - _How bad is it _- pain scale 1-10, mild, severe

*Duration *- _How long has it been present _- since yesterday, for 2 weeks, fell on Tuesday

*Timing* - _Is there a pattern _- every morning, continuous, repetitive

*Context *- _What Brings it on _- with exercise, when standing, noted on X-ray

*Modifying factors* - _What makes it better or worse _- better with Tylenol, Rx had no effect

*Associated Signs* - _What comes with it_ - other symptoms that accompany the chief complaint. 

Hope that helps
F Tessa Bartels, CPC, CEMC


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