# HPI no pain



## medicalsec (Oct 12, 2010)

I have some confusion regarding the HPI. All of the examples seem to relate to various aspects of pain.  If the patient has a lump/lesion without pain can the fact that this is a description of the problem count in the quality category. Also can the size of something count in the severity area. Lets say that the patient has a 5 cm lesion.

Does anyone have a site that gives more examples of HPI documentation (not so traditional examples). I have no problem if it is a painful situation, but we also treat lumps and bumps which require surgery, and they are not always painful, but we are discussing size, description lump/lesion. It is not always so clear if we are meeting the comprehensive category when the rules do not seem to clarify conditions that are described that are not painful.


Thanks,

Dee


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## LewinFamily (Oct 12, 2010)

Yes you can use the diameter for severity. 

Here is a link that I sometimes use that explains a few more example of the HPI components.

http://www.supercoder.com/articles/...-requirements-to-curtail-underpaid-em-claims/


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## MikeEnos (Oct 13, 2010)

Thanks for that link - I thought the article was very interesting. I fully agreed with the HPI portion.  I was also interested in the part about the 'myth of double dipping' 

To answer the question, sometimes you do need to be a bit creative and think outside of the box, but you should be able to give credit to your doctors even though there is not always pain involved (although I agree, it does seem that the HPI elements are often geared towards describing pain-related illness/injires.)  The diameter could be considered severity.  Any adjective used to describe the lump could be quality.  Of course breast could be location.  When did they first notice it? That could be duration.  You could easily document presence or abscence of  associated signs and symptoms.  There might have been some modifying factors involved, or even context.  Timing might be a bit difficult in your situation, but I see no reason why you shouldn't be able to get 4 of the HPI elements.


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## medicalsec (Oct 13, 2010)

Thanks so much for both replies. I am now also confused about the "double-dipping." Do you feel that the statement is accurate.

Thanks,


Dee


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## jdibble (Oct 13, 2010)

Hi Dee -

In answer to your question about "double-dipping" I agree with the statement in that article.  Our MAC, Highmark Medicare Services, has instructed us that it is not considered double dipping as long as you are not using it for the different body areas of the ROS or elements of the HPI, but you can use say chest pain for the HPI as location and as cardio under ROS.  They say that it is all considered part of the collection of the History and can be used as such for both without double dipping.  

You may want to double check with your carrier as to their take on this!

Good Luck!


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