# Er 99281/no ros done



## Networker3412 (Apr 9, 2010)

can anyone help me with this? We code the E&M levels for the physician in the hospital i work at and we are told that when the physicians do not write anything in the ROS and they do not check mark the box "all systemss neg" that we are to code this as 99281? can anyone tell me if this is correct? thanks


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## mitchellde (Apr 9, 2010)

I would agree with this.  That would make the history focused and since all three key components are required to met or exceeded, then the visit drops to the lowest component which makes it a 99281.


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## Networker3412 (Dec 6, 2010)

Can the ROS be documented by the nurse? If the physician does not document the ROS can we query him about it?


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## PURNIMA (Dec 9, 2010)

Hi,

For an ER Visit, we can double dip with HPI for ROS, and again if we dont find any ROS and the account is really warranting for a higher level, we can pend the record and ask for ROS.

If in case we dont get the response, we need to downcode the chart.

Hope this helps you...

Thanks,

Purnima S




littlebit29 said:


> can anyone help me with this? We code the E&M levels for the physician in the hospital i work at and we are told that when the physicians do not write anything in the ROS and they do not check mark the box "all systemss neg" that we are to code this as 99281? can anyone tell me if this is correct? thanks


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## mitchellde (Dec 9, 2010)

PURNIMA said:


> Hi,
> 
> For an ER Visit, we can double dip with HPI for ROS, and again if we dont find any ROS and the account is really warranting for a higher level, we can pend the record and ask for ROS.
> 
> ...


Just curious.  Where is it stated that you can double dip with HPI and ROS in the ER?  I have never heard of this before.


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## preserene (Dec 9, 2010)

Yes I am also very curious  and not convinced about the double dipping HPI and ROS
By the way, as regards nurse doing the job, HPI elicitation can be helped out by the nurse but not the ROS


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## liny (Dec 10, 2010)

*down code*



preserene said:


> Yes I am also very curious  and not convinced about the double dipping HPI and ROS
> By the way, as regards nurse doing the job, HPI elicitation can be helped out by the nurse but not the ROS



Remember it takes the History  Exam and Medical decsion making to reach a level
and yes you can take from the HPi for ROS


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## ivorytofu@hotmail.com (Dec 11, 2010)

Yes, you can take ROS from HPI. So remember you always have at least 1 ROS because it comes from the HPI, assuming your EDP at least restates your CC in the HPI. All you need for 99283 is one ROS.  Do you have an auditing tool?  

I know someone used the term "double-dipping" but this is not considered to be "double-dipping from HPI to ROS.   Double-dipping actually means that a coder cannot use 1 statement to count as 2 elements with the same component. 

Example:   

CC: Chest pain

HPI:  Chest pain started at 7pm. Chest feels tight.

you cannot use *tight* for both *Quality* and *Context *or *7pm* for both *Duration* and *Timing*.

Hope this helps.


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## ivorytofu@hotmail.com (Dec 11, 2010)

Here is a link from ER coder about "double dipping"

http://http://www.ercoder.com/discussion/topic.php?id=17


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## preserene (Dec 11, 2010)

History of Present illness and ROS- only for Scoring purpose

By definition HPI is the  description of the development of current illness (eg) date of onset ,how long it persists ,duration, when it get worst and whether radiating and so on and so forth. It is described by the patient; the provider must personally document. 
Review of Systems is questions made BY THE PROVIDER and made to the patient to identify signs and symptoms  that are operating in the systems of the body or being experienced in relation to the HPI. 
The review of systems  are systemwise elicitation(BY THE PHYSICIAN) with relevance to the CC, HPI and still other factors the physician elicits out of /finds out of the cumulative effect  he obtained from the other elements. Though it can be obtained from CC and HPI to merit to ROS credits, the HPI cannot replace the Review of the various systems of the body which are authentically said to be reviewed by the Physician.
1.	What I would like state is that the ROS  can not be made up by us(the coders) by picking up from the HPI or CC or from here and there and place it for ROS scoring purpose; the ROS scores should be already made up and documented by the Physician, meaning, it isstandardised by her/him  and already existing entity from her/him, whether s/he made it up from the CC or HPI, it is her/his responsibility to do so to complete it from anywhere,for which she /he is responsible. (For the Review of Systems, the physician can refer a sheet that he has in the patients chart where the physician checked off items)...

But now, what I understand from your threads, for scoring purpose of the review of systems (ROS), use of  the system(s) addressed in the HPI for ROS credit can be acceptable; Well this cannot be said as double dipping. Is that you mean? Or are you trying to convey that from the document provided we can pick up some of the HPI and/CC and credit them for ROS merits for scoring purposes? Is that you mean?
This is the way I look into it. Can you consolidate all my facts supplied here and enlighten me what all the cook ups, breakups and make ups we can do and what all the provider could do sothat the document and the scoring system can tally each other, (with all its realities) which are legal and correct.


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## jdibble (Dec 13, 2010)

According to Highmark Medicare services elements from the HPI can be used to in the ROS.  Under their frequently asked questions they state the following:

_When scoring the review of systems (ROS), can you use the systems addressed in the history of present illness (HPI) elements or is that "double dipping"?

ROS inquiries are questions concerning the system(s) directly related to the problem(s) identified in the HPI. Therefore, it is not considered "double dipping" to use the system(s) addressed in the HPI for ROS credit.

Date Posted: 10/16/2009, Date Revised: 08/30/2010_

Also, in regards to using the nurse's documentation for the ROS - yes that can be used as long as the doctor has documented that he has reviewed the information and where the information is located in the chart.  Medicare allows the PFSH and the ROS to be documented by ancillary staff or by the use of forms completed by the patient, but this information has to be sent with the notes if the chart is being audited.

Hope this helps. 

Thanks,


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