# Help with HPI elements



## jenngar (Jul 25, 2017)

I am struggling with picking out HPI elements when the provider doesn't just "spell it out" for me.. I don't know why I am having such a hard time and unfortunately the compliance/auditor that I work with isn't very helpful.  Can you please tell me which HPI elements that you see in this blurb:

_History of Present Illness 
Cardiology:  
       Notes: . The patient is here for yearly followup for her polyvalvular heart disease as noted below. The patient thinks that she doing well and really does not have any particular complaints. She has a manual exercise treadmill that she still uses and alternates that with a stationary bike. She says she tries to exercise 3 or 4 days a week, sometimes more, sometimes less. She and her husband continue to do all of the yard work and household chores and she doesn't really think that that is a struggle. She only admits that it takes him longer to do the things they do but they still get done. She denies any issues with dyspnea with exertion, she can climb stairs, carrying groceries and things of that nature without having to stop to rest. She doesn't recognize any great change in her tolerance for the things that she has to do around the house and/or the exercise.
        She said she took her blood pressure couple times today and it was pretty bearable, once it was high side and again a recheck was on the low side. When I checked her blood pressure myself shows 160/90 and she says that it is highly unusual but she does admit that she has been "cheating a little bit" and in particular sodium intake may be higher lately. She is going to pay more attention to that. Last available laboratories that were done and are from 4/11/17 and was just a basic metabolic panel. _ 

To me it reads like the patients medical history and not necessarily the reason the patient is there for a visit.

Any help would be greatly appreciated!

Jenn


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## shypearce@gmail.com (Jul 25, 2017)

HPI ( History of present Illness) patient is not presenting with a problem. This is a annual wellness visit HPI: AWV, use appropriate ICD 10 code/Medicare Code. Ex: Z00.00/G0438


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## jenngar (Jul 25, 2017)

This wasn't an AWV.. this was a cardiology office visit.


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## Narasimhareddysegai (Jul 28, 2017)

*HPI Elements*



jenngar said:


> I am struggling with picking out HPI elements when the provider doesn't just "spell it out" for me.. I don't know why I am having such a hard time and unfortunately the compliance/auditor that I work with isn't very helpful.  Can you please tell me which HPI elements that you see in this blurb:
> 
> _History of Present Illness
> Cardiology:
> ...










You Can Pick, Elements Here Are Context,Location,Modifying Factor and Associates Sign and Symptom, I think It will Help You


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## thomas7331 (Jul 28, 2017)

I agree with you that most of this is ROS and PFSH, not HPI.  What you really have for HPI is "_here for yearly followup for her polyvalvular heart disease as noted below. The patient thinks that she doing well and really does not have any particular complaints_" which is the status of one chronic condition.  Everything that follows is could be squeezed into the HPI elements if you try, but it doesn't really meet the definition of what an HPI is.  

Since this is a follow-up visit, I'd usually try to get the code level from the exam and MDM as the two out of three elements.  Some coders will try to pick out HPI elements from all of this, and if you can do it and feel like you can explain your choices and defend them in an audit, that's fine, but I personally prefer not to take that approach.  It may sound like heresy to say so, but I've found over the years that payer auditors are generally more concerned with whether or not the level of care is appropriate for the severity of illness of the patient than they are about how you count the elements of the HPI.


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## Narasimhareddysegai (Jul 28, 2017)

I also Agree With u, One Can Consider Here are Status of Chronic Condition, Which Would Be Considered as Brief Hx.


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## jenngar (Jul 31, 2017)

thomas7331 said:


> I agree with you that most of this is ROS and PFSH, not HPI.  What you really have for HPI is "_here for yearly followup for her polyvalvular heart disease as noted below. The patient thinks that she doing well and really does not have any particular complaints_" which is the status of one chronic condition.  Everything that follows is could be squeezed into the HPI elements if you try, but it doesn't really meet the definition of what an HPI is.
> 
> Since this is a follow-up visit, I'd usually try to get the code level from the exam and MDM as the two out of three elements.  Some coders will try to pick out HPI elements from all of this, and if you can do it and feel like you can explain your choices and defend them in an audit, that's fine, but I personally prefer not to take that approach.  It may sound like heresy to say so, but I've found over the years that payer auditors are generally more concerned with whether or not the level of care is appropriate for the severity of illness of the patient than they are about how you count the elements of the HPI.



Thank you. It's hard to figure stuff out on your own when your experience is limited.  I appreciate everyone's help.


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## twizzle (Jul 31, 2017)

jenngar said:


> I am struggling with picking out HPI elements when the provider doesn't just "spell it out" for me.. I don't know why I am having such a hard time and unfortunately the compliance/auditor that I work with isn't very helpful.  Can you please tell me which HPI elements that you see in this blurb:
> 
> _History of Present Illness
> Cardiology:
> ...



Now, this is a classic example of why the possible revamp of the E&M DG's in 2018 would be such as great idea. Everyone is trying to pick out something....anything, to get elements of an HPI so the provider can get paid a certain amount of $$$$. We're just looking for a word here, a word there. It really shouldn't be this way. If the selection of an E&M LOS is based solely on the MDM/medical necessity....Alleluia. Isn't that what medicine is all about? 

How sick is my patient and what do I need to do to make them better? Not, 'I need to document certain words' or 'I need to make sure I mention that the patient's grandmother passed away from an AAA at age 93'.

Roll on 2018 and let this nonsense stop.


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## avon4117 (Jul 31, 2017)

twizzle said:


> Now, this is a classic example of why the possible revamp of the E&M DG's in 2018 would be such as great idea. Everyone is trying to pick out something....anything, to get elements of an HPI so the provider can get paid a certain amount of $$$$. We're just looking for a word here, a word there. It really shouldn't be this way. If the selection of an E&M LOS is based solely on the MDM/medical necessity....Alleluia. Isn't that what medicine is all about?
> 
> How sick is my patient and what do I need to do to make them better? Not, 'I need to document certain words' or 'I need to make sure I mention that the patient's grandmother passed away from an AAA at age 93'.
> 
> Roll on 2018 and let this nonsense stop.



YES i was reading this article the other day and this would be the best EM change ever.


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## jenngar (Aug 1, 2017)

Yes, I agree.  I was actually just reading about them revamping the E/M coding guidelines.  It sounds like it would be more cut and dry instead of having all kinds of gray areas that just confuse everyone.


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