# modifying factor - can we consider modifying



## abhishekrane32@yahoo.com (Nov 17, 2012)

can we consider modifying factors in following scenarios

1.  dyspnea on exertion

2. pt feels dizziness on standing

3. arm pain is resolved after after reduction of humerus fracture

please help.
Abhishek rane. CPC


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## Naveen Rachagolla (Nov 17, 2012)

Modifying factor : The patients statements regarding anything that makes the problem better or worse . For example.* that it improved with Tyleno*l, *worse when the patient was standing*, *better when she was resting*, *sitting somewhat helped him*, and *using a pillow gave her relief*.

*Yes you can count exertion, standing and reduction of humerus fracture as the Modifying  factors*


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## FTessaBartels (Dec 14, 2012)

*Disagree*

CONTEXT

"on exertion" and "on standing" are examples of context.

Your last example "resolved after reduction" ... IS modifying factors.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## MikeEnos (Dec 16, 2012)

I agree with everyone so far.... those phrases could be considered modifying factors, or context.  You could also count "on exertion" or "on standing" as Timing... that's when the chief complaint occurs.  

There are many things that you could count as Timing, Modifying Factors, or Context.  There are many things that you could consider to be Severity or Quality (patient fell on his elbow, states his entire arm is throbbing.)  

To answer your question, you could certainly argue that those are modifying factors.  Those are things that make the chief complaint better or worse.  You could count them as other HPI elements as well (context or timing for example) but as long as you count it once you should end up with roughly the same HPI score as anyone else.  

When you've been auditing charts for a while and you become proficient at it, you will be able to mentally scan a note and identify phrases that can count as more than 1 element, make a mental note of it, then you continue reading the history and identify other elements.  At the end, you can go back to those 'wild cards' and score it in the most beneficial way possible.   That way instead of marking it down as a modifying factor, and then later in the HPI they mentioned that the pain resolved with Tylenol... you could count it as Timing so you get credit for both HPI elements.


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## joseluisvalencia (Jan 2, 2013)

MikeEnos said:


> I agree with everyone so far.... those phrases could be considered modifying factors, or context.  You could also count "on exertion" or "on standing" as Timing... that's when the chief complaint occurs.
> 
> There are many things that you could count as Timing, Modifying Factors, or Context.  There are many things that you could consider to be Severity or Quality (patient fell on his elbow, states his entire arm is throbbing.)
> 
> ...



Great way of explaining it...


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## amitkumar_s (Jan 8, 2013)

abrane18@yahoo.co.in said:


> can we consider modifying factors in following scenarios
> 
> 1.  dyspnea on exertion
> 
> ...



You can take all 3 points as modifying factors or u can take dyspnea on exertion and dizziness on standing as timing as pt feels dysnea at time of exertion or u can say at time of exertion he feels dyspnea.same goes for dizziness on standing.for first 2 points Timing is most appropriate.As exertion or dizziness does not increase or decrease .In simple terms exertion or standing doesnt affect condition or modify condition.


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## abhishekrane32@yahoo.com (Jan 11, 2013)

thanks to all...


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