# HPI vs ROS



## tlewiscpc (Jul 30, 2013)

I am having difficulty separating HPI and ROS in some E/M documentation. This is especially when there are multiple issues being addressed.   Does anyone have any advice or pointers?    For example, when there are multiple issues being addressed can you combine elements of the separate issues to get HPI or can you only obtain HPI elements from ONE issue?  

Any advice would be appreciated.
Thanks.
Tracy


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## Karolina (Aug 2, 2013)

Hi - if the patient is seen for several issues, each issue may provide HPI items. If feasible, I would satisfy HPI before moving on to the ROS. ROS should be derived from a patient inquiry. Important to remember: do not count one statement twice - for example: SOB can be either HPI (associated sign/symptom) or ROS (respiratory), but not both.


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## tlewiscpc (Aug 3, 2013)

Thanks! I think I've got the double dipping understood.  It's just when there's multiple issues I seem to get confused.  Thank you!


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## MikeEnos (Aug 4, 2013)

Karolina said:


> Hi - if the patient is seen for several issues, each issue may provide HPI items. If feasible, I would satisfy HPI before moving on to the ROS. ROS should be derived from a patient inquiry. Important to remember: do not count one statement twice - for example: SOB can be either HPI (associated sign/symptom) or ROS (respiratory), but not both.



This is a common misconception.  There is no rule against this.  I would strongly recommend you read GJ Verhovshek's excellent article, Know Double Dipping Etiquette.  He is the managing editor at AAPC, and he covers the origins of the "double dipping" myth, while thoroughly dispelling it.  

To answer the question, you are allowed to give credit when the provider documents HPI elements on any of the presenting problems.  You are not limited to just 1 problem.


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## Lynda Wetter (Aug 5, 2013)

MikeEnos said:


> This is a common misconception.  There is no rule against this.  I would strongly recommend you read GJ Verhovshek's excellent article, Know Double Dipping Etiquette.  He is the managing editor at AAPC, and he covers the origins of the "double dipping" myth, while thoroughly dispelling it.
> 
> To answer the question, you are allowed to give credit when the provider documents HPI elements on any of the presenting problems.  You are not limited to just 1 problem.



WOW! great article.
I may not have ever read that if you had not referenced that here in this post. 
Kind of takes most of what I learned and mixed it up a bit!...THANKS. (I think, LOL)


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## tlewiscpc (Aug 5, 2013)

Thanks. I will check out this article.  It's amazing to me how many differening opinions there are.  I've head that you count 1 problem towards HPI and use the other info in ROS so I was confused.    

I do note that our MAC specifically states that you "cannot 'double dip' between the three ares (HPI, ROS, PFSH).


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