# Status of Three Chronic Conditions



## dballard2004

Per the 1997 guidelines, the provider can document the status of three chronic or inactive condtions instead of the 4 HPI elements for a detailed or a comprehensive history.  My question is this, does the status necessarily have to be documented in the HPI?  I have a provider who saw a patient for HTN, DM, and CHF.  In the chief complaint, he states that the patient is here for follow-up for these condtions, but in his assessment, he documents the following:

HTN-stable
DM-well controlled with meds
CHF-stable

Does this qualify for the status three even though it is in the assessment and not the HPI?  I say no because the assessment would be part of the MDM and the guidelines state that status three is part of the HPI.  Any thoughts?


----------



## RebeccaWoodward*

Strange...I had a question on this very subject the other day.  I've always felt the 3 chronic conditions had to be documented in the HPI but there was a difference of opinion...however; the consensus was NO...you can not allow credit if it is only documented in the assessment.  I really liked one of the responses I received...I'll share...

"If you interpret “status” in “status of at least three chronic or inactive conditions” to mean the ultimate “status” of a problem from a clinical standpoint as determined by the physician by the end of the encounter, which some do, then documentation as to the physician’s judgment regarding the current clinical status would reasonably be found in the assessment area of the note—not in the history. This view, however, is not consistent with the credit being given with the History component. 

I prescribe to the view that the “status” referred to in that phrase must refer to information obtained from the patient during the history-taking, since it is credited that way. Since a patient is not qualified from a medical standpoint to explain to the doctor the ultimate/current clinical status for chronic problems they are experiencing, the “status” would refer to the patient’s non-medical subjective perception as to the current status of chronic problems they currently have, and then likely be accompanied by explanations for their perceptions and any actions/events that have occurred that have a bearing on the problem(s).  For example, it would be the patient’s answer to a doctor asking the patient their general impression about any perceived improvement/worsening with regards to a chronic condition. If the patient feels that their hypertension is worse, the doctor will likely ask the patient to explain this perception. Why do they feel it is worse? Higher BP readings at the neighborhood drug store? Worsening of certain symptoms that accompany the htn? Have they stopped exercising? The patient may provide information about the status of key “associated signs/symptoms” that accompany each of the chronic conditions. All of this history information contributes towards describing the current subjective status of the problem as experienced by the patient. The physician will then determine the ultimate clinical status based on objective data obtained during the exam and MDM components."


----------



## dballard2004

We are in complete agreement here.  The guidelines clearly state that status three applies to the HPI-not the assessment.  I don't give credit to my providers for putting it in the assessment.  My providers don't like this, but the guidelines are what they are.  Thanks so much for the reply.


----------



## cpccoder2008

*Status of 3 medical problems*

I don't like starting new forums if there are old one's out there already. If you use the status of 3 medical conditions for the HPI what documention needs to be noted ?? I attended an E/M seminar that says you have to state if it is stable/worsen but what if the doctor just puts the medication the patient is taken for the problem. 

HTN: On (medication) 200 mg twice day
DM: On ___ 50 mg once day             
CHF: On ___ 200 mg once day

Would that justify the 3 medical problems or does he have to state if it's stable or wosen, controlled or non-controlled ?? Also any links with specific documention for the status of 3 medical problems would be great. Thanks


----------



## RebeccaWoodward*

I instruct my physicians to provide the status (controlled, uncontrolled, etc) along with the medication(s) and any information deemed applicable for that encounter.  The DG's are somewhat vague as to what is expected but I did find one carrier that does provide an example.

*What is meant by "Status of chronic conditions"?*

In 1997 the Evaluation and Management (E/M) Guidelines were enhanced under the History of Present Illness (HPI) section of the 1995 score sheet to include patient's chronic conditions in which an exacerbation may have occurred resulting in the chief complaint and the reason for the patient encounter. The documentation in the patient's medical record must state a status of the chronic condition in order to meet the requirement under the History: HPI Status of 1, 2, or 3 Chronic Conditions on the 1995 scoresheet. An example could be: hypertension - stable on Atenolol.

Date Posted: 10/05/2009, Date Reviewed/Revised: 11/17/2009

https://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#7


----------



## cpccoder2008

Thank you, at least i have something to show him.


----------



## LindaEV

Our MAC lets us use this for 95 guidelines as well. 

I agree...do NOT use the assesment!

An example I give to my docs is:

 "Pt states doing well with DM, numbers stable between 90-115, still taking Metformin 500mb BID with no side effects. HTN seems stable. Checks BP's daily at home. Taking lisinopril, c/o nausea that subsides...."

All info you can get fairly simply at beginning of visit from pt.


----------



## CC5657

During a webinar with our carrier (Highmark), I asked the same question. Their answer was "The status of three chronic conditions can be pulled from anywhere within the note."


----------



## losborn

I returned yesterday from the NAMAS CPMC seminar.  Their take is that HPI can be pulled from anywhere in the note also.

Lin CPC


----------



## aguelfi

but can the reason for the visit be pulled from anywhere?  for example; "Follow up" for chief complaint. I was told to see the assessment to determine what the 3 chronic conditions are that are being evaluated. Sometimes the doc will document "follow up on DM, HTN and GERD".  I will go to the assessment to see if he documented the status of the disease.  Without that I won't give credit for 3 chronic conditions, but I still think that the cc should state more than just follow up.  Others please?


----------



## jessica1971r@gmail.com

*Help in finding hpi*

Subjective/24hr Events:  
58 y/o F hx of lap chole 7/2015 found to have adenocarcinoma. Then
underwent seg 4/5 liver resection, mediport placement. Then she developed
jaundice, underwent IR biloma drainage and PTC placement previously. She
became jaundiced and so presented today for PTC upsize and biopsy of bile
duct mass. She became hypotensive and tachycardic during procedure, septic
appearin


----------

