# Exp Problem Focused Exam



## kathy a (Apr 12, 2013)

I have a question regarding E & M coding. If a doctor doesnt do a ROS- but in the HPI talks about why patient is here and the problem applies to one system-ie patient here for arm pain.(this would be musculoskeletal) can this count as pertinent to problem-1 system?-which would fall under Exp Problem Focused. I've never been sure on this. Thanks for your help. Kathy


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## MikeEnos (Apr 12, 2013)

I strongly recommend you read this article.  It was published in the February 2013 Coding Edge magazine.  It was written by G.J. Verhovshek, MA, CPC, who is managing editor at AAPC.  The article talks about when it is (and when it isn't) appropriate to count something documented in the HPI as part of the ROS.

Here's a relevant excerpt:


> Returning to our earlier example of the patient with documented chest pain with dyspnea, you may count dyspnea as both an associated sign/symptom for the HPI and for respiratory ROS (but you should not count “chest pain” for both cardiovascular and musculoskeletal systems in the ROS).
> 
> But (and this is a big “but”), *if a patient shows up with only one complaint, you shouldn’t use that single complaint for both the history and ROS.* Rather, you should look for documented evidence that the physician dug deeper to find more information to assist him or her in identifying what is wrong with the patient and how to treat it (in other words, you should be sure that the physician truly did provide an ROS).
> 
> ...


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## kathy a (Apr 12, 2013)

Thanks Mike you answered by question. So I can use it as one of the systems if he goes into depth in his HPI?


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