# Use of Allergy as PFSH or ROS



## linc11 (Mar 18, 2011)

This is quite lengthy, but here goes....

When a patient is seen in our clinic it is protocol for our offices to always inquire about new or old allergies to medications.  My question is, when is this considered a ROS and when would this be a PFSH?  Also, as this is protocol would it be appropriate to always consider this in our E/M calculation?   

For example...an established patient presents with a contusion on their hand which occured yesterday while playing football.  Patient states it is slightly painful and hurts to the touch.  Currently taking tylenol to relieve pain. 

Patient does not have any allergies to medications and currently using inhaler for asthma.  

Plan of care....sending patient for XRAY and advised to continue tylenol.   

When looking at this I do not see where their current medication use or history of allergies to medications would be pertinent or relevant to the visit since no medication was prescribed and/or the patient did not present for allergy problems therefore, I do not believe this should be considered part of the E/M calculation.  

If anyone out there has some insight it is greatly appreciated.  I've been pouring over this for quite some time now!

Thank you!


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## Orthocoderpgu (Mar 18, 2011)

In this situation I would count it as PFSH. Your just seeing if they have any allergies just in case a Rx is prescribed and it is not relevent to the dx per se.

Now, if the patient comes in with upper resp symtoms and the doc asks a question and the patient gives a response, then I would count that to the ROS.


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## FTessaBartels (Mar 18, 2011)

*Either, or*

You can count the statement: Patient does not have any allergies to medications and currently using inhaler for asthma.   as either ROS OR as past medical history.  And you can divide it, using allergy for ROS and asthma inhaler as PMFSH.

However ... I find it helps to pay attention to the requirements for the levels of history

1) HPI ... Brief (1-3 elements) vs Extended (4+ elements)
2) ROS ... Problem pertinent vs Extended (2-9 systems), vs complete (10+ systems)
3) PMFSH  ... Pertinent (1 of the 3) vs Complete (all three)

Before you have to even worry about documenting PFSH you have to have at a MIMINUM
4+ elements of HPI AND at least 2 systems of ROS.  

In your example you had 4+ HPI (location - hand; duration - yesterday; context - playing football; assoc signs/symptoms - slightly painful

Next you would look at ROS ... the statement re allergies and asthma inhaler satisfies two systems reviewed.

In you example I do not see anything else recorded that could be used for PFSH. So you have an EPF history. (To get a detailed history you would need one more statement covering PFSH, *OR* one more system reviewed and then you could use the asthma inhaler as Past medical history.)

I don't know why you would think this is not relevant. I would argue that allergies to medications is ALWAYS relevant, especially if there is a possibility that the physician may prescribe something, or if the patient is currently taking some medication to which s/he may be having a reaction. Ditto whatever medications are already being taken and for what condition.  You need to remember that the ROS is usually taken before any examination or decision on whether to write an Rx. A provider would definitely need to take into account any allergies or possible reactions with medications already being taken before prescribing treatment. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## linc11 (Mar 18, 2011)

*Thank you*

Thank you both for your answers, they have helped a lot with my decision. 

With the adoption of EMR in our facility I'm always concerned about inappropriate selection of services being provided given the ease of selecting something with the click of a button. 

I still question if it is medically necessary to always review the patients medication allergies when they are an established patient who is seen frequently and their history is already well known?


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## uwalia (May 27, 2016)

linc11 said:


> Thank you both for your answers, they have helped a lot with my decision.
> 
> With the adoption of EMR in our facility I'm always concerned about inappropriate selection of services being provided given the ease of selecting something with the click of a button.
> 
> I still question if it is medically necessary to always review the patients medication allergies when they are an established patient who is seen frequently and their history is already well known?



Hi
I see your rationale for medical necessity for allergy for established patient but if one is to eliminate all elements of HPI, Exam & MDM , since most of the info is already known, the most you will be able to code for established patient will be 99212, unless patient condition really deteriorated and the level of MDM went up.
I don't agree with the second answer that you can divide the Allergy into ROS and asthma into PFSH. Based on the statement allergy can only go into PFSH in this scenario. The only time allergy will fall into ROS is if your problem is due to allergy eg: upper respiratory symptoms due to allergy or say you are allergic to penicillin. Hope this helps
Sunny Walia CPC-A


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