# ROS credit?



## trarut (Nov 5, 2009)

Would you give credit for a complete ROS with this statement:  *"A 10-point ROS was taken and pertinent findings are listed in the HPI."*  The only ROS listed in the HPI is constitutional.  Nothing is listed elsewhere to show what other systems the doctor may have reviewed.

Thanks 
Tracy


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## LLovett (Nov 5, 2009)

I would give credit for what is listed in the HPI, not a comprehensive ROS.

Many carriers will accept the statement "All other systems reviewed and negative" but there are 14 systems recognized. You either list the ones done individually or use the all statement to get credit. By saying 10 you have no idea what 10 were done.

Laura, CPC, CEMC


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## trarut (Nov 5, 2009)

Thanks.  We've been debating the point here and that's the direction we were leaning as well.  It's just nice to have an outside opinion sometimes!


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## krssy70 (Nov 5, 2009)

Tracy,

I have been doing some research on what can be used from the HPI for credit for the ROS. What I have found out is that whatever system you give credit for in your ROS, you cannot count in your HPI...Ex: Associated sign or symtom. It can only be counted once. So if you have already counted it in your HPI, then you cannot give credit for it in your ROS, in that instance, you would only have a problem focused History. 

Up to you, you can count it in your HPI as an associated sign or symptom, or you can count that system for your ROS.

Hope that helps,
Kristen, CPC


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## trarut (Nov 5, 2009)

Hi, Kristen.  Thanks for the input.  In this case, the statement regarding the ROS element just happens to be included in the paragraph where the physician discusses the HPI.  We're not double-dipping between the HPI and ROS.  Normally, our physicians clearly dictate the HPI and ROS as separate elements of their note which things very easy for us.  For some reason, this physician decided to switch things up and use this new statement of 10 systems reviewed and it just confused everyone


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## FTessaBartels (Nov 5, 2009)

*ROS vs HPI and double dipping*

Actually you CAN use the same "system" in HPI and ROS ... just not the exact same information.

For example - 
HPI: patient presents with rhinorrhea and headache for last two days. OTC Claritin offers some relief. No fever.

So you have an associated sign of "no fever" which falls in the constitutional system.

You can certainly obtain *other* information from the constitutional system ... chills, malaise, weight loss ... you just can't count "fever" as ROS *if *you are using it for HPI.

(I know, for this simple complaint you wouldn't be trying to justify a high level of service anyway ... just an illustration.)

Hope that made sense.

F Tessa Bartels, CPC, CEMC


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## trarut (Nov 5, 2009)

Yes, that does make sense.  We do the same when our physicians don't dictate a separate ROS.  We are an oncology practice and our physicians typically document a completely separate ROS.  We haven't had one yet that tried the "10 systems were reviewed" one-liner so we weren't sure if that was acceptable.

Thanks, everyone, for your responses!  I appreciate the information.


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