# How many times can you use a HPI element?



## pjwalsh72 (May 18, 2009)

HELP!!!  I am receiving conflicting information.  I was taught that you could only use an HPI element once per encounter.  I know that if you have multiple problems, you could take location from one problem, duration from another etc., but now I'm being told that if I have two separate problems, I could have two locations, two qualities, etc.  I need to know that if this is so, is there documentation to support this?  Thanks!


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## Karolina (May 18, 2009)

This is an interesting question. So far as I know (and I've been doing E/M for a long time) each HPI element can be used once. If you have multiple problems and location appears twice, lets say the right arm and the left hip, you have 2 items supporting the location, but you only get 1 "point" for it.


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## pamtienter (May 18, 2009)

I agree with Karolina. Each element is credited only once.


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## pjwalsh72 (May 18, 2009)

I am in agreement with you, but what I need to prove my point to my boss is documentation saying that you cannot use a HPI element more than once.  (Her thought process is that if it doesn't say you can't then it is assumed that you can.)  I've read and article where JoAnn Steigerwald (Don't know if I spelled her name correctly) says she had heard it from an E/M Auditing expert at CMS that you can, but a co-worker who spoke to a contact at New York's Medicare Carrier says absolutely not.


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## Lisa Bledsoe (May 19, 2009)

If you have multiple complaints and are using 95 guidelines, you have to choose one complaint to count in the HPI.  All others would be counted in the ROS.


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## Karolina (May 19, 2009)

Unfortunately, this is one of the many gray areas. The guidelines do not exactly spell out the do or don't so that it is hard, if not impossible, to find official clarification. 
I would suggest to contact your carrier directly and ask how they handle such a situation. Try to get a response in writing for future reference. 
If no clarification can be obtained, perhaps the best course of action would be to develop and document an internal policy. 
This is a suggestion from PHYSICIAN AUDITING WORKBOOK by DecisionHealth, page 51 - JoAnn Steigerwalds comment is also noted (middle of page 50). The author favors using each element once.
Hope this helps a little to find the right answer for your group.


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## pjwalsh72 (May 20, 2009)

Thanks everyone for your input.  I will take your advice and try to get info directly from Medicare.


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