# Using HPI for ROS



## sunshinepink (Nov 17, 2008)

If the doctor documents the following: 

History: 
Jane Doe is a 52 year old female 
Patient presents with: 
DRY EYE - pt requesting ref to opthamology 

Had lasik 2 yrs, now complains of 1 year of dry eyes and 2 weeks of eye redness. Uses over the counter drops for dry eyes already. 

- can you use eye redness for ROS
Is there any clear documentation on what is applicable to be used from the HPI for the ROS


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## FTessaBartels (Nov 17, 2008)

*It depends on how much HPI you need*

Depending on what level of E/M your looking at ... you may only need 1 element of the HPI ...so, yes, I'd use anything else not needed for the HPI towards ROS. )I'm assuming that there is no clearly identifiable ROS listed elsewhere.)

F Tessa Bartels,CPC, CPC-E/M


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## RebeccaWoodward* (Nov 17, 2008)

Yep...I would, too.


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## dmaec (Nov 17, 2008)

well - before I would have said "no" - but I've since learned, that yes you can  (see, you can teach an old dog new tricks)  I agree with Tessa and Rebecca - yup, I too would use it in the ROS if needed and 'not' already used in the HPI ..


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## RebeccaWoodward* (Nov 17, 2008)

Donna,

Just when I think I know something...someone shuffles the deck.  You guys are great!!


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