# counting HPI elements for multiple issues



## dodgerdjf (Dec 17, 2009)

With regard to the 95 guidelines i can not locate a specific instruction on a double count of an element -lets say either duration or location for two separate conditions. I see Highmark has stated that if the location is the same for leg pain and a rash -since only one location was mentioned -then only one element for location is counted. If the pt presents with left leg abscess and a left lower quad. abdominal pain -can we count the location element x two. This same question can be applied to other elements  such as  duration and associated signs and symptoms for two  different presenting problems .
There was a similar question on this forum that asked " when calculating HPI elements, do all 4 elements have to be on the same complaint".
Since that question was never  fully resolved -can anyone provide additional compliance insight on this issue.

thank you 
Dan Ferry,CPC


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## hawkinsj (Dec 17, 2009)

*elements of HPI*

The final statement in the 95 guidelines under the HPI section says 'The medical record should describe four or more elements of the present illness or associated comorbidities.  Yes you can use more than one condition, illness etc. as long as you have the needed number of descriptors to meet the requirement of whatever CPT code was billed.  If a 99223 is billed you will need 4 descriptors.  Most of the time I find that I can get all 4 as they relate to the chief complaint which is the most ideal.  I don't like to mix and match.  Besides I may need to pull some things from the HPI to meet the ROS and you can't use them in both places.  Hope that helps.

Janet


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## dodgerdjf (Dec 21, 2009)

*counting HPI elements*

Janet --thanks for your help -- this is an area of great debate from our coding team and we have a devided opinion of the source documents that attempt to clarify this topic.  .I feel the credit should be applied for the multi co-motbiities that tie into the reason for the visit. 

dan


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## LLovett (Dec 21, 2009)

I certainly agree you should give credit for HPI elements on more than one issue. I have had this confirmed from both my carrier WPSMedicare, and Highmark Medicare.

I would suggest getting guidance from your local carrier in writing to settle any interoffice debates.

Laura, CPC, CEMC


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## Jagadish (Dec 21, 2009)

Hi Dan

Please visit the following thread:

https://www.aapc.com/memberarea/forums/showthread.php?t=26948

Duration counted twice for two complaints

I was at a coding symposium hosted by the Wisconsin Medical Society in October. The E/M coding panel consisted of, among others, reps from Medicare, commercial insurance, and auditors. 

They all agreed that if you have two different complaints you can count an element twice ... i.e. duration for the cold and duration for the shoulder pain.

It was news to me ...

And you are correct: if you have 1 or 12 associated symptoms for the SAME complaint, you still only count 1 HPI element.

Hope this answers the question!


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