# Double Dipping with ROS?



## Kevinph84 (Sep 3, 2008)

I have confusion regarding the review of systems. I am a new coder, having almost a year of actual coding experience. Let me say the real world is nothing what school had pictured! My manager had saw my proficiency with E&M coding, and has been grooming me for our current system wide audit.

I was originally taught that a symptom being used in the HPI, can not be used in review of systems. This example is from an actual case. 

"Patient is here with a skin infection." Then in the ROS, the physician only states "Generally feeling well, no other skin complaints." That statement only has me giving credit for for constitutional. 

We currently have a consultant come on board to help provide physician education. The consultant has cited me for not selecting the "No other skin complaints." I told him my reasoning was that I was instructed it was double dipping. I understand his side, that the skin is our largest organ, and multiple concerns can errupt.

Another incident, the physician stated "No drug allergies". The consultant said I should use that for ROS, if there aren't any ROS available. I consider that a part PFS history, and another EM coder has agreed.

Can anyone give me some insight on this situation? I am confused that I could be undercoding or potentially overcoding. Is the consultant's view double dipping, or should I get some more of that dip? Thank you all for your time!

Respectfully Yours,
Kevin P. Honig, CPC-A


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## FTessaBartels (Sep 3, 2008)

*NOT double dipping*

Kevin,
You ask good questions. That's how you will learn.
"Double dipping" refers to using the *exact same words *for more than one bullet.
Example from your scenario has skin mentioned TWO times. Once in the HPI, and again when there is the statement "no other skin complaints." So this is *NOT* double dipping to count these *two separate statements*, one for HPI and one for ROS.  
However, I hope you have yet another statement for the chief complaint, because if you don't then the "patient here for a skin infection" is your CC and I wouldn't count that as HPI. 
As for "no drug allergies" - one of the systems is Immunologic/Allergic, so, yes, I would count that as ROS. But you *could* count it as Past Medical History. The important thing is *where* do you *need* the check mark? 
You are, indeed, lucky if you have a provider who clearly defines each area of history and hits all the bullet points. In reality many providers lump all this information together without clear "headings" so we coders are left to decipher what is HPI, what is ROS, what is PFS.  Fortunately the guidelines allow us leeway in counting the bullet points based on the words in front of us, as long as we don't count any specific word (or phrase) in satisfying more than one bullet. 
If you haven't already signed up for emuniversity.com that might be a great resource for you.
Good luck, Kevin, you seem to be on a path to success.
F Tessa Bartels, CPC, CPC-E/M


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## Kevinph84 (Sep 4, 2008)

*Thank you!*

Thank you for the quick response. So we can use the body system that is related to the HPI and Cheif complaint? Just as long as it is documented twice in the encounter?

Respectfully Yours,
Kevin


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## Lisa Bledsoe (Sep 5, 2008)

Yes - as lont as it is noted twice...
I totally agree with everything FTessaBartels said!


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