# Is "asymptomatic" a quality



## CatchTheWind (Apr 16, 2014)

We are dermatology. If a lesion is described as "asymptomatic," can we count that as a quality?


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## LLovett (Apr 17, 2014)

I would consider that a pertinent negative for associated signs and symptoms.

Quality would be a descriptive word such as "irregular" referring to the shape or a color "black" when discussing a skin lesion. 

Laura, CPC, CPMA, CEMC


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## CatchTheWind (Apr 17, 2014)

I learned that "associated signs and symptoms" were only the SECONDARY signs and symptoms, and that a primary S&S such as "itchy" or "painful" is a quality. That's why I thought "asymptomatic," as a negative for itchy or painful, would be a quality. Am I mistaken?


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## CatchTheWind (Apr 18, 2014)

FYI, I've gathered some examples of "associated signs and symptoms":

Chief complaint: chest pain.  Associated S&S: shortness of breath.
Chief complaint: migraine. Associated S&S: nausea.
Chief complaint: stress.  Associated S&S: headache.

The point in all of these is that the "associated S&S" does not describe the chief complaint, but is secondary to it. 

Since "asymptomatic" actually describes the chief complaint itself (just as, for example "lesion is itchy" which is undisputedly a quality), I am thinking that it could be counted as a quality.


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## OCD_coder (Apr 18, 2014)

I must agree with LLOVETT that "asymptomatic" would be credited towards Associated signs and symptoms not quality just as she described in her post.  The HPI is an elaboration of the chief complaint in the patients own words and the findings do not have to be a positive finding.  Another example: No pain = severity.

The provider get's credit for asking the extent and disclosure of any related signs or symptoms to the presenting problem even if they are negative/normal by the patient's information.

You are correct in your examples that they would be credited towards Associated S&S.  But what about the patient that presents for a presenting problem of possible anemia based on resent lab work, but who is asymptomatic.  Credit for location and Ass. S&S and context could be given to the provider.


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## LLovett (Apr 21, 2014)

That is an interesting take on associated signs and symptoms. Do you have anything in writing supporting this? 

I also find your use of the word "secondary" very interesting as well. Generally in clinical documentation when something is referred to as secondary it is the same as saying it was due to or caused by. So I'm not sure how it is possible to rank a symptom as primary or secondary. Like the example of stress and headache, what would a primary sign or symptom be for stress? For your other examples, I just disagree with your assessment. Those are directly related to the chief complaints. I'm fine with calling them associated signs and symptoms, don't get me wrong, I'm just having trouble following the way you are counting some and not others.

Before anyone jumps on me and tells me to be nice, I am not being mean, I am truly interested to know if there is something out there drilling down to this type of specificity when counting HPI elements. I have worked and continue to work with payers all over the country and I am always on the look out for things I don't know.

Laura, CPC, CPMC, CEMC


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## CatchTheWind (Apr 21, 2014)

I probably should not have used the term "secondary to" in explaining "associated signs and symptoms."  The plain wording itself, as being symptoms *associated with* the chief complaint, is more accurate.

 I have seen a number of sources, but nothing from a formal source. Here are a couple that I have come across:

From http://www.emergencymedicine.mckessonrevenews.com/index.php/archives/4-a-clear-picture-of-hpi: Associated Signs and Symptoms: Signs and/or symptoms that accompany the original complaint or symptom (i.e., mild burning knee pain has been intermittent since yesterday after mowing the yard ? no relief with acetaminophen ? also some noted swelling; frequent intense throbbing headache that started this morning after an argument with spouse ? some relief after lying down ? also pain in neck and jaw).  The writer's point is that, in the first example, the chief complaint is knee pain, the quality is painful, and the associated S&S is swelling.  In the second example, the chief complaint is headache, the quality is throbbing, and the associated D&D is pain in neck and jaw.

And here is an excellent breakdown of all the HPI elements from FTessaBartels at https://www.aapc.com/memberarea/forums/showthread.php?t=24901

Location - Where - the site, is it diffuse, localized?

Quality - What kind - sharp, dull, constant, intermittent

Severity - How bad is it - pain scale 1-10, mild, severe

Duration - How long has it been present - since yesterday, for 2 weeks, fell on Tuesday

Timing - Is there a pattern - every morning, continuous, repetitive

Context - What Brings it on - with exercise, when standing, noted on X-ray

Modifying factors - What makes it better or worse - better with Tylenol, Rx had no effect

Associated Signs - What comes with it - other symptoms that accompany the chief complaint.


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## CatchTheWind (Apr 22, 2014)

I came up with some more information - this time from our own EMR system.

According to the coders who designed the system, the following are all potential qualities of a rash: asymptomatic, blistering, burning, flaking, itchy, painful, red. (Note that asymptomatic is right there on the list!)

Potential associated signs and symptoms are chills, cough, diarrhea, sore throat, and fever.

This supports the other examples I've given, in which associated signs and symptoms are NOT the signs and symptoms of the chief complaint, but are problems that accompany it.


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