# NKDA - How are others counting?



## KurtRego (Jul 31, 2007)

I would be interested in finding out how fellow coders are currently counting the NKDA?  Is this a ROS or counted as a PFSH?

Any input would be appreciated along with the rationale for the choice.

Kurt Rego, CPC
Corporate Compliance


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## rthames052006 (Aug 2, 2007)

I was told at a Medicare seminar by the nurse reviewers that NKDA should be counted under PFSH.  What do others do.

roxanne


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## amjordan (Aug 2, 2007)

It should be counted in PFSH.


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## bedwards (Aug 3, 2007)

I think it depends on how your medicare carrier views it.  We use it under ROS or PFSH but not both places.


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## coder911 (Aug 3, 2007)

I generally count this as an element of the ROS. If you look under medicare E/M guidelines it shows "allergic/immunologic" as a system - I perceive this as a general statement that can apply to any allergy reviewed. Allergies (unless otherwise stated) are a current issue for the patient - and can potentially affect the doc's treatment options.


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## kevbshields (Aug 6, 2007)

CMS has made documentation guidelines for this relatively clear--where I (personally) find dissent is in the interpretation of presenters, auditors and educators.

According to CMS, it may be counted as either Past Med. Hx. or as a ROS (All/Imm), but only one of those.  It is pretty standard for auditors/coders to just automatically slam it into PFSH, although it may be needed elsewhere (e.g., ROS).  Since the allowance is permitted by CMS, I would say it needs to be counted where it is needed in the document.

If specific FIs have rules outside those of CMS, they should place those in writing.  I would also pay heed to what the Medical Reviewers (not Clinical Reviewers) are stating from those FIs; these are the people reviewing your documentation, after all.

Hope this helps.


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## Belinda Frisch (Aug 22, 2007)

*Ros*

I, personally, consider NKDA a ROS (allergy). Typically, past history is easy to get anywhere else and it's another point in the provider's favor to use it as a system.


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## donsqueen (Jan 27, 2008)

NKDA stands for no known DRUG allergies. My outside consultant said that it should be counted as PFSH over ROS for 2 reasons: 1: it is documented (in my clinic) by the MA's not the provider and 2: it is not generally specific to the particular problem the patient is coming in for.


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## goldejoa (Jan 28, 2008)

I always count it in ROS.  In the ED, where I code,  I feel it is always pertinent to nature of the presenting problem.

JG


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## khaspert (Jan 28, 2008)

*Nkda*

This is part of the past medical history.

If a patient is asked about other allergies such as environmental allergies like hay fever, this would be part of the ROS.


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## rthames052006 (Jan 28, 2008)

khaspert said:


> This is part of the past medical history.
> 
> If a patient is asked about other allergies such as environmental allergies like hay fever, this would be part of the ROS.



I agree with you Khaspert... thats what I was taught by the auditors at Medicare.

Roxanne Thames, CPC


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