# HPI Element - I was wondering if anyone could give me their opinion



## jmcalhaney (Oct 25, 2012)

I was wondering if anyone could give me their opinion on what HPI elements that you can pull from the following:

A 50 year old, referred for nausea, vomiting, diarrhea, and abdominal pain.The patient states, she was in usual health 4 to 6 weeks ago.  She had loss of appetite, early satiety, and weight loss.  The patient states she has lost 25 pounds over that time.  For 3 to 4 weeks, she was having N&V.  This seems to be resolving.  She has had a change in bowel habits with decreased stool frequency over the last 6 weeks.  Over the last 7 to 10 days, she has had some diarrhea.  She has also had some black bowel movements.  She denies rectal bleeding or history of anemia.  When asked about abdominal pain for about a month, she had lower generalized pelvic pain.  This seems to be resolving.  The patient has been to see Dr. X and his colleagues 4 times over the last month and was diagnosed with UTI and what seems to be H. Pylori.  I do not have all those records at this time.

I am only finding 3 elements of the HPI in this history statement (Location, Duration, and Associated Signs and Symptoms).  The Dr. coded it as a level 3 new patient consult, but I can't get to a level 3 without having 4 components of the HPI.  Does anyone else see anything that can be used?


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## Naveen Rachagolla (Oct 26, 2012)

I hope you can come with *Quality* aslo as one of the HPI, as the patient says she had *lower generalized pelvic pain * i think here patiend is describing the type of pain also, so we can take quality.

Lets wait and for others inputs.


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## ollielooya (Oct 26, 2012)

Naveen, thanks for posting your thoughts, I was going to post similar observations and agree. Somewhere buried deep within the bowels of this forum is another posting very similar to the question being asked.  A search might bring it up with the accompanying answers.


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## twizzle (Oct 27, 2012)

jmcalhaney said:


> I was wondering if anyone could give me their opinion on what HPI elements that you can pull from the following:
> 
> A 50 year old, referred for nausea, vomiting, diarrhea, and abdominal pain.The patient states, she was in usual health 4 to 6 weeks ago.  She had loss of appetite, early satiety, and weight loss.  The patient states she has lost 25 pounds over that time.  For 3 to 4 weeks, she was having N&V.  This seems to be resolving.  She has had a change in bowel habits with decreased stool frequency over the last 6 weeks.  Over the last 7 to 10 days, she has had some diarrhea.  She has also had some black bowel movements.  She denies rectal bleeding or history of anemia.  When asked about abdominal pain for about a month, she had lower generalized pelvic pain.  This seems to be resolving.  The patient has been to see Dr. X and his colleagues 4 times over the last month and was diagnosed with UTI and what seems to be H. Pylori.  I do not have all those records at this time.
> 
> I am only finding 3 elements of the HPI in this history statement (Location, Duration, and Associated Signs and Symptoms).  The Dr. coded it as a level 3 new patient consult, but I can't get to a level 3 without having 4 components of the HPI.  Does anyone else see anything that can be used?


 The degree of wait loss is all part of the HPI and is severity.


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## MikeEnos (Oct 29, 2012)

I see these types of note a lot - where the provider seems to list Associated Signs and symptoms over, and over, and over, and over then they give a modifying factor, then another, then another, then another.  It ends up being a pretty lengthy paragraph but there's really only 2 or 3 elements there.  In cases like this you have to do some mental gymnastics to tease out the other elements.  It may be a little creative, but here's what I can identify:

Location - Abdomen
Duration - 4 to 6 weeks
Associated Signs and Symptoms - Loss of appetite (among other things)
Quality - _Black _bowel movements
Severity - lost 25 pounds
Possibly Timing - Over the last 7 to 10 days


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