# Associated Signs and Symptoms in HPI vs. ROS



## dballard2004 (Oct 21, 2009)

My providers are having a difficult time understanding the differance between the associated signs and symptoms element of the HPI vs. ROS. I can tell them what the CMS definition is of ROS, but it still causes confusion. Can someone please explain to me the differance in a way that I can take back to my providers to make this less confusing? Thanks.


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## RebeccaWoodward* (Oct 21, 2009)

HPI (Assoc signs and symptoms) and ROS can sometimes become interchangeable and can be used accordingly as long as you don't "double dip".

Example: 

Patient states that her shoulder has been painful since her fall last Saturday.  She continues to have popping (quality) and  swelling (Assoc sign)

*Versus*

Patient states that her shoulder has been painful since her fall last Saturday. She continues to have popping (quality) and swelling (Assoc sign). *Patient denies numbness or weakness. * (ROS)


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## kevbshields (Oct 21, 2009)

What I always remind coders is that ROS is a verbal system inventory.  This differs from HPI as typically that is provided in the patient's own words.

As Rebecca pointed out, they can be interchangeable, although I'm sure the providers need to know that.


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## dballard2004 (Oct 21, 2009)

Thanks to both of you!  This is helpful.


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## FTessaBartels (Oct 21, 2009)

*HPI vs ROS*

The Associated signs/symptoms in the HPI are what the patient voluntarily reports. 

The ROS is an inventory of systems where the provider asks questions of the patient regarding possible symptoms or history of issues by system.

So if the patient comes in and relates: I fell off my bicycle yesterday and landed on my left wrist.  I put ice on it overnight, but it's still swollen. I can't bend it and my fingers are tingly.  
Here you have context (fell off bicycle), duration (yesterday), location (left wrist), modifying factors (ice overnight), associated signs (swelling, tingling and decreased ROM)

However ... you wouldn't NEED all those signs/symptoms ... you have 4 elements of HPI before you even get to the swelling, etc.   So you COULD use those elements of the HPI as ROS (MS and neuro for the tingling).

The provider would have also asked questions in a review of systems (or had the patient complete a questionaire) ... so may have been able to report: no fractures, no fever, positive for tingling and swelling of LLE, no other problems with ROM or sensation. 

Hope that helps. 

F Tessa Bartels, CPC, CEMC


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## dballard2004 (Oct 22, 2009)

Thanks Tessa.  This is very helpful.


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