# ROS - Please help! Frustrated!



## Love Coding! (Aug 28, 2009)

Hello everyone,

I am in Arizona and I have a question regarding ROS.

I have a provider we both work in dermatology.  I was taught that when it came to review of systems only pertinent negatives and positives count.  My provider wants to know how she can state at least 2 review of systems?  She was taught in hospital coding that the term "noncontributory" was sufficient.  I explained to her the statement was not sufficient.  Can someone give me a statement what she can use in her dictation?  

Our medicare carrier is Noridian

Thank you!


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## FTessaBartels (Aug 28, 2009)

*ROS for dermatology*

Well ... depends on the problem. 

Skin ... "negative (or positive) for rash" or itching or scaling
Constitutional ... "no fevers"
Allergies ... "no known drug, food or environmental allergies" or "allergic to _(whatever)______"
Musculoskeletal ... "no joint pain" 

That's four likely pertinent systems just off the top of my head.

Depending on your carrier you can list the pertinent positives/negatives and then state (provided it was actually DONE) "all other systems reviewed and are negative."

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Love Coding! (Aug 28, 2009)

FTessaBartels said:


> Well ... depends on the problem.
> 
> Skin ... "negative (or positive) for rash" or itching or scaling
> Constitutional ... "no fevers"
> ...



Hi Tessa,

Thank you for your reply...I have another question in the example you gave me, if those symptoms were in the HPI and used as elements of the HPI can you use them again for the ROS?  

Second question - Does pertinent negatives count in the HPI?  I was told that you cannot.

Thank you and you have awesome advice.

dscoder74


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## FTessaBartels (Aug 31, 2009)

*Double dipping*

If those specific symptoms are part of the HPI, then NO, you cannot use them for the ROS. 

You are asking how to get 2 ROS. That tells me that you are looking for a detailed history.  But do you need a detailed HPI?  Is that medically necessary for the problem(s) you are addressing and the level of care you are providing?

Also ... if you have 5 or 6 elements of HPI, you can stop counting at 4 and use the rest for ROS if appropriate. 

As for negative responses in the HPI ... Yes, I count negative responses as associated signs/symptoms in the HPI if appropriate to the presenting problem. So let's say you have a patient with a rash on his arm. 

Your HPI might be something like: "Patient noted rash on left forearm yesterday. Started using new laundry detergent this week. Denies itching. Negative for swelling or joint pain at elbow or wrist.

You'd have location (left forearm), duration (yesterday), modifying factors (new laundry soap), and associated signs/symptoms (negative itching). 

You could then count the "negative joint swelling or pain" as an ROS element of musculoskeletal ...  You could also ask about any symptoms of rash, itching, etc on other parts of the body and STILL get an ROS credit for integumentary. So now you have 2 ROS ...

Ask about allergies and you have a past medical history.

Voila - a detailed history (4 HPI, 2 ROS, Past med Hx)

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Love Coding! (Aug 31, 2009)

FTessaBartels said:


> If those specific symptoms are part of the HPI, then NO, you cannot use them for the ROS.
> 
> You are asking how to get 2 ROS. That tells me that you are looking for a detailed history.  But do you need a detailed HPI?  Is that medically necessary for the problem(s) you are addressing and the level of care you are providing?
> 
> ...



Hi Tessa,

You are awesome as always, so basically you have no double dipping, pertinent negatives used toward the HPI cannot be used again in the ROS, that makes sense! 

Thank you!!!!!

dscoder74 :0)


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