# "Double dipping"



## bwomack (Sep 8, 2011)

I have a question about the ROS and "double dipping".  My doc has dictated an H&P and in the HPI section has listed the problem as chest pain with associated sign and sypytom being shortness of breath.  These are the only elements that could be construed as possible ROS elements.  

In the ROS she has listed out her elements but when it comes to the cardiovasular and the respiratory she states "see HPI".  

I have already counted the elements in the HPI for the HPI, am I thinking correctly that I cannot count these in the ROS section also?  If this cannot be counted for both areas, does anyone have documentation to back this?  I have searched and do not find anything addressing this straight on.


Thanks for any insight you can give


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## LindaEV (Sep 8, 2011)

http://www.donself.com/documents/HPI.pdf

try this link. It's old, but it is a letter from CMS saying it's probably ok to "double dip" in these cases.


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## bwomack (Sep 8, 2011)

Thanks Linda I haven't checked Don's site out in quite some time.  I will certainly check it out.  Thank you for suggesting it.


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## OCD_coder (Sep 8, 2011)

I disagree with the interpretation of the letter. The letter clearly states that it is not correct to double dip, read the last sentence of the first paragraph. ... "information  for coding the ROS may be pulled from the HPI but a single statement cannot be used for credit in both  areas." 

You cannot use the exact same statement for both elements in the HPI and again for ROS.  The Hx can be documented as one paragragh and elements for HPI and ROS and PFSH can be obtained out of the entire HPI area.  If the elements are given credit for Location and Associated Signs and Symptoms in the HPI, they cannot and should not be again given credit for cardiovascular and respiratory in the ROS.  There must be an independent statement for each.


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## Mojo (Sep 8, 2011)

mworcester said:


> I disagree with the interpretation of the letter. The letter clearly states that it is not correct to double dip, read the last sentence of the first paragraph. ... "information  for coding the ROS may be pulled from the HPI but a single statement cannot be used for credit in both  areas."



Actually, it was this statement that caused the confusion. The response from Dr. Lindberg states, "It is not necessary to mention an item of history twice in order to meet the guidelines for Review of Systems. Repetition of information or data is not required as long as it is appropriately referred to. Once should be enough." Dr. McCann concurred with Dr. Lindberg's response.


Check with your payers for guidance. Creating an internal office policy may be helpful.

WPS Medicare:
Q 6. Can a physician count a single history item in both the HPI and ROS? For example, could we count "shortness of breath" as an associated sign and symptom in the HPI and respiratory system in the ROS? 

A 6. A clearly documented medical record would prevent the need to "double-dip" for HPI and ROS, but WPS Medicare, in rare circumstances, could accept counting one statement in both areas if necessary. 


Highmark Medicare Services:
When scoring the review of systems (ROS), can you use the systems addressed in the history of present illness (HPI) elements or is that "double dipping"?

ROS inquiries are questions concerning the system(s) directly related to the problem(s) identified in the HPI. Therefore, it is not considered "double dipping" to use the system(s) addressed in the HPI for ROS credit.


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## rthames052006 (Sep 9, 2011)

Highmark Medicare is my carrier and we follow that ruling when it comes to the original question the poster had.






Mojo said:


> Actually, it was this statement that caused the confusion. The response from Dr. Lindberg states, "It is not necessary to mention an item of history twice in order to meet the guidelines for Review of Systems. Repetition of information or data is not required as long as it is appropriately referred to. Once should be enough." Dr. McCann concurred with Dr. Lindberg's response.
> 
> 
> Check with your payers for guidance. Creating an internal office policy may be helpful.
> ...


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