# Ros -constitutional



## jbagsic (Jul 25, 2007)

quick question with regards to ROS,,
hpi : pt presents with knee pain since x days. 6/10. tried otc. 

^^ can we get ros from that statement? musculo?




another question,, skin tags.. " hpi: presents w/ skin tag. would like to be removed. 
ros: skin: no rash 
PE: constitutional : wdwn
 skin:  lesion 11 skin tags
assessment : skintags

order cryotherapy 1-15 "

^^ can i score a level of service for this encounter or its procedure code only? 11200?


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## amsmith22 (Jul 26, 2007)

1st scenario I say yes, you can count that as review of muscuolo system

2nd scenario I say no, if the cryosurgery is done the same day the HPI and exam are not enough, in my opinion, to constitute a separately identifiable E&M.


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## jbagsic (Jul 26, 2007)

thanks for the fast reply! im still mixed up w/ the history part of e/m. does this mean in every chief complaint there is always an ROS? so its very rare to have a problem focus history? it is very confusing if i should pull out an  ROS especially when the provider writes in paragraph form.


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## coder911 (Jul 27, 2007)

I suppose you could find an element of the ROS in the CC - it wouldn't happen very often, but it's possible.

I would say that you could not pull out a ROS from the first scenario - I see elements of HPI and a CC, but you aren't able to "double-dip" elements. So if you count the knee pain as the CC, you wouldn't be able to use it again as part of the ROS.

On the second scenario, I would agree that you would only charge for the cryo on the skin tags (11200)


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## AHVC (Aug 16, 2007)

You can count that as ROS IF it is not used in the HPI.  It can be used in one or the other, not both.  Be careful not to double-dip and give credit in HPI and ROS.

Good luck

Ali H. Vincent CPC, CPC-EMS, BSHA
United States Air Force AHLTA Clinical Systems Analyst


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## jbagsic (Aug 16, 2007)

thank you very much


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## JenniferCalma (Oct 17, 2007)

*definitely can*

definitely can



jbagsic said:


> quick question with regards to ROS,,
> hpi : pt presents with knee pain since x days. 6/10. tried otc.
> 
> ^^ can we get ros from that statement? musculo?
> ...


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## jmanter (Oct 26, 2007)

It is procedure only, the encounter doesn't qualify for modifer 25 since no service beyond the ususal associated with the procedure is there.

As for the first case, I think 2 ROS could be used- MS and neuro. 

I quite frankly am amazed about the double dipping remarks. The ROS is always interrelated to the HP. Can you cite documentation to support this rule ?


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## namt (Nov 6, 2007)

*Cpc & Cpc-h*

Try this link in regards to the double-dipping issue:
http://medicalnewswire.com/artman/publish/article_6570.shtml


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## valleycoder (Nov 25, 2007)

i'm with coder911....i would use knee pain as HPI, not ROS.


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## Rita Bartholomew (Dec 5, 2007)

Double-dipping refers to using the same element within one of the history components.  In other words, you can use same element for satisfying requirements in HPI and ROS, but you cannot use the same element twice within, for instance, the ROS (example:  chest pain can be used in both HPI and ROS, but not as "cardiovascular" and "musculoskeletal" in the ROS.

Rita Bartholomew, CPC-H
Maine Medical Center
Portland, ME


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## werththewait (Dec 6, 2007)

I would say no to the first one for sure.  That sounds like the CC and you can pull HPI out of there.  And you need a CC.  Therefore not being able to use as ROS.


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## Kris Cuddy (Dec 27, 2007)

For the question about the skin tags, does anyone else think it's concerning that the surgical procedure isn't documented, eg, prep, actual area on the body where the skin tags were, method of removal, how well the patient tolerated the procedure, post-op care instructions, etc? 

In my personal opinion, the documentation as it is doesn't support 11200. It does support an E/M service with the MDM supporting the order for cryosurgery.

Kris


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## smillar (Jan 17, 2008)

I'll have to disagree also with the "double dipping" part of the above discussion.  With our carrier, Highmark Medicare Services, it is stated as "

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"?

According to The Medicare Part B Reference Manual, Chapter 23, "Evaluation and Management", section e.3, 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.
Date Posted: 07/18/2005, Date Reviewed/Revised: 12/13/2007

Link to actual information http://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#15

Shelby


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## smillar (Jan 17, 2008)

I'll have to disagree with the above discussion of "double dipping" in reference to the HPI and the ROS....  Our carrier Highmark Medicare Services posted this on their website and this is what we follow.

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"?

According to The Medicare Part B Reference Manual, Chapter 23, "Evaluation and Management", section e.3, 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.
Date Posted: 07/18/2005, Date Reviewed/Revised: 12/13/2007

Link:http://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#15


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## reichtina320 (Feb 12, 2008)

*double dipping*

Great link!  I hope everyone will take the time to read that.  There is so much miscommunication about the double dipping issue.

thanks
tina



namt said:


> Try this link in regards to the double-dipping issue:
> http://medicalnewswire.com/artman/publish/article_6570.shtml


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## RebeccaWoodward* (Feb 19, 2008)

Your first question...this is my training~

HPI-Location, duration, severity and modifying factors

2nd question...No...only the procedure

I work with Ortho/Neuro Surgeons and this has been an extreme topic in our facility with outside consultants.  Your 1st scnenario does not have impressionable ROS for me. 

Rebecca


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## jbagsic (Feb 19, 2008)

thanks for the replies.


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