# modifying factor HPI



## GAcoder (May 21, 2014)

Would you use this statement as modifying factor in HPI?  I say no, some say yes.  I'm not sure.
She has tried nothing for the symptoms. The treatment provided no relief
Thank you for your response


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## dclark7 (May 21, 2014)

Just my opinion, but I agree with you.  If she hasn't tried anything of course the treatment didn't provide relief there was no treatment.  Since she didn't try anything for the symtpoms, she didn't modify them in any way.


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## OCD_coder (May 21, 2014)

I have written very successful appeal letters using negative information all the time, so this is just my own experience and opinion here.

The History/HPI is a querry by the phsyician to identify the extent of the presenting problem.  Even if the answer is a negative one, the provider should get credit for asking, not penalized for what the patient has or has not done.  That's like saying because the patient has not measured for a fever we shouldn't give credit for Constitutional in the ROS.  That is out of the providers control and they are simply discovering what has and has not happened with the patient to determine what course the workup will take or not.

I would personally, give the provider credit for modifying factor in this example.  I also give credit for associated signs and symptoms when the provider states "no additional symptoms found."


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## beulastella (May 21, 2014)

I say yes, as the patient attempted (or) tried something to relieve the pain. whether we get +ve response, -ve response or no response(means it doesn,t change,still it persists) due to the medication, We can consider it as modifying factor.


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## MarcusM (May 21, 2014)

Clearly the patient has some type of complaint because few people go to the doctor to say, "nothing is wrong with me." Either the symptoms are not "that bad" or she did not know what to do so she did "nothing" which could be a "holistic" treatment that did not work since she is now at the doctor seeking other treatment options.


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## abhishekrane32@yahoo.com (May 21, 2014)

definitely no, this statement is too vague.. the treatment provided no relief , which treatment they should mention, so this is not a modifying factor at all.

Abhishek Rane


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## LLovett (May 21, 2014)

I agree with OCD, pertinent negatives count the same as positives.

Having said that, in this case I most likely would not give credit because this appears to be inappropriate use/lack of updating in a template since the statement does not make sense.

Just my take on it,

Laura, CPC, CPMA, CEMC


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## dclark7 (May 22, 2014)

I agree that I have used negative statements (though not usually as a modifying factor more in associated signs & symptoms).  However, This clearly states that the patient did not try anything to relieve the symptoms therfore there was no modifying factor.  And if you didn't try any treatment then of course the non-treatment is not going to change the problem.


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## Siva03 (May 23, 2014)

It is not always the HPI elements documented should be positive. HPI elements are just the check list for the provider to collect the info from the patient regarding the illness, So both in HPI and ROS  the negative statements are acceptable.

Thanks,
Sivakumar CPC, CPC-H


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## wfriddle (May 30, 2014)

I am torn on this one. I agree that you can count negatives statements and that the doctor should get credit for asking about modifing factors. I guess I have an issue with the way it is worded. If the doctor had said "nothing has relieved/worsened the symptons" I would feel better about counting it. But saying the patient didn't do anything isn't really a modifing factor by definition. This is part of the reason I find E/M coding so confusing, there is too much left up to interpretation.


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