# How may HPI elements to you get ?



## Orthocoderpgu (Jul 30, 2009)

Pt has been on RX hyzaar for several years, over the last couple of weeks, she has been having palpations and periods of lightheadedness which seem to be worse at rest, tend to go away shen she is active.

CC was palpitations and lightheadedness


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## Lisa Bledsoe (Jul 30, 2009)

I get 4:
duration = 2 wks
quality = palpitations (or lightheadedness)
assoc s/s = lightheadedness (or palpitations)
timing = worse at rest/tend to go away when active


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## RebeccaWoodward* (Jul 30, 2009)

quinnwebb said:


> Pt has been on RX hyzaar for several years, over the last couple of weeks, she has been having palpations and periods of lightheadedness which seem to be worse at rest, tend to go away shen she is active.
> 
> CC was palpitations and lightheadedness



Over the last couple of weeks- Duration
She has been having palpations-Context
and Periods of lightheadedness-Assoc signs and symptoms
which seem to be worse at rest-tend to go away when she is active-timing

Now...HPI is often a matter of interpretation and I could see some of these being applied towards different elements but this was my take on it.


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## Orthocoderpgu (Jul 30, 2009)

Thank you for your help ! Sometimes it's hard to see the forrest for the trees especially this close to Friaday.


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## ckatchmarik (Aug 1, 2009)

Should the CC of palpitations and lightheadedness, not stand alone though?  I recently was in on our Medicare carriers "lunch & learn" series, it was stated that the cc must stand alone and it should not be used within your HPI.  If this is in fact true, you would not have an extended HPI.


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## RebeccaWoodward* (Aug 3, 2009)

cporter said:


> Should the CC of palpitations and lightheadedness, not stand alone though?  I recently was in on our Medicare carriers "lunch & learn" series, it was stated that the cc must stand alone and it should not be used within your HPI.  If this is in fact true, you would not have an extended HPI.



*Q* 22. Can the History of Present Illness (HPI) elements be counted for both the Chief Complaint (CC) and the associated signs/symptoms? *For instance*, a patient presents with chest (location) pain (CC) that she has had for 3 days (duration). She also experiences shortness of breath (associated signs/symptoms) when walking up the stairs (context).

*A* 22. Yes. According to the E/M 1995 and 1997 DG, "The CC, ROS, and PFSH may be listed as separate elements of history or they may be included in the description of the history of present illness 

http://www.wpsic.com/medicare/part_b/education/evalmngmntqahistory.shtml

Using palpitations for the CC (quinnwebbs example), I can still extract 4 elements for an extended HPI.


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## LLovett (Aug 3, 2009)

When I look at this I assume there is another entry that states the patient was here for palpitations and lightheadedness based on the way it was originally posted. If there isn't then you're correct, you would'nt count those as part of your HPI elements.

My take on the elements is a little different though, lol.

I would give credit for mod factor on the Rx also, unless that was needed for past history.

Laura, CPC, CEMC


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