# Palmetto GBA and HPI and ROS



## medicalsec (May 22, 2011)

Does anyone know Palmetto GBA's policy on using the symptoms dictated in HPI for both HPI and ROS credit, such as SOB for associated signs and symptoms and also using it for a system credit for ROS. I have read countless articles on the Internet that say that it is not considered double-dipping. One of the doctors that I bill for writes everything in one paragraph with no separation of history elements. I can't seem to find an answer to this on Palmetto's website or any other site on the Internet that would reference Palmetto's policy.

I have researched other posts on this site, and I see that many people insist that it is double dipping, but others are insistent that it is not double-dipping. Some say that different Medicare carriers have different rules, so I am trying to get some information on Palmetto's policy.

Thanks for your help!

Dee

Found this on a website. Any thoughts?



FAQ 1.  For documentation purposes under the Medicare guidelines, can a single historical item be credited in both the HPI and ROS? For example, could nausea and vomiting be used as a symptom in the HPI and also be credited as a system (GI) in the 
ROS?  


Some confusion exists over this issue. While it is true that a single item cannot be used twice within the same section of the history (either HPI, ROS or PFSH), it appears that a single item may be used in 2 separate historical sections. Based on correspondence with CMS representatives, ACEP believes that under the CMS documentation guidelines, the use of a single historical item in both the HPI and ROS is recognized as an acceptable practice. These letters can be viewed on the ACEP web site. As with many aspects of the documentation guidelines, individual carrier variation may exist and members are advised to seek clarification with local representatives.

For example, "Nightly," in the statement 'nightly leg pain' could not be credited for both duration and timing in the HPI. However, in the statement 'chest pain with shortness of breath', "shortness of breath" could be credited as an associated sign and symptom in the HPI and also credited in the Respiratory system of the ROS for the same record.


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## dadhich.girish (May 23, 2011)

No, I do not agree with double dip.  One point can be used only at one place, although it is up to you whether you want to use one either in HPI or ROS.  Like for example, the patient is allergic to something and is coming in for sneezing, which can be a modifying agent.  If you do not count it in history, you can take it in ROS under allergy/immunology.  This is what I was taught and I strongly agree with it too.


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## medicalsec (May 24, 2011)

Thanks for the reply! If anyone has addressed this with Palmetto. I would appreciate your reply also.



Thanks,

Dee


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## Mojo (May 24, 2011)

I couldn't find anything on the Palmetto GBA website, either.

Like so many aspects of coding, it is carrier specific. I agree with Dr. Linberg's (Washington's former Medicare Part B Medical Director) response to this double-dipping debacle: "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."


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