# Bullets



## cpccoder2008 (Jun 18, 2009)

We use the 1997 Guidelines, Can you use a bullet from both the ROS and the PE and get credit ?


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## LLovett (Jun 18, 2009)

ROS doesn't count towards exam or vice versa. They are 2 completely different things. ROS is the provider asking what is going on, exam is the provider physically checking what is going on.

Laura, CPC


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## cpccoder2008 (Jun 18, 2009)

So if you use Constitutional in the ROS can you count it again for the PE ?


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## cpccoder2008 (Jun 18, 2009)

I guess a better wording of the question would be, Can you count a bullet more than once ? 

Ex: 

HPI- 66 y/o female with abdominal pain. No fever or weight loss. General apperance is well maintained.

PE- General: No fever or weight loss. No acute distress.


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## LLovett (Jun 18, 2009)

You can review the same system you examine, yes.

In your example

HPI- 66 y/o female with abdominal pain. No fever or weight loss (this would be cons ROS). General apperance is well maintained (this would be a cons exam bullet even though it is listed under HPI).

PE- General: No fever or weight loss (if the vitals are documented you could get the other cons exam bullet here). No acute distress.

Does that make sense?

Laura, CPC


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## Coder2hear813 (Jun 18, 2009)

There are three bullets for constituional exam bullet for my speciality(ENT): 

[*]Measurement of any 3 of the following 7 vital signs:sitting or standing blood pressure,supine blood pressure,pulse rate and regularity,respiration,temperature,height,weight(May be measured and 
recorded by ancillary staff)

[*]General appearance of patient

[*]Assessment of ability to communicate and quality of voice


ROS constitutional is if the patient reports weight gain,wieght loss, etc.

Hope this helps 

Shana CPC, CPC-H


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## cpccoder2008 (Jun 18, 2009)

so can i use it twice if only documented once ? Can i use Con in the HPI for a ROS and use it for PE ?  My physician might write 

HPI- 66 y/o female with abdominal pain.

PE-

General- No fever or weight loss. 

Could i use one bullet for ROS and one for PE ?


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## LLovett (Jun 18, 2009)

If the documentation is only no fever, no weight loss the only thing that could be in my opinion is ROS. If there are also vitals, ie bp 120/80, wt 150, temp 98.6, then that is an exam element. 

Bottom line, one statement can not be counted twice. 

Laura, CPC


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## cpccoder2008 (Jul 13, 2009)

katmryn78 said:


> If the documentation is only no fever, no weight loss the only thing that could be in my opinion is ROS. If there are also vitals, ie bp 120/80, wt 150, temp 98.6, then that is an exam element.
> 
> Bottom line, one statement can not be counted twice.
> 
> Laura, CPC



So you can't use the no fever or weight loss as a bullet for Cons under the PE for General Apperance ?


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## FTessaBartels (Jul 13, 2009)

*Your specific question*

cpccoder2008, You ask: *so can i use it twice if only documented once ? Can i use Con in the HPI for a ROS and use it for PE ? My physician might write 

HPI- 66 y/o female with abdominal pain.

PE-

General- No fever or weight loss. *

NO ... you cannot use the exact same statement (documented only once) to count for both ROS and exam.  

The physician *MAY* have documented two statements, one under HPI that patient had no complaint of fever or weight loss (which would count as ROS constitutional), and then the physician *may* have recorded the temp and weight (if using 95 guidelines, you'd still get a bullet for constitutional ... 97 needs 3 vital signs to get a bullet).

F Tessa Bartels, CPC, CEMC


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## cpccoder2008 (Jul 14, 2009)

Ok. I think i'm understanding better now. I know that i can't use the same statement twice. But how do i determine if i can get a bullet from the constitutional for either ROS or PE ?? What makes the two different ? I am reffering to the 1997 Guidelines. What are some examples of constitutional ? I know for the PE three vitals count as one bullet and general appearance as another. BUt why would fever and weight loss only count towards ROS ? Couldn't weight loss be considered general appearance ? I have reviewed the E.M university site which is very helpful with examples but i can't seem to find any for constitutional.


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