# ROS-all systems negative



## Networker3412

How are you supposed to calculate the ros when the doctor only check marks the all systems negative box and there is nothing that we can take from the HPI section? It this calculated to as no ROS ?


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## cmcruz

That would be counted as a complete review of systems, you would take the statement "all systems negative" to mean that all systems were reviewed and they are all negative.  I hope this helps.

Christine Cruz, CPC
Professional Billing


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## Networker3412

from what i was taught you cant consider this to be a complete ros when the box is the only thing checked marked. I have read other posts within aapc and that is what everyone else says along with the aapc book on E&M coding that there has to be at least positive and negative system checked.  I am just not sure how to calculate this when the physician has not marked any positive or negative systems that he reviewed. Only the box is checked marked......??? any help would be appreciated.


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## eadun2000

littlebit29 said:


> from what i was taught you cant consider this to be a complete ros when the box is the only thing checked marked. I have read other posts within aapc and that is what everyone else says along with the aapc book on E&M coding that there has to be at least positive and negative system checked.  I am just not sure how to calculate this when the physician has not marked any positive or negative systems that he reviewed. Only the box is checked marked......??? any help would be appreciated.



It is a counted as a full review of systems.  You said there had to be at least one positive and negative system checked.  Well, if ALL SYSTEMS reviewed and are NEGATIVE, how do you think there is going to be a positive if all are negative?


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## RebeccaWoodward*

littlebit29 said:


> How are you supposed to calculate the ros when* the doctor only check marks the all systems negative box and there is nothing that we can take from the HPI section?* It this calculated to as no ROS ?



Is this a complete PE?  No complaints? If this was a problem oriented visit, it seems that there would be a least one positive or is this mgmt of chronic conditions?  What's the CC?


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## Networker3412

According to the other posts in the forums alot of ppl are saying that this is not a complete ros when the only thing that is checked marked is the box. I looked online at other sites and I also looked in the AAPC study guide and it all states : 
E/M University Coding Tip: When documenting the ROS , it is not necessary to list each system individually.  It is acceptable to document a few pertinent positive or negative findings and then say: “All other systems were reviewed and are negative.” in the aapc book its states that a complete ros is the positive and negative responses for all additional body systems related to the problem at least 10 systems must be noted. 

</EM>So now i am getting confused because alot of the other posts say you cant count the box as complete ROS and now i am being told it is a complete ros??? So how do i calculate this when it is just the box that is checked marked and i cant pull any information from the hpi??oh and this  is for the ER E&M codes 99281-99285.


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## Networker3412

The other posts on here say that checking the box is not enough for a complete because what systems were reviewed and negative.????


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## RebeccaWoodward*

I understand your concern and it's a valid one.  I have an issue with simply checking a box notating "all systems negative" when there must be a reason they are presenting to the *ER*.  If there isn't any information in the HPI to work with, I would not allow this statment...but that's just me.


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## depaul

It is a complete review of systems. When I was preparing for the CEMC exam last fall the practicum exam had this same scenario and the rationale was if it is documented all system are negative then it is counted as a complete ROS. 

Diane Bazuin, CPC, CEMC


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## Pam Brooks

littlebit29 said:


> According to the other posts in the forums alot of ppl are saying that this is not a complete ros when the only thing that is checked marked is the box. I looked online at other sites and I also looked in the AAPC study guide and it all states :
> E/M University Coding Tip: When documenting the ROS , it is not necessary to list each system individually.  It is acceptable to document a few pertinent positive or negative findings and then say: “All other systems were reviewed and are negative.” in the aapc book its states that a complete ros is the positive and negative responses for all additional body systems related to the problem at least 10 systems must be noted.
> 
> </EM>So now i am getting confused because alot of the other posts say you cant count the box as complete ROS and now i am being told it is a complete ros??? So how do i calculate this when it is just the box that is checked marked and i cant pull any information from the hpi??oh and this  is for the ER E&M codes 99281-99285.



There are many talented and experienced coders who post on this board, and I have off-line discussions with several of them quite frequently.  That having been said, there are a number of posts from coders who tell us, "this is what I do".  As a professional coder, it is your reponsibility to research the documentation guidelines and use them as the basis for your standardized coding process.  Consultants and other coders may certainly give their opinions, but the DGs really must take precedence.  E&M University (Peter Jensen...and I talk to him all the time) is a consultant who provides recommendations.  The AAPC study guide is just that....a guide.  And even years ago, when I took the CPC exam, it was a known fact that CMS and the AAPC coding guides didn't necessarily agree...but the AAPC won't fine you if you make a coding error.  I recommend you use only regulatory guidance to support your coding policy, not just comments from this board. The best responses you'll get from this discussion board are the ones that point you directly to the regulatory guidance.   This is from the 1995 CMS guidelines:

A complete ROS inquires about the system(s) directly related to the problem(s) identified in theHPI plus all additional body systems.
DG: At least ten organ systems must be reviewed. Those systems with positive or
pertinent negative responses must be individually documented. For the
remaining systems, a notation indicating all other systems are negative is
permissible. In the absence of such a notation, at least ten systems must be
individually documented.

What this tells us that simply checking off 'all others negative' is inappropriate, because CMS requires us to document *pertinent positives and negatives*.  Exclusion of this documentation constitutes no system review.


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## RebeccaWoodward*

Quote:It is a complete review of systems. When I was preparing for the CEMC exam last fall the practicum exam had this same scenario and the rationale was if it is documented all system are negative then it is counted as a complete ROS. 

Diane Bazuin, CPC, CEMC 



How is it that someone presents to the ER with no complaints?  The poster stated that there wasn't anything to pull from the HPI.  I find a compliance issue with this.  This appears to be a fast track way of documenting without providing information about the nature of the presenting problem.


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## jdibble

*Poor documentation!*



RebeccaWoodward* said:


> How is it that someone presents to the ER with no complaints?  The poster stated that there wasn't anything to pull from the HPI.  I find a compliance issue with this.  This appears to be a fast track way of documenting without providing information about the nature of the presenting problem.



I agree with Rebecca in this scenario.  Something is missing from this documentation if nothing can be found in the HPI and the documentation states ALL systems negative.  The patient is in the ER so it isn't a routine visit - something has to be a positive somewhere!  By just checking one box that says all systems negative, it seems that the provider is just being lazy in completing his documentation.  In this case I would not award them with a complete ROS.  I find it hard to believe that nothing was reveiwed for the HPI during this encounter or that all was negative! Why was this patient in the ER??

In our Urgent Care we have a template for the doctors to follow - but each system has to be either checked with a positive item or checked as negative.  This eliminates the ability for the doctor to be lazy and just check one box!

Thanks,


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## eadun2000

littlebit29 said:


> According to the other posts in the forums alot of ppl are saying that this is not a complete ros when the only thing that is checked marked is the box. I looked online at other sites and I also looked in the AAPC study guide and it all states :
> E/M University Coding Tip: When documenting the ROS , it is not necessary to list each system individually.  It is acceptable to document a few pertinent positive or negative findings and then say: “All other systems were reviewed and are negative.” in the aapc book its states that a complete ros is the positive and negative responses for all additional body systems related to the problem at least 10 systems must be noted.
> 
> </EM>So now i am getting confused because alot of the other posts say you cant count the box as complete ROS and now i am being told it is a complete ros??? So how do i calculate this when it is just the box that is checked marked and i cant pull any information from the hpi??oh and this  is for the ER E&M codes 99281-99285.



Okay for an ER visit, you have to have at least one positive... I mean the patient came in for a reason.  So in this scenario, I would say no ROS were done/documented.  You cannot just check the box to check the box.  However, if the patient was coming in say for a yearly exam, I can see the box being checked if the patient did not have any complaints.  Hope this makes sense.


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## martinni1974

I would have to agree with Pam, all others negative should not be used routinely and there should be some documentation of the CC and a correlating HPI/ROS documentation pertaining to such.


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