# Double Dipping HPI/ROS



## Love Coding! (Feb 14, 2012)

Hello,

I have a question about the ROS and "double dipping". My doc has dictated an inital hospital visit and in the HPI section has listed the problem as chest pain with shortness of breath.  In the ROS she has listed out her elements but when it comes to the cardiovasular and the respiratory she states "see HPI". 

Can I use these for both HPI elements and ROS?  I looked in the 1995/1997 documentation guidelines and it does not state a rule like this.  

If there is literature on this, can someone direct me to that please?  I am here in AZ and we go through Noridian.

Thank you!


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## rlh27 (Feb 14, 2012)

this is an answer from the highmark medicare website:

https://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#15


When scoring the review of systems (ROS), can you use the systems addressed in the history of present illness (HPI) elements or is that "double dipping"?
ROS inquiries are questions concerning the system(s) directly related to the problem(s) identified in the HPI. Therefore, it is not considered "double dipping" to use the system(s) addressed in the HPI for ROS credit.

Date Posted: 10/16/2009, Date Revised: 11/19/2011

hope this helps.


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## Love Coding! (Feb 15, 2012)

rlh27 said:


> this is an answer from the highmark medicare website:
> 
> https://www.highmarkmedicareservices.com/faq/partb/pet/lpet-evaluation_management_services.html#15
> 
> ...



Thank you RLH27, this is the frustrating part about E/M so many suggestions of the same rule and so different interpretations.  I have heard that you cannot use a describing factor for the ROS if it's already used as a describing factor in the HPI.

Thanks again...


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## rthames052006 (Feb 15, 2012)

dscoder74 said:


> Thank you RLH27, this is the frustrating part about E/M so many suggestions of the same rule and so different interpretations.  I have heard that you cannot use a describing factor for the ROS if it's already used as a describing factor in the HPI.
> 
> Thanks again...



 dscoder74:

I see your mac is not Highmark Medicare so you maybe under differant rules regarding "double dipping".  My advice would be to check with your carrier before applying this method to your auditing/coding.


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## Love Coding! (Feb 15, 2012)

rthames052006 said:


> dscoder74:
> 
> I see your mac is not Highmark Medicare so you maybe under differant rules regarding "double dipping".  My advice would be to check with your carrier before applying this method to your auditing/coding.



I thought the same thing, thank you, my MI are Noridian and Palmetto GBA


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## rlh27 (Feb 15, 2012)

i suppose it's easy to find the plethora of info provided by trailblazer and highmark   even my mac, cahaba, has an answer to the HPI ROS double dipping question on their FAQ but I looked on yours briefly and didn't see anything.  didn't find anything on the MedAssets database search which usually spits out a gem or two.  good luck!


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## Love Coding! (Feb 15, 2012)

rlh27 said:


> i suppose it's easy to find the plethora of info provided by trailblazer and highmark   even my mac, cahaba, has an answer to the HPI ROS double dipping question on their FAQ but I looked on yours briefly and didn't see anything.  didn't find anything on the MedAssets database search which usually spits out a gem or two.  good luck!



Thanks so much for looking and letting me know! Much appreciated!


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