# ROS vs HPI



## Ann  (Aug 10, 2011)

I am confused regarding HPI. Last year during an E&M webinar the instructor stated that "HPI is not a negative finding. Remember that HPI is a symptom - so how can it be a negative finding."  Last week I attended another webinar and that instructor stated that HPI can be a negative or positive.  Which way is correct?


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## LindaEV (Aug 10, 2011)

I'm with you. I was always taught the same thing. The HPI is what the_ patient says _about their illness "my left leg hurts when I run, and motrin is not helping". When I see "no right leg pain, no swelling, no warmth, no redness" then I know these are responses to what the doc is asking.

The same thing came up in a seminar I was in (given my our local Medicare carrier) and I questioned it. To my suprise, I seemed to be in the minority in the room. 

I'd like some better examples of negative responses for an HPI.


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## FTessaBartels (Aug 11, 2011)

*Negative HPI*

I DO give credit for negatives for associated signs/symptoms.  

I recently saw my physician due to recurring headache.  I described my problem as a "*typical sinus mask headache, mostly around the right eye/cheek, since last Tuesday, but without any sinus drainage or post nasal drip, no fever, or other symptoms of usual sinus infection.  Have taken some Tylenol when the pain gets to where I can't just ignore it; that works for a few hours, but the headache comes back*." 

This was exactly how I myself (the patient) described it to the physician.  I described the typical "associated signs/symptoms" as negative without any prompting from the physician. 
So I'd give credit for 4 HPI elements for the above: location, duration, assoc signs, modifying factors.  But I would have given credit even if she had had to ask me about this to elicit the information. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## LindaEV (Aug 11, 2011)

I have this history dictation guide hanging on my wall. I don't know where I got it, but it says under assoc. signs and symptoms that this should be "other things or issues associated with or accompanying the problem." and then at the end of the example statements it says "if patient is responding to Physician questions mark ROS, if the patient offers the information mark HPI"

Most patients are NOT in the medical field, and would not offer up the clear HPI like you did. Who gives the best HPI's? Well E/M coders of course. 

I still don't agree.
Guidelines say:
_The HPI is a chronological description of the development of the patient's present illness from the first sign and/or symptom or from the previous encounter to the present. It includes the following elements:
• location,
• quality,
• severity,
• duration,
• timing,
• context,
• modifying factors, and
• associated signs and symptoms._

Iif something is non-existent...how is it a symptom?
I am not trying to argue with you...I really want to understand...like I said before, I realize many people give negative responses credit. There's a good possibilty I may be wrong...I'm just not convinced yet.


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## LLovett (Aug 11, 2011)

CC. Chest pain

HPI. Pt complains of chest pain for 2 hours, crushing in nature and pt feels short of breath.

Location, Duration, Quality, Associated Signs and Symptoms

CC. Chest pain

HPI. Pt complains of chest pain for 2 hours, crushing in nature but pt denies shortness of breath.

Location, Duration, Quality, Associated Signs and Symptoms.

As long as it is a pertinent negative response WPS Medicare says it is correct to count it for HPI.

Another example.

CC. Leg pain

HPI. Pt complains of Rt leg pain that is throbbing in nature for 2 days, fell down the stairs. 

Location, Quality, Duration, Context

CC. Leg pain

HPI. Pt complains of Rt leg pain that is throbbing in nature for 2 days, no known injury. 

Location, Quality, Duration, Context.

Hope this is helpful,

Laura, CPC , CPMA, CEMC


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## Ann  (Aug 15, 2011)

Laura,
Can you please tell me where you found the information from WPS? I was unable to find that.
Thanks,
Ann


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## rthames052006 (Aug 15, 2011)

*Pertinent negative response is the key!!!*



LLovett said:


> CC. Chest pain
> 
> HPI. Pt complains of chest pain for 2 hours, crushing in nature and pt feels short of breath.
> 
> ...




I agree with Laura and with Tessa.  The key here is "pertinent" negative responses.  There are times when a person has CC but doesn't have all the symptoms that normally go "hand in hand" with the condition.


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## LLovett (Aug 15, 2011)

http://wps.mediasite.com/mediasite/Viewer/?peid=e753387384fb443c8a886b6fa17fe2771d

This is an education. Info you want is on slide 29 but she says it at approx 01:05. So if you skip forward to slide 29 you just have to listen for about a minute. I have been thru this education 2 times on the phone conference and once in person. This is always the response.

Laura, CPC, CPMA, CEMC


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