# HPI elements - had cold symptoms



## LindaEV (Nov 25, 2009)

When calculating HPI elements, do all "4" have to be on the same complaint?

for example, pt came in for cold and shoulder pain..

Pt has had cold symptoms for five days (duration) and has been taking Robitussin with some relief of symptoms (modifying factors). complains of low grade fever (associated signs and sympoms). She also has pain in her shoulder, which she describes as a 7/10 (severity). It hurts worse in the evenings (timing).

neither condition has 4 elements...but is this still considered extended/comprehensive??


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## RebeccaWoodward* (Nov 25, 2009)

LINDALOUH said:


> When calculating HPI elements, do all "4" have to be on the same complaint?
> 
> for example, pt came in for cold and shoulder pain..
> 
> ...



Do you mean does 5 days (duration) need 4 HPI elements of it's own (example)...? NO...

You have a perfect example of an Extended HPI...

"An extended HPI consists of at *least four elements *of the HPI"

http://emuniversity.com/HistoryofPresentIllness.html#HPI elements


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## LindaEV (Nov 25, 2009)

Thanks Rebecca....now just to clarify...can I use certain elements more than once if they are used for seperate complaints....

cold for 5 days (duration), robitussin has not been helping (mod. factors)
shoulder pain for 7 days (duration), has been taking aleve with little relief (mod. factors)

And if complaint was ONLY cold....I could not use elements more than once, correct...cough with fever,chills,runny nose(assoc sx's times 1, not three right?)


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## MBronowicki (Nov 25, 2009)

I would go with pain (location, shoulder) severity (7/10) accompanied by fever/flu symptoms and timing (worse in the evenings)    YOU HAVE 4.

Margaret B.


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## Jagadish (Nov 30, 2009)

The following is an excerpt from an E/M auditor's hand book:
"If a patient has multiple complaints, you can have one or two elements from each of two or three complaints, to total four elements. Each individual complaint does not require four elements, but the sum must be four elements."

Linda-
Hope this answers your question!


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## FTessaBartels (Dec 1, 2009)

*Duration counted twice for two complaints*

I was at a coding symposium hosted by the Wisconsin Medical Society in October. The E/M coding panel consisted of, among others, reps from Medicare, commercial insurance, and auditors. 

They all agreed that if you have two different complaints you can count an element twice ... i.e. duration for the cold and duration for the shoulder pain.

It was news to me ...

And you are correct: if you have 1 or 12 associated symptoms for the SAME complaint, you still only count 1 HPI element.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## LindaEV (Dec 1, 2009)

That was my next question...about counting duration twice...but makes sense to me since they are different complaints.

Thank you Tessa


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## Jagadish (Dec 3, 2009)

Tessa

If you have any documentation in regards to this issue, of the symposium you attended; please share it. My email: nullobrain@yahoo.com


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## FTessaBartels (Dec 3, 2009)

*two complaints*

No documentation from the symposium. It was verbally stated more than once during the 4-hours session.

F Tessa Bartels, CPC, CEMC


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