# Can you get 4 in this HPI??



## coder25 (Mar 16, 2010)

68 Y/O female presents with abdominal pain since 4:00 am yesterday afternoon.  She complains of pain located in the periumbilical area with localization to the RLQ.  She reports a normal bowel movement but has been dealing with constipation for several weeks.  She denies any nausea or vomiting, but does complain of some belching, which is new for her.  She has no fevers/chills/sweats.  She does have a history of similar symptoms last week, which have resolved spontaneously.

This is what I can come up with, any additional help is greatly appreciated!

location--abdominal pain

timing--yesterday afternoon

associated S&S--belching/constipation

Could I use belching or the constipation as a location, or just keep it with signs and symptoms?  

I am not sure what else I could use.

Thanks again for your help!

Peggy


----------



## FTessaBartels (Mar 16, 2010)

*Hpi*

Location - "Where is it"  -  site, diffuse, localized
Quality - "What kind is it"  -  sharp, dull, constant
Severity - "How bad is it" - pain scale 1-10, mild, severe, worsening
Duration - "How long" - length of time it has been present
Timing - "Is there a pattern" - continuous, repetitive, relation to something else.
Context - "What brings it on" - does it occur with a specific activity
Modifying Factors - "What makes it better or worse" - treatments tried
Assoc. Signs/Symptoms - "What comes with it" - other symptoms that accompany the main complaint.

In your example you have Location (abdomen), Duration (yesterday), Assoc signs/symtpoms (belching /constipation).  

I'd be willing to listen to arguments that would give credit for Modifying Factors since a previous episode "spontaneously resolved."  I am conflicted about giving credit for that. 

F Tessa Bartels, CPC, CEMC


----------



## coder25 (Mar 16, 2010)

Thanks for responding Tessa!  That is what I thought that I could only get 3 HPI.  She is a Medicare patient, guess this now a subsequent hospital code.  

Peggy


----------



## Colliemom (Mar 16, 2010)

I agree, I only see 3

Location - abdomen
duration - since yesterday
ass. signs and symptoms - belching and constipation

too bad the provider didn't mention the severity or quality of the symptoms...


----------



## FTessaBartels (Mar 17, 2010)

*Hospital admission?*



coder25 said:


> Thanks for responding Tessa!  That is what I thought that I could only get 3 HPI.  She is a Medicare patient, guess this now a subsequent hospital code.
> 
> Peggy



So this is an H&P?   I would use the 99499 unlisted E/M code and base my price on 99221.  This is the specific guidance given by our Medicare carrier in Wisconsin - WPS.

F Tessa Bartels, CPC, CEMC


----------



## coder25 (Mar 18, 2010)

Yes Tessa,

This is an H&P, however, by our webinar conference with Highmark Medicare Services, they do not want us to use the unlisted code.  They stated that we had to use the subsequent hospital codes, even for the admissions and for consultations.  


Peggy


----------



## sbrown64 (Apr 9, 2010)

*Additional HPI*

Why wouldn't anyone count constipation as context - what 'may' cause the problem?

Location - abdomen
Duration - since yesterday
Context - constipation
Associated S/S - belching

Schawn Pedersen, CPC, CEMC


----------



## Pam Brooks (Apr 12, 2010)

I would give 'quality' for normal BM, and 'duration' for several weeks of constipation. With abdominal pain for the location, and 4:00 for timing, you have four histories.  ROS:  GI and Constitutional.


I would argue a level four, with a clear conscience!


----------



## colleenwade (Apr 12, 2010)

*HPI elements*

68 Y/O female presents with abdominal  LOCATION pain since 4:00 am yesterday afternoon  DURATION.  
She complains of pain located in the periumbilical area with localization to the RLQ  LOCAITON.  
She reports a normal bowel movement but has been dealing with constipation  ASSOC'D SIGNS/SYMPT for several weeks DURATION.  
She denies any nausea or vomiting ASSOC'D SIGNS/SYMPT, but does complain of some QUALITY belching ASSOC'D SIGNS/SYMPT, which is new for her.
She has no fevers/chills/sweats. ASSOC'D SIGNS/SYMPT
She does have a history of similar symptoms last week, which have resolved spontaneously. TIMING _(pattern of wirsening/imporving)_

*Y - LOCATION*
*Y - QUALITY*
N - SEVERITY
*Y - DURATION*
*Y - TIMING*
N - CONTEXT
N - MODIFYING FACTORS
*Y - ASSOC'D SIGNS/SYPT*

This is just my opinion...  hope it helps!


----------

