# Hpi elements-I am just



## HOWRU2DAY (Feb 25, 2013)

I am just trying to make sure that I am getting this right. An associated sign and symptom must be a symptom that the patient has. I have seen this be counted as an associated sign for a symptom that the patient does not have." no reflux or strider ." Context should be what the patient was doing when the symptoms occured. The statement of "Patient walks 2 miles per day on the treadmill". I am thinking that this would not be context.


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## Pam Brooks (Feb 25, 2013)

The Associated signs and symptoms are those that are present relative to the chief complaint.  In addressing the comment in your post, "no reflux or stridor", you'd use this as a system review.

I describe context as "circumstance".  What was happening, how did this happen, what were the circumstances surrounding the chief complaint? So if "patient walks 2 miles a day on the treadmill", and the chief complaint was shin splints, this could be considered context.  Otherwise, I'd call it social history.


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## Tonyj (Feb 25, 2013)

Pam Brooks said:


> The Associated signs and symptoms are those that are present relative to the chief complaint.  In addressing the comment in your post, "no reflux or stridor", you'd use this as a system review.
> 
> I describe context as "circumstance".  What was happening, how did this happen, what were the circumstances surrounding the chief complaint? So if "patient walks 2 miles a day on the treadmill", and the chief complaint was shin splints, this could be considered context.  Otherwise, I'd call it social history.



My 2 cents, "no reflux or stridor" you can also use it for associated signs and symptoms as a negative.


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## shruthi (Feb 26, 2013)

Tonyj said:


> My 2 cents, "no reflux or stridor" you can also use it for associated signs and symptoms as a negative.



You cannot use 'no reflux or stridor' as associated signs and symptoms, but this can only be used as ROS.
Symptoms which are not present cannot be counted, but in case of ROS even though it is negative we can consider.

Thanks,
Shruthi


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## Pam Brooks (Feb 26, 2013)

Tonyj said:


> My 2 cents, "no reflux or stridor" you can also use it for associated signs and symptoms as a negative.


 
I respectfully disagree.  Signs and symptoms must be present in order to count for HPI.  Pertinent positives and negatives apply to ROS, not HPI.


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## jimbo1231 (Feb 26, 2013)

*Interesting Discussion*

Did we establish what the actual Chief Complaint/Presenting Problem was? All I see is they were walking on a treadmill and have no reflux or stridor. I have a feeling it is chest pain which can well be related to walking on that treadmill! But overall I agree with everyone!

Jim


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## Tonyj (Feb 26, 2013)

Pam Brooks said:


> I respectfully disagree.  Signs and symptoms must be present in order to count for HPI.  Pertinent positives and negatives apply to ROS, not HPI.



This is the response from a previous threat dated 2009 concerning pertinent negatives as HPI elements under associated signs and symptoms. Please read post attached.

12-22-2009, 01:27 AM  
Jagadish  
Guru   Join Date: Apr 2007
Posts: 155 

  --------------------------------------------------------------------------------

The following is from CPT assistant April 1996 / Volume 6, Issue 04. According to this we can take pertinent negatives as HPI elements under Associated Signs and Symptoms.

Generalized symptoms, such as chills and/or fever (and its levels) headaches, overall weakness, or exhaustion are often relevant. A clinician may ask patients directly about "pertinent positives and negatives," such as the presence of bloody or tarry stools associated with changing bowel habits. 


This is also confirmed in "Emergency Department Services" Webinar dated
December 11, 2008 by Highmark Medicare Services. Pages 13-14 of https://www.highmarkmedicareservices...r-handouts.pdf 
__________________
Thanks,
Jagadish, CCS-P, CPC


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## Pam Brooks (Feb 26, 2013)

Since 1996 and 2008 were awhile ago, and things change in coding, I thought I'd share the instructions from our contractor, NHIC, in the March 2012 version of the E&M guidelines. Other contractors (like Trailblazers) may disagree. As long as you're following the guidelines of your local carrier, I guess you can argue that counting a negative response as a positive sign/symptom is valid. 


*Associated signs and symptoms describe the symptom/pain and other things that happen when this symptom/pain occurs (chest pain leads to shortness of breath, headache leads to vision constriction). *

There is no mention here of using signs and symptoms that are not happening. I stick by my guns on this one in that any negative response would be included as a system review, not an associated sign or symptom.


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