ED Coding and Reimbursement Alert

Question: I have a question about the review of systems (ROS) portion of E/M services. What are the differences among problem-pertinent, extended, and complete ROS?


Kentucky Subscriber

Answer: You-ll need to know the differences among the three ROS levels because ROS is a vital component to determining your E/M code level.

Problem-pertinent: The ED physician performs a problem-pertinent ROS when he reviews a single system for the patient during the encounter. A problem-pertinent ROS can support up to a level-three E/M service (99283, Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity)--but be sure to choose your E/M code based on your physician's entire set of encounter notes, not just the ROS level. 
 
Extended: When the physician conducts an extended ROS, there must be evidence that he checked the system directly related to the patient's problem and a -limited- number of additional systems. According to Medicare, -limited- can be anywhere from two to nine systems, depending on the service your physician provides. An extended ROS can support up to a level-four service (99284, - a detailed history; a detailed examination; and medical decision-making of moderate complexity). 
 
Complete: The physician must review 10 or more systems to qualify for a complete ROS and must individually document those systems with positive or pertinent negative responses. For the remaining systems, a notation that all other systems are negative is permissible. In the absence of such a notation, the physician must individually document at least 10 systems.

A complete ROS can support a level-five E/M (99285, - a comprehensive history; a comprehensive examination; and medical decision-making of high complexity).