ED Coding and Reimbursement Alert

Question: Encounter notes indicate that during the course of an E/M, a patient complains of chest pain. In response, the physician asks the patient to describe the chest pain; he also asks the patient if he has had any heart palpitations or a rapid heartbeat. Is this a problempertinent or extended review of systems (ROS)?

South Carolina Subscriber

Answer: This is a problem-pertinent ROS, in which the physician conducts a single system review. This ROS level can support up to a level-three ED E/M (99283, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...).

To reach the next level of ROS (extended), the physician must review between two and nine systems. Although your physician did ask about three issues (chest pain, palpitations, rapid heartbeat), all the questions were part of a cardiovascular system review.