Know if you can rule duration in or out. If you’ve been an E/M coder for any length of time, you know all too well how important the history of present illness (HPI) is to determining the correct level for an office or outpatient E/M service. But keeping those elements straight, and knowing how many of them to count in determining levels, can sometimes be a challenge. So, read the following guide and get the full lowdown on which elements to apply and when to apply them. First, Know HPI Definition HPI is a “chronological description of the development and/or progress of the patient’s present illness/injury,” explains Yvonne Dillon, CPC, CEDC, director of emergency department services for Bill Dunbar and Associates, LLC, in Indianapolis, Ind. Providers take HPI when interviewing the patient about the condition that caused them to visit the practice. The provider should get the description from the patient’s own words during the encounter “from the first sign and/or symptom, or from the previous encounter, to the present visit,” explains Dillon. Check Which Element List You Should Use Depending on the payer, there are seven or eight HPI elements, reminds Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. For Medicare and Medicaid payers, the HPI elements are: Caveat: CPT® does not include duration in its list of HPI elements, so some private payers might only use the other seven elements. If you are unsure of a payer’s HPI element list, call your representative to check. Use 3-Element Limit for Brief HPI Once you’ve got a handle on what HPI is, and which element list you’ll use, you’re ready to check the encounter notes to see whether the provider performed brief or extended HPI. When a provider reviews one to three elements during the E/M, she is performing brief HPI, confirms Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska. Because CPT® considers a brief HPI part of a problem-focused or expanded problem-focused history, it can support the following E/M office visit levels: Scenario: A Medicare patient reports to the orthopedist with a chief compliant of shoulder pain (location). The patient reports that the pain has gone on for about a month (duration). HPI: The provider reviewed two elements, so this is an example of a brief HPI. Count to 4 Before Considering Extended HPI When a provider reviews four or more elements during the E/M, she is performing an extended HPI, Swanson says. Having enough elements to qualify as an extended HPI means the care might mean coding for a detailed or comprehensive history. When you spot an extended HPI on an encounter form, it might make the visit eligible for the following E/M office visit levels: Remember: An extended HPI does not guarantee a higher-level E/M code; it only makes reporting these E/M codes possible. The provider must still must satisfy other encounter requirements (review of systems [ROS] level; past, family, social history [PFSH] level; physical exam level; medical decision-making level) in order to select a higher-level E/M office visit code. Consider this example A Medicare patient reports to your office complaining of upper leg and knee pain. The provider asks the patient: HPI: The provider reviewed seven systems, so this case is an example of extended HPI.