Neurology & Pain Management Coding Alert

Question: What are the various review of system (ROS) levels?

Kentucky Subscriber

Answer: There are four ROS levels that contribute to the history level you select for an E/M service. ROS progresses from "nonavailable" to "problem-pertinent" to "extended" and "complete."

- In a problem-pertinent ROS, your physician asks questions about the system directly related to the problem the patient identified in the history of present illness (HPI).

- When the physician asks about a limited number of additional systems, he meets the criteria for an extended ROS.

Important: Extended ROS documentation must include positive responses and pertinent negatives for two to nine systems, according to both the 1995 and 1997 Documentation Guidelines for E/M Services. You can view the guidelines on the Web at http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp.

- A complete ROS requires inquiring about all organ systems. The physician must review at least 10 organ systems and individually document those systems with positive responses and pertinent negatives.

Tip: For the remaining systems, the neurologist can use a notation to indicate that all other systems are negative. Without such a notation, he must individually document at least 10 systems for the documentation to support a complete ROS.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.