Oncology & Hematology Coding Alert

Question: What is the difference between problem-pertinent, extended and complete review of systems (ROS) on an E/M service?

Kentucky Subscriber

Answer: You-ll need to know the difference between the three ROS levels because ROS is a vital component to determining your level of history, which, in turn, determines the level of E/M service.

Problem-pertinent: The 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 an expanded problem-focused level of history, which can support up to a level-three established patient E/M service (99213) or level-two new patient E/M service (99202) -- 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. "Limited" can be anywhere from two to nine systems, depending on the service your physician provides. An extended ROS can support up to a detailed level of history, which can support a level-four established patient E/M service (99214) or level-three new patient E/M service (99203).

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 comprehensive level of history, which can support a level-five established patient E/M service (99215) or a level-four or -five new patient E/M service (99204 or 99205).