Pediatric Coding Alert

You cannot choose an E/M code before settling on ROS level.

One of the important aspects of evaluation and management (E/M) coding is history, and a vital part of selecting the appropriate history level is nailing the provider’s review of systems (ROS) level.

Without determining the appropriate ROS level, you could have trouble choosing the proper E/M code.

Keep ROS from becoming an issue by reviewing this expert FAQ.

Q: What Is ROS?

A: According to Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Ill., “ROS is part of the history for an E/M service for the physician to understand any conditions the patient has experienced in the past.”

The “systems” referenced in ROS are:

• Constitutional symptoms (fever, weight loss, etc.)
• Eyes
• Ears, nose, mouth, throat
• Cardiovascular
• Respiratory
• Gastrointestinal
• Genitourinary
• Musculoskeletal
• Integumentary (skin and/or breast)
• Neurological
• Psychiatric
• Endocrine
• Hematologic/lymphatic
• Allergic/immunologic

To conduct ROS, the pediatrician asks a series of questions related to the patient’s signs/symptoms. Providers use ROS data to zero in on the problem by helping to clarify a differential diagnosis and identifying any needed testing. ROS will also help the accumulate “baseline data on other systems that might be affected by any possible management options,” explains Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Neb.

Remember: In order to bulwark your ROS coding, be sure that the systems the pediatrician reviews relate to the systems listed as problems in the history of present illness (HPI), says Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC. If there’s no link between ROS and HPI, you might have to review your ROS choice.

What Are the Different ROS Levels?

There are three different levels of ROS, confirms Anderanin:

1. Problem-pertinent: For a problem-pertinent ROS, the pediatrician must review a single system. So, if the provider treats a patient for a runny nose, and notes indicate that he reviewed the ears, nose, mouth, throat system, it’s a problem-pertinent ROS.

2. Extended: The pediatrician must review between two and nine systems for extended ROS. So, if the provider treats a patient for a runny nose, upset stomach, wheezing, and fever, he’s reviewed four systems:

• ears, nose, mouth, throat;
• gastrointestinal
• respiratory; and
• constitutional.

3. Complete: If the pediatrician reviews at least 10 systems, you can mark complete ROS. According to the 1995 and 1997 E/M Documentation Guidelines, you must review and individually document all 10-plus systems with positive or pertinent negative responses for complete ROS. For the remaining systems, a notation indicating “all other systems are negative” is allowable. Without this notation, however, you must have individual documentation proving review of 10 or more systems for complete ROS.