Wiki HPI: "4 or more Associated Comorbidities"...what's that REALLY mean?

[BrendanMcAndrew]

Hi folks,

Hope this Thursday finds you all well. I'm wondering if anyone can provide some insight on the topic of "associated comorbidities".

The 1995 CMS E/M guidelines state that the HPI is considered detailed if:
1. 4 or more elements of the HPI are documented (Location, severity, timing, etc..)
2. 4 or more "associated comorbidities" are documented.

I understand the first scenario just fine, but I could use some more explanation as to what the second scenario means.

What exactly does 4 or more associated comorbidities mean?
Do the medical problems have to be specifically related to each other, or can the patient just simply have 4 or more medical problems that don't relate to each other but are present at the time of exam (for example: COPD, Anxiety, GERD, Hypertension).

Thanks!!!!

 

[Kris Cummings]

That specific statement does indicate the comorbidities must be associated with the presenting problem(s).

There's also the 1997 E/M DG bullet for HPI where, for an extended HPI, one may use either four elements of HPI, or the status of three chronic or inactive conditions. On January 9, 2013, CMS responded to an inquiry from WPS on whether that can be used in with both DG's (1995 and 1997) and CMS indicated yes it may. I'm attaching a copy of that letter.



I hope that helps.

 

[daedolos]

That thumbnail is illegible. You have a link?

Peace
?_?

 

[Kris Cummings]

I can only load the attachment/image as AAPC forum settings allow. So, here's a link to a CMS FAQ that advises effective 9/10/2013, "...physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service".

Here's the link: https://www.cms.gov/Medicare/Medica...sicianFeeSched/Downloads/EM-FAQ-1995-1997.pdf

Good luck.