Wiki HPI: Associated signs

[natashalage]

Hello to All and thank you in advance for your help!
I am struggling to understand why I cannot use patient's 'No" response to Associated signs to count it as an element for HPI. An example could be: patient's Office visit for hemorrhoids. I have location, duration, quality; I just need one more element to count total 4 for HPI. I have 10 ROS and I have 3 PFSH. In HPI patient states 'no bleeding, no nausea, no constipation." May I count pt's denial to Associated signs as an element? I believe the doctor did his diligence by asking and pt replied; it just happened to be a negative response to Associated signs.
What is the rational here?
Thank you.

 

[twizzle]

Hello to All and thank you in advance for your help!
I am struggling to understand why I cannot use patient's 'No" response to Associated signs to count it as an element for HPI. An example could be: patient's Office visit for hemorrhoids. I have location, duration, quality; I just need one more element to count total 4 for HPI. I have 10 ROS and I have 3 PFSH. In HPI patient states 'no bleeding, no nausea, no constipation." May I count pt's denial to Associated signs as an element? I believe the doctor did his diligence by asking and pt replied; it just happened to be a negative response to Associated signs.
What is the rational here?
Thank you.

You cannot use 'no' because it is not an associated sign and symptom. They don't have it so you can't cant count it as something they do have. The 'no bleeding, no nausea, no constipation' are ROS. In your own words, the doctor asked the patient these questions and the answer was 'no'.

 

[Pathos]

I can understand your reasoning, the provider spent time and effort to rule out certain conditions by asking if the patient had certain symptoms. However, if Medicare/insurance companies allowed this practice, then basically every E/M visit would automatically have the Associated Signs/Symptoms element filled out. All the provider has to ask if the patient had this or that sign/symptom. If the patient has a sign/symptom, this would count towards the overall Medical Necessity and Complexity of the patient; probably not so much if the patient didn't have a sign/symptom.

CMS guidelines