Wiki Level of HPI when more than one problem

[tag60]

I'm unsure what to count/focus on in the HPI when determining the level of E/M when there is more than one problem being addressed. An experienced coder told me to just pick one problem and count the elements for that one problem (location, quality, duration, etc.). Another experienced coder told me to consider all problems and count up all elements. Sometimes I'll get a note where the patient has two or more problems/complaints, but the HPI for each problem alone is somewhat skimpy. If I focus on only one problem to count up the HPI elements, I'll get problem focused, but if I consider both problems, this might bump it into the expanded problem focused level of HPI. This can obviously make a difference in the final E/M level of visit. So, the question is, can I count more than one problem for the HPI?

Thanks in advance!

 

[CatchTheWind]

You can count points from all problems combined. However, most MACs won't let you count the SAME element twice. To explain:

Patient has a rash with location and severity noted, and a lesion with location and duration noted.

If you are in Novitas's jurisdiction, you get four points (location x2, severity, and duration).

In other jurisdictions, you get three points (location, severity, and duration).

Here's the article explaining the issue:

https://www.aad.org/dw/monthly/2012/september/understanding-hpi-elements