You can document an HPI without symptoms. Just by saying the patient presents with CKD, the location (kidney) has already been identified, which is one element and enough for a brief HPI. So for example, "the patient presents for evaluation of CKD which was identified last April by their PCP by lab-work ordered during a routine physical. Recent labs the disease has worsened but the patient remains asymptomatic.' This could support a detailed HPI since it includes information about location, duration, context, quality and associated signs and symptoms. And remember that if it's an established patient you only need two out of three components, so if the patient remains asymptomatic, you would not expect the provider to need to document much history if there's nothing new since the last visit, the exam and MDM would really make up the visit.