Review of Systems question

[suckstobeme]

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Do you guys ever use "Limited by Age" as a review of systems disclaimer for Peds patients? I don't see a ton of Peds anymore as we have a Pediatrician in the ED seeing most kids for the part of the day when I work.

I do use the "Limited by Age" sometimes, but I'm not sure if it gives you full credit for coding purposes. If so, how old of a patient do you tend to use it on? If you have a shy 6yr old who can answer some questions but won't tell you if it hurts when he pees, is it legit to use it?

 

[turkeyjerky]

Do you guys ever use "Limited by Age" as a review of systems disclaimer for Peds patients? I don't see a ton of Peds anymore as we have a Pediatrician in the ED seeing most kids for the part of the day when I work.

I do use the "Limited by Age" sometimes, but I'm not sure if it gives you full credit for coding purposes. If so, how old of a patient do you tend to use it on? If you have a shy 6yr old who can answer some questions but won't tell you if it hurts when he pees, is it legit to use it?

I use it all the time. I tell the scribes to routinely put in in for <6 (although for some reason they still leave everything else crossed off...grr)

I have no idea about the biking, interested to find out

 

[GeneralVeers]

I use it all the time. I tell the scribes to routinely put in in for <6 (although for some reason they still leave everything else crossed off...grr)

I have no idea about the biking, interested to find out

I use it all the time. I tell the scribes to routinely put in in for <6 (although for some reason they still leave everything else crossed off...grr)

I have no idea about the biking, interested to find out

I use it all the time too. Generally "dementia" "altered mental status" and "clinical condition". Other than a game the government plays for non-payment if you miss this, why on earth do we have to document this crap? It's completely useless for EM.

 

[EctopicFetus]

A better way to document this is negative per family. Whether this is acceptable depends on what your billing company says. When I teach other to document I find that limited by age stuff to be unacceptable and sloppy. Of course what is ok for a resident is different than an attending chart.

In the end you can ask the parents about vomiting, fever, etc. a limited ROS is ok. You can always finish with “have you noticed anything else medically with the kid”? Any other symptoms? Of course if the parents are insane you may get more than you bargained for.

 

[Angry Birds]

I use it all the time too. Generally "dementia" "altered mental status" and "clinical condition". Other than a game the government plays for non-payment if you miss this, why on earth do we have to document this crap? It's completely useless for EM.

I also use "H&P limited by .... " liberally. It's awesome.

 

[deleted109597]

Correct. Technically anything you can't get a straight answer from the patient from is "limited by" and you still get credit for trying.

 

[Vandalia]

I was so tempted at times to include, "Limited by patient stupidity..." Never had the nerve, though.

 

[deleted836128]

ALWAYS. In a situation where I will be stuck with an incomplete ROS, documentation that there was a history limitation gives me a “pass” so I can still get credit for that ROS! I use it all the time for kids who really can’t provide much history (usually just the babies and toddlers), demented patients, even those histrionic patients that are so dramatic they can’t be bothered to give you a full history. If you can’t get all the questions you want to be answered answered, it needs to be mentioned that the reason for this is some history limitation. Otherwise it might make me look lazy and not thorough - I don’t like that!

 

[Angry Birds]

I was so tempted at times to include, "Limited by patient stupidity..." Never had the nerve, though.

H&P is limited by the fact that I don’t give a s***

 

[GeneralVeers]

H&P is limited by the fact that I don’t give a s***

Seriously. I usually just make up ROS. Anyone who spends time actually asking 10 ROS questions is wasting a lot of time. Most of the time the patients will sit and think about each and every one as if it's a valuable nugget of gold. They will then relate an interesting (to them) anecdote about their lives.

 

[RustedFox]

Seriously. I usually just make up ROS. Anyone who spends time actually asking 10 ROS questions is wasting a lot of time. Most of the time the patients will sit and think about each and every one as if it's a valuable nugget of gold. They will then relate an interesting (to them) anecdote about their lives.

Yep.
They do this all the time and I hate it.
"Have you noticed any other symptoms?"
- Well, I was at the gun show yesterday, and my brother lives in Georgia.
"Thanks for that. Have you noticed any other symptoms?"

 

[gutonc]

Seriously. I usually just make up ROS. Anyone who spends time actually asking 10 ROS questions is wasting a lot of time. Most of the time the patients will sit and think about each and every one as if it's a valuable nugget of gold. They will then relate an interesting (to them) anecdote about their lives.

I'm not in the ED, but I have a list that I rattle off rapid fire for every patient. I don't give them time to think, or honestly even listen. If it's something they care about, they'll tell me. If it's something I care about, I'll ask very specifically.

 

[RoyBasch]

I use it all the time for kids who really can’t provide much history (usually just the babies and toddlers)

Is this legit? I always assumed the ROS for infants and young children was based on the parents reporting (as is the entirety of the history for that matter). People are putting ROS "limited by clinical condition" on a 6 month old? Obviously its ok for the demented elderly adult; however, infants and young children are usually present with their parent/caregiver 95% of the time.

 

[thegenius]

Seriously. I usually just make up ROS.

LOL

ROS is 100% made up. All important questions are asked in the first minute. How often does someone has a rash when they complain of ear pain

 

[RoyBasch]

Seriously. I usually just make up ROS. Anyone who spends time actually asking 10 ROS questions is wasting a lot of time. Most of the time the patients will sit and think about each and every one as if it's a valuable nugget of gold. They will then relate an interesting (to them) anecdote about their lives.

Pretty much this most of the time.

 

[Angry Birds]

Dude, it's totally legit to just put "See HPI. Rest of ROS negative." It's one click in my EMR. I do that instead of putting down specific negatives, since I think it's more defensible.

 

[southerndoc]

Dude, it's totally legit to just put "See HPI. Rest of ROS negative." It's one click in my EMR. I do that instead of putting down specific negatives, since I think it's more defensible.

One of Georgia's major insurers no longer accepts the all other systems reviewed clause.

 

[hundreddaysoff]

One of Georgia's major insurers no longer accepts the all other systems reviewed clause.

Luckily for Georgia, I instead check the complete systems reviewed clause in Meditech.

This has the added benefit that AFAIK, "complete" means whatever I want it to mean.

 

[RoyBasch]

Dude, it's totally legit to just put "See HPI. Rest of ROS negative." It's one click in my EMR. I do that instead of putting down specific negatives, since I think it's more defensible.

Depends what you mean by "legit." Is it medicolegally defensible? Maybe. Although I think documented as specifically inquired and negative is probably stronger in the event of an untoward outcome seemingly unrelated to why the pt was seen in the ER that day. I.e. Pt seen for foot pain. Pt dead of an MI 1 week later. ROS specific negative for chest pain or dyspnea on ER visit could be very protective.

But on a more practical day-to-day basis not relating to far fetched malpractice, "ROS negative except as noted in HPI" is not acceptable for billing purposes as far as number of points of ROS necessary for respective level of complexity of a chart (level 5 chart requires 10 ROS). This has been hammered home many times by our billers and coders.

 

[Angry Birds]

Depends what you mean by "legit." Is it medicolegally defensible? Maybe. Although I think documented as specifically inquired and negative is probably stronger in the event of an untoward outcome seemingly unrelated to why the pt was seen in the ER that day. I.e. Pt seen for foot pain. Pt dead of an MI 1 week later. ROS specific negative for chest pain or dyspnea on ER visit could be very protective.

But on a more practical day-to-day basis not relating to far fetched malpractice, "ROS negative except as noted in HPI" is not acceptable for billing purposes as far as number of points of ROS necessary for respective level of complexity of a chart (level 5 chart requires 10 ROS). This has been hammered home many times by our billers and coders.

I think there is specific verbiage that does count. I just don’t remember it offhand. It’s one click for me.

 

[KGflyboy]

I think there is specific verbiage that does count. I just don’t remember it offhand. It’s one click for me.

I think whether this counts it not may vary depending on your coders and billers. It definitely counts for me, but I've seen other places where everyone was told we have to specifically mention all the systems we assessed.