Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition.

The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.

Question: What’s considered a “complete” review of systems (ROS)?

Answer: Per the 1995 Medicare documentation guidelines, 10 systems, including pertinent positives and negatives, constitute a complete review of systems, which is required for Level 5 (99285) visits. If you review all the systems with the patient and document the pertinent positives and negatives, you may use statements such as, “Complete review of systems is negative except as noted above,” or “All systems negative except as noted above.”

Some payers deviate from the guidelines and may require 10 individual systems to be documented, while others don’t accept statements such as “A 10-system review was completed and was negative,” as they feel that there is no indication of which 10 systems were reviewed. Be wary of some EHR systems, as they may group responses to the ROS, making it seem like you’re getting to 10 when you actually have only eight or nine.

These are the officially recognized systems:

• Constitutional (eg, fever, weight loss)
• Eyes
• Ears, Nose, Throat, Mouth
• Cardiovascular
• Respiratory
• Gastrointestinal
• Genitourinary
• Musculoskeletal
• Integument (skin and/or breast)
• Neurological
• Psychiatric
• Endocrine
• Hematologic/Lymphatic
• Allergy/Immunology

Brought to you by the ACEP Coding and Nomenclature Committee.

DR. FRIEDENSON is the chief medical officer of Reventics, a coding, RCM and provider engagement company, and president of ACEP’s Colorado Chapter. He practices emergency medicine in Thornton, Colorado, and educates physicians on a variety of documentation topics. DR. LEMPERT is chief medical officer, health care financial services, at Knoxville, Tennessee-based TeamHealth.