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Otolaryngology Coding Alert


Take These Steps to Show PFSH Checked

Question: Can I count past, family, social history (PFSH) items that I record using a sheet?

Georgia Subscriber

Answer: Yes. You can use a sheet to record PFSH. Properly document that you updated the sheet by noting -Refer back to _________ for pertinent information- in your current encounter. List any changes from the initial recoding to the current visit. When referencing information in other documents, make sure the referenced information is present. An insurer/auditor may also request that the information be copied/included with the progress note.

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Otolaryngology Coding Alert

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