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Pain Management Coding Alert

Reader Question:

Modify CLIA-Waived Claims for Coding Success

Question: How often must you update the review of systems [ROS] for a patient? With every new problem? Once every year? I understand that you can use ROS from a previous visit and reference that date, but how many years back can you go? We have found three-plus years that a patient has gone without a new ROS. I have always heard that you get a new ROS on a patient with a new problem/body part and when your ROS is over a year old? I cannot find, in the guidelines, where it states the time frame allowed for using a ROS that you already have.

South Carolina Subscriber

Answer: The E/M guidelines don’t specify how often you should update your ROS. From a medically relevant perspective, however, your physician should update the ROS every time he sees a patient that requires a review (of some or all of the systems). Many practices have the patient complete an ROS form once per year, and then at every visit, the physician updates the information based on the medical necessity of that encounter. As far as years, it doesn’t matter how far back the ROS goes, as long as your physician consistently updates it accordingly.

Bottom line: Your physician has to stay current on a patient’s medical condition. The patient’s condition and your physician’s role within that condition dictate how often the ROS should be updated.