ROS and the Three Levels

What is Review of Systems (ROS)?



The Review of Systems (ROS) is a subjective account of a patient's present or past experiences with illnesses and/or injuries affecting any of the 14 applicable organ systems.



You should know the differences between the three ROS levels



Know the differences between the three ROS levels to determine the proper level of history and as such, evaluation & management code level:



First, a problem-pertinent ROS occurs when the otolaryngologist reviews a single system during the encounter, most likely the system directly related to the problem identified in the patient's HPI. For a practice, "pertinent" refers to the ENT system which means the otolaryngologist reviews at least one item within the ENT system.



This type of ROS supports a level two new patient evaluation & management service (99202) or a level three established patient E/M service (99213).



Secondly, when the doctor conducts an extended review of systems, he should review a 'limited' number of systems. According to Medicare (and most other payers), 'limited' should be a total of two to nine systems including the ENT system.



An extended ROS can support a level three new patient service (99203) or a level four established patient service (99214).



Even though an otolaryngologist primarily treats the ear, nose, and throat, "he has the whole picture as there may be factors that are pertinent to the [patient's] problem.



Thirdly, when your otolaryngologist reviews 10 or more systems, he achieves a complete ROS. A complete ROS can support a level four or five new patient evaluation & management (99204-99205) or a level five established patient visit (99215).



Tip: Know the systems you will be counting. One of the systems you will see your otolaryngologist address during a review of systems might include a symptom such as trouble swallowing.



To add to the ear, nose, and throat system, there are 13 other systems your otolaryngologist might review: genitorurinary; constitutional; eyes; cardiovascular; respiratory; gastrointestinal; musculoskeletal; integumentary; neurological; psychiatric; endocrine; hematologic/lymphatic; and allergic/ immunologic, Martin explains.



Who can record the ROS?



The otolaryngologist doesn't essentially need to record the ROS himself. It may be documented by the patient or auxiliary staff as long as the physician/NPP initials and dates patient populated forms and states they reviewed and/or agree with this documentation.



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