Health Information Technologies and Processes

CMS ROS change and Pre-Op H&Ps

  • 1.  CMS ROS change and Pre-Op H&Ps

    Posted 14 days ago
    As we know, starting January 1, 2020 CMS is changing coding requirements for most office visits and certain parts of the history and physical are no longer required to satisfy billing requirements and only need to be documented if clinically relevant, including a review of symptoms.

    In my organization (and many others) a complete (14 point) ROS is currently required for a note to be accepted as a pre-op History and Physical in our operating rooms. As our practice offices will be adopting the new CMS rule this may lead to issues in documentation, audits, and delays.

    How have you addressed this in your organizations? What policy/Bylaws changes have adopted to address the CMS rule change?

    Maria Caban Alizondo, MOL, MLC, RHIT, FAHIMA
    Director, HIIMS
    UCLA Health System

  • 2.  RE: CMS ROS change and Pre-Op H&Ps

    Posted 13 days ago

    We have not changed what we require in our H&Ps.



  • 3.  RE: CMS ROS change and Pre-Op H&Ps

    Posted 10 days ago
    Thank you, Karla for your response, it’s very helpful.

    So far, it appears that most organizations are not looking at changing pre-op H&P requirement.




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