What constitutes a "Complete ROS"?

A "Complete Review of Systems" (ROS) is defined as an assessment that includes a review of 10 or more systems. In the context of Evaluation and Management (E/M) coding, a complete ROS signifies a thorough inquiry into the patient’s health status across multiple bodily systems, providing a comprehensive understanding of the patient’s condition and relevant health history.

The requirement to address 10 or more systems allows the healthcare provider to capture more detailed information that might be crucial for diagnosis and treatment planning. This extensive approach often aids in identifying conditions that might not be immediately apparent.

A review of only one system would be classified as an incomplete or problem-focused ROS, while reviewing two to nine systems indicates a limited or expanded review but does not meet the threshold required for a complete assessment. A brief symptom check, on the other hand, typically involves only a quick inquiry into a few specific symptoms related to a presenting issue and is not comprehensive enough to qualify as a complete ROS. Thus, the requirement for a complete ROS truly emphasizes the importance of gathering comprehensive patient information for effective management and coding.