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    History of present illness: Duration vs timing

    Q: What is the difference between duration and timing as part of the history of present illness (HPI)?

    A: Elements of HPI include severity, context and modifying factors, but it also includes the elements of duration and timing.

    To the nonmedical eye, duration and timing may appear to be the same thing. But, according to documentation guidelines, these two elements of the HPI can be very different.


    (How long?)
    Length of time it has been present


    (Is there a pattern?)
    Continuous or repetitive

    Establishing the onset for each symptom or problem and a rough chronology of the development of the problem are also important. To do this for duration, it’s important that the provider ask: How long have you had these symptoms? When was the test run that confirms that diagnosis?

    To do this for timing, the provider may ask: Is it primarily nocturnal, diurnal or continuous? Or has there been a repetitive pattern for the symptom? Also, there could be an event that causes or triggers the problem (e.g., burning in the chest area happens after eating spicy food, knee pain hurts the worst in the morning, the fever has been off and on throughout the day). Of course, each of these questions should be driven by the medical need to know.  If it’s not pertinent to understand the patient’s condition, these areas (as with all) HPI elements should not be counted towards the level of HPI, or in turn, the Evaluation and Management code level.


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