What are the Review of Systems (ROS) requirements to bill a level 4 office visit?

To bill a level 4 office visit (99214) on the Review of Systems (ROS), you need documentation of at least 2 to 9 organ systems. These organ systems include constitutional (fever, weight loss), eyes, ears/nose/mouth/throat, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary (skin), neurological, psychiatric, endocrine, hematologic/lymphatic, and allergic/immunologic. For a level 4 visit, you must document both positive and negative findings for the systems reviewed. The ROS is just one component of the overall documentation requirements for a level 4 visit, which also includes a detailed history (chief complaint, extended HPI with at least 4 elements, and at least 1 element from PFSH), and a detailed examination (at least 12 elements from 2 or more organ systems), along with moderate complexity medical decision making. The ROS helps establish medical necessity by showing a thorough evaluation of the patient's condition and helps justify the level of service being billed. Remember that all documented systems must be relevant to the presenting problem and medical necessity of the visit.