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Example of an HPI that I don't know for sure how the breakdown is for, the HPI components.  Can someone help me with the breakdown on this to help me understand E/M coding. I was thinking that there was modifying factors : when she cleans herself with clean water, quality: irritation, and context: when cleans herself.  I don't feel like I am understanding this correctly can some one help me in understanding the breakdown

HX: Patient is a 27-year-old white female who presents today in follow-up. I originally saw her for vulvar and clitoral irritation. She is suffering from vulvar vestibulitis syndrome. I advised her to modify her diet as well as change her soap and treatment of that area. She washed her vulva multiple times a day with harsh soaps and wipes and we discussed changing these behaviors. Patient states she has done these things. She states she is some better. She has noted now that when she cleans herself with clean water she feels well. After she urinates she does still have some irritation and she thinks the urine is irritating that area. Otherwise she is doing better.

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