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Wiki Where to count cyanosis in the Examination

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SHIBA425

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I am looking for all viewpoints I can get when it comes to determining if "cyanosis" should always be counted as part of the "skin" exam or as part of the "cardiopulmonary" exam.

For example:

51 y-o-f with shourtness of breath and cough. underwent bronchoscopy 2 weeks ago which showed diffuse nodularity throughout the tracheobronchial tree with endobronchail metastasis verified by biopsy. She is on oxygen.

Here is the documented exam:

VITALS: TEMP-98.8, BP 120/72, PULSE 73, RESPIRATIONS18, &O2 SAT is 94% on two liters.
HEAD & NECK: No accessory pulmonary muscle use.
LUNGS: Essentially clear
HEART: Regular, slightly tachycardic
ABDOMEN: Soft and nontender. No hepatosplenomegaly. No CVA tenderness or bladder distension.
EXTREMITIES: No focal bony tenderness or joint swelling. No clubbing, cyanosis or edema.
NEUROLOGICAL: the patient is intact

The question is......Count it as skin or count it under cariopulmonary?
I have asked a few physicians and they say it can really be both, so if that is true where do I count it? :confused:

Thank you for any assistance.
 
http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp

Page 19 for the 97 guidelines

Musculoskeletal (General Multi-System)
-Examination of gait and station
-Inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory
conditions, petechiae, ischemia, infections, nodes)

What examination are you trying to credit? Cardiology has this listed in extremities-page 22
Respiratory-page 44
 
Last edited:
SHIBA425 said:
I am looking for all viewpoints I can get when it comes to determining if "cyanosis" should always be counted as part of the "skin" exam or as part of the "cardiopulmonary" exam.

For example:

51 y-o-f with shourtness of breath and cough. underwent bronchoscopy 2 weeks ago which showed diffuse nodularity throughout the tracheobronchial tree with endobronchail metastasis verified by biopsy. She is on oxygen.

Here is the documented exam:

VITALS: TEMP-98.8, BP 120/72, PULSE 73, RESPIRATIONS18, &O2 SAT is 94% on two liters.
HEAD & NECK: No accessory pulmonary muscle use.
LUNGS: Essentially clear
HEART: Regular, slightly tachycardic
ABDOMEN: Soft and nontender. No hepatosplenomegaly. No CVA tenderness or bladder distension.
EXTREMITIES: No focal bony tenderness or joint swelling. No clubbing, cyanosis or edema.
NEUROLOGICAL: the patient is intact

The question is......Count it as skin or count it under cariopulmonary?
I have asked a few physicians and they say it can really be both, so if that is true where do I count it? :confused:

Thank you for any assistance.
Click to expand...

In the scenerio you've presented I would count it under musculosketal.
 
Counting Cyanosis

Thank you for your information. I am aware fo the 1997 guidelines and wehre cyanosis would be counted for 1997. I am using 1995 and possibly looking at placing it under Integumentary/Skin?
 
Musculoskeletal or Pulmonary

I'd be inclined to still place it under musculoskeletal ... AND that's where the doctor placed it.

If not, then I'd count it under cardiopulmonary since it's a symptom of poor oxygenation.

F Tessa Bartels, CPC, CEMC
 
Actually under the 97 guidelines on page 19 it is listed under Extremities, which is a body area and not an organ system. We usually count this under cardio because it is a sign of oxygenation problems.
 
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