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Where to count cyanosis in the Examination

  1. #1
    Default Where to count cyanosis in the Examination
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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?

    Thank you for any assistance.

  2. #2
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    North Carolina
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    Actually...my auditing software places it under Musculoskeletal (Inspection and/or palpation of digits or nails) for:

    No clubbing, cyanosis

  3. Default
    I agree that it can be either one...use it where you need it

  4. #4
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    North Carolina
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    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 by RebeccaWoodward*; 01-27-2009 at 06:19 PM.

  5. #5
    Default
    Quote Originally Posted by SHIBA425 View Post
    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?

    Thank you for any assistance.
    In the scenerio you've presented I would count it under musculosketal.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  6. #6
    Default 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?

  7. #7
    Location
    North Carolina
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    In that case, using 95 DG, I would (personally) place it under skin.

  8. #8
    Location
    Milwaukee WI
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    4,466
    Default 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

  9. #9
    Default
    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.

  10. #10
    Location
    North Carolina
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    It depends which exam you're using............

    Musculoskeletal

    1) Examination of gait and station
    2) Inspection and/or palpation of digits and nails (e.g., clubbing, cyanosis, inflammatory conditions, petechiae, ischemia, infections, nodes)

    http://www.emuniversity.com/PhysicalExam.html

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