AAPC - Back to school
Results 1 to 9 of 9

Thread: NAD: psych or constitutional exam?

  1. #1
    Join Date
    Apr 2007
    Rose City (Portland, Oregon)

    Default NAD: psych or constitutional exam?

    AAPC: Back to School
    I've always counted NAD as psych because the 97 guidelines show "mood and affect" under psych. That said, most physicians documented NAD under constitutional and they have said they learn it as a constitutional exam (general appearance) while in med school.

    Opinions on the matter?

  2. #2


    I've always counted it as psych as well because of where it is counted in the 1997 exam.

  3. #3

    Default NAD - Psych or Constitutional

    If I am auditing someone in a Behavior Med practice, I count NAD as psych. Other specialties, I count as Constitutional.

  4. #4
    Join Date
    Apr 2007
    Greeley, Colorado

    Default constitutional

    I count it in constitutional as it is part of the patient's general appearance.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Join Date
    Apr 2007
    Kansas City, MO


    It's such a vague statement. No distress with what? Breathing? Distressed with pain? I generally use it with constitutional...but I wouldn't necessarily say it could never be used in psych.

  6. #6
    Join Date
    Apr 2007


    I always count this as cons, I don't see how you could count it as psych.

    Laura, CPC, CEMC

  7. #7
    Join Date
    Apr 2007
    Milwaukee WI

    Default Constitutional

    I always count is as constitutional.

    I expect something more specific for psych ("pleasant demeanor" or "visibly upset").

    F Tessa Bartels, CPC, CEMC

  8. #8
    Join Date
    Apr 2007
    Boston, MA


    I count NAD as constitutional as well. It doesn't really say much about the patient's psych status. A&Ox3 I count as psych.
    Karolina, CPC, CPMA, CEMC

  9. #9
    Join Date
    Apr 2007
    Jacksonville, FL River City Chapter


    Every doctor I've ever asked about that statement has said that it refers to whether, upon initial gross examination of the patient, the patient is experiencing any acute respiratory or cardiovascular distress that would indicate the need to suspend a normal visit encounter and instead convert to some type of intervention and possibly transport to a more acute location. I count is as general appearance under Const.

    When the word "distress" is used outside of the medical field it usually means psychiatric and some coders apply the word this way without realizing the different use by doctors.

    Seth Canterbury, CPC, ACS-EM
    Last edited by SCanterbury; 01-11-2010 at 08:03 AM.

Similar Threads

  1. Exam -- constitutional
    By msingh23 in forum E/M
    Replies: 3
    Last Post: 11-07-2014, 11:27 AM
  2. Pt not able to do psych exam
    By mrssimon43005@yahoo.com in forum Behavioral Health
    Replies: 0
    Last Post: 05-15-2014, 01:19 PM
  3. Constitutional vs. Psych?
    By sullivak in forum E/M
    Replies: 0
    Last Post: 01-07-2013, 03:57 PM
  4. Replies: 3
    Last Post: 09-29-2010, 02:47 PM
  5. "Constitutional" E&M ROS / General Exam
    By mmunoz21 in forum E/M
    Replies: 1
    Last Post: 05-22-2008, 02:21 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.