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NAD: psych or constitutional exam?

  1. #1
    Rose City (Portland, Oregon)
    Default NAD: psych or constitutional exam?
    Medical Coding Books
    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. Default
    I've always counted it as psych as well because of where it is counted in the 1997 exam.

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

    Laura, CPC, CEMC

  7. #7
    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
    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
    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.

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