You are not crazy wondering about these differences. T
he best explaination I have discovered is this: I do a lot of teaching and this question is frequently asked or I ask it of the attendees. Most nurses think SOB is appropirately called Dyspnea; many physicians believe they are the same; BUT some physicians think of SOB is what you are after running up 3 flights of stairs where as dyspnea is that same labored breathing but without the 3 flights. A patient with dyspnea is SOB to them but has some underlying cause (not the 3 flights).
Now this is a symantics discussion for sure, but what I always say is when in doubt code the word that the physician wrote down. Because changing SOB to Dyspnea or vice verse results in a different ICD9 code which may cause problems. It is only one 5th digit off but it is different.
I hope this helps - but yes this is one of those tricky coding areas.
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