Here is the scenario that is cause for thought and feedback....

Medicare patient
Sex; female
Pain Scale: 4
Pain location: Chest
Surg Hx: Hysterectomy

Allergies: Epinephrine, Furosemide, Tramadol

Here for eval of chest pain. Hx of Coronary artery disease, RCA stenting in 2004. In the past week, she has had an onset of chest pain that began with a few twinges of pain lasting for a few seconds, underlying the left side. In the past few days this has increased to to involve sternal area as well. The pain does not feel like a pulling muscle. She took some Devocet with improvement of symptoms.

She denies cough and dyspnea. There is no dysphagia or odynophagia. The pains are worse when lying on left side. No leg swelling. No calf pain or hemopytosis. She denies fever, chills, and PND.

Current Meds: Cozaar, Plavix, and Darvocet

Family Hx: Son and brother with MI; Mother with HTN.

Social: She is a non-smoker.

Phys Exam:
General -- overweight, pleasant in no distress
Neck: JVP not elevated
Lungs: Clear to asculation and percussion. Respirations are unlabored. No chest wall tenderness.
Cardiac: Rhythm is reg with normal S1 and S2 and 1/6 mid-systolic murmur at lower left sternal border. No radiation. JVP not elevated.
Abd: soft and nontender. No mass. No aortic bruit.
Extrem: Without edema. No calf tenderness.
Chest: X-ray reviewed personally by shows normal heart size and clear lung fields. No change from 2005. EKG shows show normal sinus rhythm. rate 56, with no repolarization change. Toponin I is .03.

IMPRESSION: Chest Pain. Suspect noncardiac pain, prob chest wall. Advised continued use of Darvocet. She was instructed in nitroglycerin use as trial. PHone follow in 48 hours. Possible Myoview test in future.

My thoughts and questions: Can we code a EKG, for example, 93010? How about an Xray code? We have a partial EKG strip that has the doctor handwriting stating, "Normal EKG" and the doctor also signs the EKG strip machine strip and his interpretation. I feel that this is not enough to code a 93010 because we don't have the doc saying, "Interpreted by me" or anything like it. Bottomline: I would lean towards just a 99203 with 786.50.