# Extremities: No clubbing, cyanosis or edema



## mcandia

I need feed back on this, when the statement extremities no clubbing, cyanosis or edema is stated it counts toward a cardiovascular exam.

My question is this: When I find that a cardio exam has already been documented (murmur, rhythm etc.) I have been giving credit under body area for extremity for this. I have also been told that for cyanosis you could credit it under skin.

Is anyone else using this statement for extremities when a cardiac exam is separately documented?

Thanks,
Maria


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## sdaapckelly

We apply what was suggested to you.  If we already have CV, we use the statement for MS or Int.


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## 1073358

Definition of clubbing:
Clubbing is a physical sign characterized by bulbous enlargement of the ends of one or more fingers or toes (Figure 44.1). Proliferation and edema of connective tissue result in loss of the normal angle between the skin and nail plate and excessive sponginess of the nail base. Clubbing is usually acquired and is associated with certain cardiopulmonary and gastrointestinal disorders, but may occur in congenital or familial forms. Acropachy is an alternative term for clubbing. Acquired clubbing is often reversible when the associated condition is treated successfully.

Clubbing itself indicates a CV problem, but I think that during the physical exam, dr is examining the extremities to find the clubbing, therefore I think it is ok to count as MS


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## mcandia

*Extremities:no clubbing, cyanosis or edema*

Thanks everyone for your responses - very helpful.

Maria CPC, CPC-H, CEMC


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## FTessaBartels

*1997 guidelines*

The 1997 guidelines show the following bullet under *Musculoskeletal*:
Inspection and/or palpation of digits and nails (e.g. *clubbing*, *cyanosis*, inflammatory conditions, petechiae, ischemia, infection, nodes)

The 1997 guidelines show the following bullet under *Cardiovascular*:
Examination of extremities of* edema *and/or varicosities

It sounds as if you are using 1995 guidelines. Our practice usually uses 1995 guidelines,  but the defnitions under 1997 guidelines sometimes help me identify what system I'm looking at.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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