# 97 Exam bullets



## lkoch829 (Mar 7, 2008)

Can one count the same bullet more than once when determining exam level? For example:

"Patient has positive bowel sounds in all four quadrants.  No masses were noted. He does have pain with palpation in all abdominal quadrants."

Under the abdominal exam guidelines, it lists "exam of abdomen with notation of presence of masses or tenderness" as one element identified as a bullet. Can I count the statement above as using that "element" 3 times or does it count as the use of 1 "element"?  It will make a difference in the overall level selected for the exam.

Thank you.


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## RebeccaWoodward* (Mar 8, 2008)

In my opinion, you have two bullets~

One for examining the abdomen for masses

One for palpation

Any other opinions?


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## codegirl0422 (Mar 8, 2008)

I would count it only once. 

To me the pain would be part of the tenderness. - "Examination of abdomen with notation of presence of  masses or tenderness"

It does not list palpation under the GI (Abdomen) area and my opinion, it would have to, to be able to count it. I reason that because palpation is mentioned under the chest bullet, the respiratory bullet, the lymphatic, and under the cardiovascular it mentions palpation of heart. To count palpation of the abdomen I think it would need to mention it under the GI bullet. 

Any other opinions?



lkoch829 said:


> Can one count the same bullet more than once when determining exam level? For example:
> 
> "Patient has positive bowel sounds in all four quadrants.  No masses were noted. He does have pain with palpation in all abdominal quadrants."
> 
> ...


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## RebeccaWoodward* (Mar 10, 2008)

I stand corrected.  I'll make sure to have my coffee next time.  Thanks!


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