# NAD: psych or constitutional exam?



## andersee (Jan 4, 2010)

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?


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## tdcook70 (Jan 4, 2010)

I've always counted it as psych as well because of where it is counted in the 1997 exam.


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## Dorothy Steed (Jan 4, 2010)

*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.


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## Lisa Bledsoe (Jan 5, 2010)

*constitutional*

I count it in constitutional as it is part of the patient's general appearance.


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## LindaEV (Jan 5, 2010)

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.


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## LLovett (Jan 5, 2010)

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

Laura, CPC, CEMC


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## FTessaBartels (Jan 6, 2010)

*Constitutional*

I always count is as constitutional.

I expect something more specific for psych ("pleasant demeanor" or "visibly upset").

F Tessa Bartels, CPC, CEMC


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## Karolina (Jan 7, 2010)

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.


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## SCanterbury (Jan 11, 2010)

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


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