# Where to count cyanosis in the Examination



## SHIBA425 (Jan 27, 2009)

I am looking for all viewpoints I can get when it comes to determining if "cyanosis" should always be counted as part of the "skin" exam or as part of the "cardiopulmonary" exam.  

For example:

51 y-o-f with shourtness of breath and cough.  underwent bronchoscopy 2 weeks ago which showed diffuse nodularity throughout the tracheobronchial tree with endobronchail metastasis verified by biopsy.  She is on oxygen.  

Here is the documented exam:

VITALS: TEMP-98.8, BP 120/72, PULSE 73, RESPIRATIONS18, &O2 SAT is 94% on two liters.
HEAD & NECK: No accessory pulmonary muscle use.
LUNGS: Essentially clear
HEART: Regular, slightly tachycardic
ABDOMEN: Soft and nontender. No hepatosplenomegaly. No CVA tenderness or bladder distension.
EXTREMITIES: No focal bony tenderness or joint swelling. No clubbing, cyanosis or edema.
NEUROLOGICAL: the patient is intact

The question is......Count it as skin or count it under cariopulmonary?  
I have asked a few physicians and they say it can really be both, so if that is true where do I count it?   

Thank you for any assistance.


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## RebeccaWoodward* (Jan 27, 2009)

Actually...my auditing software places it under Musculoskeletal (Inspection and/or palpation of digits or nails) for:

*No clubbing, cyanosis *


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## renifejn (Jan 27, 2009)

I agree that it can be either one...use it where you need it


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## RebeccaWoodward* (Jan 27, 2009)

http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp

Page 19 for the 97 guidelines

Musculoskeletal (General Multi-System)
-Examination of gait and station
 -Inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory
conditions, petechiae, ischemia, infections, nodes)

What examination are you trying to credit?  Cardiology has this listed in extremities-page 22
Respiratory-page 44


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## rthames052006 (Jan 27, 2009)

SHIBA425 said:


> I am looking for all viewpoints I can get when it comes to determining if "cyanosis" should always be counted as part of the "skin" exam or as part of the "cardiopulmonary" exam.
> 
> For example:
> 
> ...



In the scenerio you've presented I would count it under musculosketal.


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## SHIBA425 (Feb 3, 2009)

*Counting Cyanosis*

Thank you for your information.  I am aware fo the 1997 guidelines and wehre cyanosis would be counted for 1997.  I am using 1995 and possibly looking at placing it under Integumentary/Skin?


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## RebeccaWoodward* (Feb 3, 2009)

In that case, using 95 DG, I would (personally) place it under skin.


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## FTessaBartels (Feb 3, 2009)

*Musculoskeletal or Pulmonary*

I'd be inclined to still place it under musculoskeletal ... AND that's where the doctor placed it.

If not, then I'd count it under cardiopulmonary since it's a symptom of poor oxygenation. 

F Tessa Bartels, CPC, CEMC


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## linpen223 (Mar 2, 2009)

Actually under the 97 guidelines on page 19 it is listed under Extremities, which is a body area and not an organ system.  We usually count this under cardio because it is a sign of oxygenation problems.


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## RebeccaWoodward* (Mar 2, 2009)

It depends _which _exam you're using............

Musculoskeletal 

    1)   Examination of gait and station 
    2)   Inspection and/or palpation of digits and nails (e.g., clubbing, *cyanosis*, inflammatory conditions, petechiae, ischemia,           infections, nodes)

http://www.emuniversity.com/PhysicalExam.html


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