# Can I count as a bullet



## dwaldman (Dec 28, 2010)

Patient is alert and oriented x 3

Can I count this as Orientation to time, place, and person or is there a more appropriate way for the physician to document this to meet the criteria for this bullet under psychiatric in 97' guidelines.


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## Jagadish (Dec 28, 2010)

Under 1997 specialty exam, you get two bullets for that statement. One bullet for Alert (attention span and concentration) and one more bullet for Ox3.


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## abishard (Dec 28, 2010)

For the 1997 General Exam, this counts as alert and oriented.


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## dwaldman (Dec 28, 2010)

I am confused.

Where is there a bullet for Alert as a standalone bullet?


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## btadlock1 (Dec 28, 2010)

dwaldman said:


> I am confused.
> 
> Where is there a bullet for Alert as a standalone bullet?



I'm confused about this, as well. There were several examples in the Medical Record Auditor curriculum that credited statements such as "alert" and "mildy anxious" to constitutional - When is it Constitutional, and when is is Psych?


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## Jagadish (Dec 28, 2010)

https://www.highmarkmedicareservices.com/em/pdf/scoresheets/10223.pdf


Orientation to time, place and person - One bullet
Recent and remote memory
Attention span and concentration - One bullet (Alert)
Language (e.g., naming objects, repeating phrases)
Fund of knowledge (e.g., awareness of current events, past history, vocabulary)
Mood and affect (e.g., depression, anxiety, agitation, hypomania, lability)


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## dwaldman (Dec 28, 2010)

Didn't think to look in the psych single organ exam. Thank you for the link and your help with my question.


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## LLovett (Dec 29, 2010)

I disagree that "Alert" gets you credit for attention span and concentration. A&Ox3 is 1 bullet under 97. 

How does that tell what the attention span and concentration are? 

Laura, CPC, CPMA, CEMC


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## Jagadish (Dec 29, 2010)

Alertness is the state of paying close and continuous attention, being watchful and prompt to meet danger or emergency, or being quick to perceive and act. It is related to psychology as well as to physiology. A lack of alertness is a symptom of a number of conditions, including narcolepsy, attention deficit disorder, chronic fatigue syndrome, depression, Addison's disease, or sleep deprivation.

Alertness is a global observation of level of consciousness i.e. awareness of, and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporose

Please let me know why cannot we consider this as an exam bullet.


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## btadlock1 (Dec 29, 2010)

Jagadish said:


> Alertness is the state of paying close and continuous attention, being watchful and prompt to meet danger or emergency, or being quick to perceive and act. It is related to psychology as well as to physiology. A lack of alertness is a symptom of a number of conditions, including narcolepsy, attention deficit disorder, chronic fatigue syndrome, depression, Addison's disease, or sleep deprivation.
> 
> Please let me know why cannot we consider this as an exam bullet.



Impressive argument! I bet you're skilled in writing appeals. I agree, and have also been trying to find the answer to this. I haven't had any luck, so I'm interested to get clarification, as well.


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## LLovett (Dec 30, 2010)

Psychiatric 

[*] Description of speech including: rate; volume; articulation; coherence; and spontaneity with notation of abnormalities (eg, perseveration, paucity of language)

[*] Description of thought processes including: rate of thoughts; content of thoughts (eg, logical vs. illogical, tangential); abstract reasoning; and computation

[*] Description of associations (eg, loose, tangential, circumstantial, intact)

[*] Description of abnormal or psychotic thoughts including: hallucinations; delusions; preoccupation with violence; homicidal or suicidal ideation; and obsessions

[*]Description of the patient's judgment (eg, concerning everyday activities and social
[*]situations) and insight (eg, concerning psychiatric condition) 
*Complete mental status examination including*
Orientation to time, place and person
• Recent and remote memory
• *Attention span and concentration*
• Language (eg, naming objects, repeating phrases)
• Fund of knowledge (eg, awareness of current events, past history, vocabulary)
• Mood and affect (eg, depression, anxiety, agitation, hypomania, lability)

"Alertness is a global observation of level of consciousness i.e. awareness of, and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporose"

Concentration: act or process of concentrating, especially the fixing of close, undivided attention.

Attention span: The length of time during which a person can concentrate on a subject or idea.

How does the statement "Alert" tell us their ability to concentrate and the length of time they can pay attention to something? 

In all the auditing courses I have been too, both private and given by Medicare carriers, and the audits I have been thru A&Ox3 is 1 bullet under 97. Alert tells us they are conscious and that is not a bullet.

Laura, CPC, CPMA, CEMC


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## Jagadish (Jan 1, 2011)

The statement saying that patient is alert, itself means that he is in a state of paying close and continuous attention. This itself is the focus of mental status examination in all the verbal and nonverbal exercises or tests that are done to test the cognition under the bullet "Attention span and concentration".


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## LLovett (Jan 3, 2011)

*Agree to disagree I guess*

I wish you all the best in counting that. I am speaking from my experience working with auditors employed by the OIG and various consultants in the field. 

When using 97 guidelines they do not count the "A&O" at all unless it is "A&Ox (1, 2, or 3)", then it is 1 bullet.

Laura, CPC, CPMA, CEMC


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