daboronda
Contributor
How would this be coded or is it as I think, not billable? Thank you for your input.
Lumbar discography (aborted secondary to vasovagal episode with loss of consciousness and enuresis)
Patient was consented, prepped and draped referral provocative lumbar discography. He had received clindamycin 900 mg IV without incident. We were about to start the procedure when he reported that he was "not feeling well". His heart rate initially was normal but started becoming bradycardic going as low as 32. He had loss of consciousness secondary to bradycardia and hypotension (75 over 47). He had loss of consciousness for less than 30 seconds.
We immediately administered glycopyrrolate 0.4 mg IV bolus and opened up his IV fluids to wide open. His heart rate immediately increased to 104. He regained consciousness. We rolled him on his back and elevated his legs and continued to give IV fluids.
His 1st pressure after return of consciousness was 91/54. He maintained satisfactory oxygenation throughout. His subsequent vital signs were heart rate 102, blood pressure 96/49 and heart rate 99, blood pressure 115/58. He remained stable.
I contacted his primary care physician to discuss the case. He agreed with me that patient should be transported to the emergency room for evaluation. We contacted 911 and had an emergency crew sent to deliver him to the emergency room. Again, patient remained stable after his initial loss of consciousness. At no point did he report dyspnea or chest pain.
I called the emergency room to give report but was put on hold indefinitely and was not able to finish my report as I was continuing to help with his monitoring.
Assuming he is okay in the emergency room, I would suggest he has a stress test to evaluate for silent ischemia from DM.
Lumbar discography (aborted secondary to vasovagal episode with loss of consciousness and enuresis)
Patient was consented, prepped and draped referral provocative lumbar discography. He had received clindamycin 900 mg IV without incident. We were about to start the procedure when he reported that he was "not feeling well". His heart rate initially was normal but started becoming bradycardic going as low as 32. He had loss of consciousness secondary to bradycardia and hypotension (75 over 47). He had loss of consciousness for less than 30 seconds.
We immediately administered glycopyrrolate 0.4 mg IV bolus and opened up his IV fluids to wide open. His heart rate immediately increased to 104. He regained consciousness. We rolled him on his back and elevated his legs and continued to give IV fluids.
His 1st pressure after return of consciousness was 91/54. He maintained satisfactory oxygenation throughout. His subsequent vital signs were heart rate 102, blood pressure 96/49 and heart rate 99, blood pressure 115/58. He remained stable.
I contacted his primary care physician to discuss the case. He agreed with me that patient should be transported to the emergency room for evaluation. We contacted 911 and had an emergency crew sent to deliver him to the emergency room. Again, patient remained stable after his initial loss of consciousness. At no point did he report dyspnea or chest pain.
I called the emergency room to give report but was put on hold indefinitely and was not able to finish my report as I was continuing to help with his monitoring.
Assuming he is okay in the emergency room, I would suggest he has a stress test to evaluate for silent ischemia from DM.