Elund
Networker
The documentation:
Why should 93350 be reported? The documentation doesn't seem to specify everything that the code requires; it doesn't mention M-mode. It also doesn't seem to indicate that the reporting physician provided the interpretation for either this or the resting echo.
OFFICE - ESTABLISHED
SEX: FEMALE
AGE: 58
Date: 01/01/20XX
Follow up and tests
PROBLEM LIST:
1. S/P St. Jude aortic valve replacement for severe symptomatic aortic valve stenosis.
2. Hospital visit 2-1/2 weeks ago for chest wall pain associated with shortness of breath, sinus tachycardia and fluid retention, managed with diuretics.
ALLERGIES: Penicillin.
MEDICATIONS:
Tylenol #3 b.i.d.
Coumadin AD
Lasix 40 mg q.d.
KCl 20 mEq q.d.
Metoprolol succinate 75 mg b.i.d.
INTERVAL HISTORY: The patient has had no difficulty with breathing. She has some wound discomfort, but her wound is healing nicely.
Stress echocardiogram today shows:
1. After 2-1/2 minutes of stage I of a standard Bruce protocol, she became hypotensive down to 75 systolic. This resolved spontaneously.
2. Left ventricular function was appropriate.
(Note: Echocardiogram 10 days ago showed a normal functioning mechanical St. Jude aortic valve with normal left ventricular systolic function.)
PHYSICAL EXAMINATION:
VITAL SIGNS: BP 108/78 in the left arm (lg. cuff) lying, seated and standing. Pulse is 86 and regular, oxygen saturation 93% on room air.
CONSTITUTIONAL: In no acute distress.
HEENT: Eyes: No xanthelasma or exophthalmos. No arcus senilis. Tongue midline. Mucous membranes moist, with no cyanosis.
RESPIRATORY: Respirations even and unlabored. Good air entry bilaterally. No
adventitious sounds. Chest has normal contour.
CARDIOVASCULAR: PMI normal. Neck veins flat. No carotid bruits. S1 normal. Grade 2/6 short to medium length aortic systolic murmur. Consistent aortic closure sound. No diastolic murmur appreciated. No clicks or gallops. Abdominal aorta not palpable, no bruit. Femoral, tibial, dorsalis pedis pulses intact. No leg swelling.
GASTROINTESTINAL: Abdomen: Soft. Positive BS x4 quads. No masses or tenderness. No hepatosplenomegaly.
SKIN: Chest: Midline wound is healing appropriately. Skin is otherwise pink, warm, dry and intact. No rashes.
NEUROLOGIC/PSYCH: Cranial nerves II-XII grossly intact. Alert and oriented x3. Affect normal.
ASSESSMENT:
1. S/P St. Jude mechanical aortic valve replacement, normally functioning.
2. Exercise-induced hypotensive, most consistent with deconditioning effect.
3. Fluid retention following the above, now resolved has been on diuretics.
PLAN
1. Will reassess chemistry panel, to assess for hypovolemia.
2. Refer to Medical Center.
3. Office visit 01/01/20XX
Robert Jones, MD
Cardiology
101 Ridge Road
Apple Creek, MI 42328
STRESS ECHOCARDIOGRAM
Patient Name: Charla Smith
Date: 01/01/20XX
INDICATION: S/P St. Jude mechanical aortic valve replacement, evaluate for exercise rehab.
Medications: Tylenol, Coumadin, Lasix, KCl, metoprolol.
Medications withheld: On all medications.
Entry vital signs: BP 108/78, pulse late 86 and regular, oxygen saturation 93% on room air.
PROCEDURE:
Resting Echo shows nonspecific ST-T changes.
Resting echo shows normal wall motion in all segments, ejection fraction 60%, trace mitral regurgitation per color flow Doppler.
The patient exercised on a standard Bruce protocol for 2 minutes 30 seconds into stage I. She became progressively short of breath. Blood pressure declined from 108 to 75 systolic. Test was terminated.
FINDINGS: Peak heart rate of 108 b.p.m., which is approximately 67% of maximum predicted heart rate.
Blood pressure response was hypotensive.
Peak EKG shows no ST segment changes. No induced arrhythmia.
No oxygen desaturation.
Exercise capacity is Functional class III.
Peak exercise echo shows apical cavitary obliteration. There was no evidence of left ventricular dilatation. No exercise-induced segmental wall motion abnormality.
CONCLUSION:
1. Exercise-induced hypotension consistent with peripheral deconditioning, possible hypovolemia from diuretics.
Robert Jones, MD
Electronically signed by ROBERT JONES, MD 1/1/20XX
SEX: FEMALE
AGE: 58
Date: 01/01/20XX
Follow up and tests
PROBLEM LIST:
1. S/P St. Jude aortic valve replacement for severe symptomatic aortic valve stenosis.
2. Hospital visit 2-1/2 weeks ago for chest wall pain associated with shortness of breath, sinus tachycardia and fluid retention, managed with diuretics.
ALLERGIES: Penicillin.
MEDICATIONS:
Tylenol #3 b.i.d.
Coumadin AD
Lasix 40 mg q.d.
KCl 20 mEq q.d.
Metoprolol succinate 75 mg b.i.d.
INTERVAL HISTORY: The patient has had no difficulty with breathing. She has some wound discomfort, but her wound is healing nicely.
Stress echocardiogram today shows:
1. After 2-1/2 minutes of stage I of a standard Bruce protocol, she became hypotensive down to 75 systolic. This resolved spontaneously.
2. Left ventricular function was appropriate.
(Note: Echocardiogram 10 days ago showed a normal functioning mechanical St. Jude aortic valve with normal left ventricular systolic function.)
PHYSICAL EXAMINATION:
VITAL SIGNS: BP 108/78 in the left arm (lg. cuff) lying, seated and standing. Pulse is 86 and regular, oxygen saturation 93% on room air.
CONSTITUTIONAL: In no acute distress.
HEENT: Eyes: No xanthelasma or exophthalmos. No arcus senilis. Tongue midline. Mucous membranes moist, with no cyanosis.
RESPIRATORY: Respirations even and unlabored. Good air entry bilaterally. No
adventitious sounds. Chest has normal contour.
CARDIOVASCULAR: PMI normal. Neck veins flat. No carotid bruits. S1 normal. Grade 2/6 short to medium length aortic systolic murmur. Consistent aortic closure sound. No diastolic murmur appreciated. No clicks or gallops. Abdominal aorta not palpable, no bruit. Femoral, tibial, dorsalis pedis pulses intact. No leg swelling.
GASTROINTESTINAL: Abdomen: Soft. Positive BS x4 quads. No masses or tenderness. No hepatosplenomegaly.
SKIN: Chest: Midline wound is healing appropriately. Skin is otherwise pink, warm, dry and intact. No rashes.
NEUROLOGIC/PSYCH: Cranial nerves II-XII grossly intact. Alert and oriented x3. Affect normal.
ASSESSMENT:
1. S/P St. Jude mechanical aortic valve replacement, normally functioning.
2. Exercise-induced hypotensive, most consistent with deconditioning effect.
3. Fluid retention following the above, now resolved has been on diuretics.
PLAN
1. Will reassess chemistry panel, to assess for hypovolemia.
2. Refer to Medical Center.
3. Office visit 01/01/20XX
Robert Jones, MD
Cardiology
101 Ridge Road
Apple Creek, MI 42328
STRESS ECHOCARDIOGRAM
Patient Name: Charla Smith
Date: 01/01/20XX
INDICATION: S/P St. Jude mechanical aortic valve replacement, evaluate for exercise rehab.
Medications: Tylenol, Coumadin, Lasix, KCl, metoprolol.
Medications withheld: On all medications.
Entry vital signs: BP 108/78, pulse late 86 and regular, oxygen saturation 93% on room air.
PROCEDURE:
Resting Echo shows nonspecific ST-T changes.
Resting echo shows normal wall motion in all segments, ejection fraction 60%, trace mitral regurgitation per color flow Doppler.
The patient exercised on a standard Bruce protocol for 2 minutes 30 seconds into stage I. She became progressively short of breath. Blood pressure declined from 108 to 75 systolic. Test was terminated.
FINDINGS: Peak heart rate of 108 b.p.m., which is approximately 67% of maximum predicted heart rate.
Blood pressure response was hypotensive.
Peak EKG shows no ST segment changes. No induced arrhythmia.
No oxygen desaturation.
Exercise capacity is Functional class III.
Peak exercise echo shows apical cavitary obliteration. There was no evidence of left ventricular dilatation. No exercise-induced segmental wall motion abnormality.
CONCLUSION:
1. Exercise-induced hypotension consistent with peripheral deconditioning, possible hypovolemia from diuretics.
Robert Jones, MD
Electronically signed by ROBERT JONES, MD 1/1/20XX
Why should 93350 be reported? The documentation doesn't seem to specify everything that the code requires; it doesn't mention M-mode. It also doesn't seem to indicate that the reporting physician provided the interpretation for either this or the resting echo.