Clubbing

Is Clubbing and Cyanosis enough to support the musculoskeletal exam of an organ system?

Comments

  • Yes. Be careful cyanosis is really related to CV. and could be skin.

    Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P


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  • Ive used it there before

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
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    Is Clubbing and Cyanosis enough to support the musculoskeletal exam of an organ system?
  • Yes and I've seen it listed in respiratory

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382

    stem?
  • edited June 2017


    I agree. I have always seen clubbing as CV but I do know that it is listed
    under MS in many of the tools. I can see bruising as skin but not cyanosis
    but you may have something showing otherwise.

  • We had an auditor who stated just the documentation of "clubbing and cyanosis" is not enough to support the musculoskeletal exam of an organ system. I have always given this statement credit in the extremity section of the note. To meet the requirement for musc. organ system you would need to document about the muscle tone, gait, stability, joints, etc.

    But we had another auditor who disagreed.
  • edited June 2017
    That is that auditors personal opinion but it is not supported by any official source.

    CMS guidelines clearly list it as part of the musculoskeletal organ system. "Inspection and/or palpation of digits and nails (e.g., clubbing, cyanosis, inflammatory conditions, petechia, ischemia, infections, nodes)"

    TT


    Todd Thomas, CPC, CCS-P ERcoder, Inc
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  • It is truly amazing how E/M Guidelines are so subjective and open to interpretation. I wonder if the Cost portion of MIPS will be also when it comes to the risk area.
    Maxine


    Maxine Lewis, CMM, CPC, CPC-I, CCS-P, CPMA
    Main: 513-771-7070
    Direct: 513-672-4363
    Fax: 513-326-7640
    200 Northland Blvd
    Cincinnati, OH 45246
    mlewis@scrogginsgrear.com
    www.scrogginsgrear.com

    This electronic message transmission contains information from ScrogginsGrear, Inc. which may be confidential or privileged. The information is intended for the use of the individual or entity named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this electronic transmission in error, please notify us by telephone (800-359-3970) or by electronic mail (consultants@scrogginsgrear.com) immediately. If any tax advice is contained in this communication, it is not intended or written to be used for the purpose of avoiding any penalties that may be imposed under federal law and cannot be used for that purpose.

  • edited June 2017
    As I posted earlier the 1997 guidelines sometimes list it in musculoskeletal and sometimes in extremities depending on the specialty exam. BUT it is not part of either for the musculoskeletal specialty exam.

    Sent from my iPhone

  • Hello-

    If you are using the 1997 guidelines for general multi-system exam, clubbing & cyanosis do fall into the musculo-skeletal system box. Check the CMS Evaluation & Management Guidelines manual. :)


    Donna M. Beaulieu, C-CDI, CPMA, CPC-I, CRC, CPC, CEMC, CIMC, CEDC, CFPC, CCP-P, CRP
    Certified Green Belt, Lean Six Sigma
    Assistant Director, Patient Financial Services
    Emory Healthcare
    404-778-6688



  • We are using the 95 Guidelines.
  • edited June 2017


    But in other specialty exams it falls under extremity. To me it really is
    a wash unless you are going for a comprehensive exam where extremity would
    not count towards the 8 required under 1995 guidelines.


  • edited June 2017
    Yup I know they fall there but medically seems it is CV. But we know that things aren't always logical.

    Ruby Woodward
    Sent from my iPhone

  • Isnt’ cyanosis more respiratory I think I Have seen it there under guidelines

    Karyn Cardenas-Foray, CPC, CPMA ,CHCA, CEMC,CIMC,CSEMC
    AHIMA ICD10 PROFICIENT
    Government Reimbursement Analyst-Sharp Health Care
    PFS-CCD 3rd Floor
    858-499-4382

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