Medical Coding Basics Cardiology Part 2
I grabbed another one, and again it is herefor a sixmonth check. These are routine, very common cases where a person has a cardiacproblem. Again, I'm going to go ahead and slide down to the bottom. I always like towork from the bottom up. I see that our patient has sleep apnea, hypertension and hypercholesterolemia. Then, he not only listed what the diagnosiswas, but actually tells you what he's doing about it or the status of it. Sleep apnea,using oral device as prescribed; so he's probably got a sleep apnea machine that hesleeps with. Hypertension, well controlled on above medication. Now, even though it saysit's well controlled, he has to take a medication
or he would have hypertension; so that isdefinitely codable. Then, same thing with his cholesterol, it's adequately controlledon above medication. The plan is, everything is going to continue and he wants to do anecho and office visit in six months. I'm going to slide back up to the top andI'm going to start looking at our problem list, again you don't code off of a problemlist because it can be copied and pasted. Again, you want to follow your office or yourcompany's guidelines about things like that problem list. Here we've got a person with afib, but nowhe's made a point to say â€œnone since 20XX.â€�
That tells me that I'm not going to codethat, either saying â€œNo, he does not have it.â€�It's not that they're taking medicationis the reason why they don't have it. He's saying that there's not been any reported.Hypertension, hyperlipidemia and sleep apnea and that they're using that oral device,the machine. Then, I'm going to go down to look at thesemedications, Cardizemâ€¦ I know what all of these are, but I went ahead and wrote downwhat some of these are because if you are not familiar, you need to be familiar withthe medications. You can go to drugs , webmd , there's all kinds, just Googleit, it will tell you.
I'm going to go to this history, the thingsthat jumped out at me, one, the palpitations he didn't address it. In other words, thepalpitations aren't something that we're going to worry about. He is using his oraldevice as prescribed. That constitutes the sleep apnea. They did a lab for the cholesteroland the triglycerides. Now we know he's actively being treated. Again, they checkedthe blood pressure. Over here, look, nothing is wrong here with the cardiovascular, scannedall of these, nothing jumps out at you. And you need to know these terms, â€œBS x4quadsâ€� you need to know what they mean. â€œNo carotid bruits,â€� they're talkingabout the carotid arteries. The â€œneck veins
are flatâ€� meaning they're not bulgingout that would indicate an issue with your blood pressure. â€œNo murmurs, clicks, orgallopsâ€� if you don't know what a murmur, a click, and a gallop sounds like, you canactually go to YouTube and you can hear them. It's really cool, different types of breathingtoo. So, we're limited to â€“ because I alwayswant to code things sleep apnea, hypertension, and the hypercholesterolemia. This persongot a 99214 as well. The pure hypercholesterolemia is 272.0, the 401.9 for the hypertension,and sleep apnea is 780.57. Those are very, very common codes especially the first two.You probably have them memorized even though
you're not supposed to memorize codes, youreally can't help it when you do them over and over. What about those medicationsé Cardizem isused for hypertension. Metoprolol is Lopressor and you may see that advertised on TV, a bloodpressure medication, beta blocker. What about this one,that it's like, â€œHuh! I don'tknow what that medication was.â€� It's actually Tambocor and it's for an irregular heartbeatrhythm, and Pravastatin is for cholesterol. Again, those are the things that you needto be aware of when you're doing cardiology. You need to know medications pretty well.Don't worry if you don't know them very
How To Stop Snoring or Sleep Apnea Symptoms
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You have sleep apneawhat now
Typically what we will do after you're diagnosedwith sleep apnea is we'll bring you back for a titration study. And basically what thatdoes is those are done in the lab and our technicians or respiratory therapists willactually measure you to determine what size of mask that you need and what type of maskthat you are most comfortable with because there are multiple types. There's a type thatcovers the nose and the mouth and a and a type that covers just the nose. And withinthe types that cover the nose, there's ones that sits over the nose like a dome as wellas ones that go up in the nose almost like thick oxygen prongs. And so typically whenwe bring you back for your titration we determine
which feels most comfortable to you and thenwhat we do is we start with a low airway pressure through the machine and we continue to monitoryou to see if you have sleep apnea. If you're demonstrating sleep apnea through your studythen we continue to increase your pressure until we see those events go away and that'stypically then around the pressure that we'll prescribe for you to start using at home.But even after that you need to have regular followups with your sleep physician becauseadjustments are typically needed to optimize things. This is because sometimes people sleepa little bit differently at home then they do in the laboratory. It really depends onthe severity, in my experience, of their sleep
apnea. Typically what I see is the more severesomebody's sleep apnea, the more they notice a difference more quickly. And I've had patientsthat have said they've slept the best night of their life that they've slept in the lasttwenty years after just one night of using their CPAP. But as we know, sleep deprivationis not something that goes away overnight. And so if somebody has had significant sleepapnea and been sleep deprived from it for years, typically it can take weeks to monthsuntil somebody really starts feeling their optimum. It's important that if you're diagnosedwith obstructive sleep apnea or central sleep apnea that you do get treated because we knowthat patients that go for a long period of
time years to decades without being treateddo have an increased risk of early strokes, heart disease, those types of things. There'salso now been shown some linkages to difficulty in controlling things like blood sugar, yourblood pressure and those types of things in patients that have significant sleep apneaand aren't being treated.