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PED-EM-L  August 2009

PED-EM-L August 2009

Subject:

Re: Odd visits

From:

Robert Waddell II <[log in to unmask]>

Reply-To:

Robert Waddell II <[log in to unmask]>

Date:

Wed, 26 Aug 2009 20:52:32 -0600

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (228 lines)

I'm sure you are correct Dr. Soprano and I'm sure sharing humor, not  
offending is the motivation of the thread.  There is value in  
realizing that some "things" are universal - 1) pregnancy = you are or  
you're not, 2) patients continue to fail to read the medical books on  
who they are to live, die, or conduct themselves, 3) the names, mother  
tongue, and time zone may differ, yet healthcare practitioners rarely  
the only ones astonished at the fact humans have evolved to be the  
lead of the food chain, and 4) sometimes we simply need to know we are  
not the only ones caught completely of guard by what people say and do.

As an EMS educator there is significant importance in assuring that  
our students and colleagues are properly informed of the variable  
sides of patient thought processes and our responses.  I would like to  
collect the oddities if folks are still willing to share, offline.

Take care,

Bob

Robert K. Waddell II
307 920 2020
[log in to unmask]




On Aug 26, 2009, at 6:32 PM, Joyce Soprano wrote:

> Are we done yet, folks? I am sure these parents and patients would  
> be pretty sad to hear how they are being mocked in such an open  
> forum. I think we can put an end to this string of emails.
>
>
> --
> Joyce Soprano, MD
> Associate Professor of Pediatrics
> Associate Fellowship Director
> Pediatric Emergency Medicine
> University of Utah School of Medicine
> (801) 587-7448 office
> (801) 587-7455 fax
>
> Interoffice/Hospital Mail: Ped Emerg Med-Williams Bldg. 295 Chipeta
> Standard Mail: PO Box 581289, Salt Lake City, UT 84158
>
>
>
>
>
> On 8/26/09 5:37 PM, "Coop" <[log in to unmask]> wrote:
>
> Ok what do you do with the chief complaint in a 3 year old "my child  
> has never been himself"?
>
>
>
> Robert J. Cooper, MD, FAAP
> Orlando Medical Director
> After Hours Pediatrics
> [log in to unmask]
>
>
>
>
> ________________________________
> From: "Brown, Julie C." <[log in to unmask]>
> To: [log in to unmask]
> Sent: Wednesday, August 26, 2009 6:33:52 PM
> Subject: Re: Odd visits
>
> Sometimes I can find a symptom:
>
> 780.91 Fussy infant (baby)
> 780.92 Excessive crying of infant (baby)
> 780.95 Excessive crying of child, adolescent, or adult
> 780.7 Malaise and fatigue
> 780.99 Other general symptoms
> 792 Nonspecific abnormal findings in other body substances
> 799.3 Debility, unspecified
> 782.9 Other symptoms involving skin and integumentary tissues
>
> Plus I might add these V-codes
>
> V29 Observation and evaluation of newborns for suspected condition not
> found
>    V29.9 Observation for unspecified suspected condition
> V71 Observation and evaluation for suspected conditions not found
>    V71.9 Observation for unspecified suspected condition
>
> This may be a helpful section of the ICD codes:
> SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS (780-799)
> This section includes symptoms, signs, abnormal results of  
> laboratory or
> other investigative procedures, and ill-defined conditions regarding
> which no diagnosis classifiable elsewhere is recorded.
> Signs and symptoms that point rather definitely to a given diagnosis  
> are
> assigned to some category in the preceding part of the classification.
> In general, categories 780-796 include the more ill-defined conditions
> and symptoms that point with perhaps equal suspicion to two or more
> diseases or to two or more systems of the body, and without the
> necessary study of the case to make a final diagnosis. Practically all
> categories in this group could be designated as "not otherwise
> specified," or as "unknown etiology," or as "transient." The  
> Alphabetic
> Index should be consulted to determine which symptoms and signs are to
> be allocated here and which to more specific sections of the
> classification; the residual subcategories numbered .9 are provided  
> for
> other relevant symptoms which cannot be allocated elsewhere in the
> classification.
> The conditions and signs or symptoms included in categories 780-796
> consist of: (a) cases for which no more specific diagnosis can be made
> even after all facts bearing on the case have been investigated; (b)
> signs or symptoms existing at the time of initial encounter that  
> proved
> to be transient and whose causes could not be determined; (c)
> provisional diagnoses in a patient who failed to return for further
> investigation or care; (d) cases referred elsewhere for  
> investigation or
> treatment before the diagnosis was made; (e) cases in which a more
> precise diagnosis was not available for any other reason; (f) certain
> symptoms which represent important problems in medical care and  
> which it
> might be desired to classify in addition to a known cause.
> SYMPTOMS (780-789)
> NONSPECIFIC ABNORMAL FINDINGS (790-796)
> ILL-DEFINED AND UNKNOWN CAUSES OF MORBIDITY AND MORTALITY (797-799)
>
> Sometimes I feel truly stuck, and will give the diagnosis they came in
> suspecting, plus the V-code for concern for condition not found.
>
> For the 'omphalitis' patient, how about:
>
> 782.9 Other symptoms involving skin and integumentary tissues
> plus
> V29.9 Observation for unspecified suspected condition
>
>
>
> Julie Brown, MD, MPH
> Assistant Professor, Pediatric Emergency Medicine
> Mailstop B5520
> Seattle Children's Hospital
> Seattle, Washington, USA
> (206) 987 4016
>
>
> -----Original Message-----
> From: don zweig [mailto:[log in to unmask]]
> Sent: Wednesday, August 26, 2009 3:05 PM
> To: Brown, Julie C.
> Cc: [log in to unmask]
> Subject: Re: Odd visits
>
> What do you usually put on normal exam type cases so one may get
> paid?  is normal exam paid by insurance?
>
> don
> On Aug 26, 2009, at 2:30 PM, Brown, Julie C. wrote:
>
>> I can't help but add to the list:
>>
>> 1.  The baby rushed back by a nurse for omphalitis and mottled
>> skin.  I
>> washed off the gentian violet around the umbi stump, which was  
>> healing
>> normally, and noted the normal if slightly reticulated skin with  
>> brisk
>> capillary refill.  The tough part was what to give as a diagnosis for
>> this beautiful perfectly healthy newborn.
>>
>> 2.  The 3-year-old with a small splinter brought in for streaking
>> redness.  The resident told me she felt it was cellulitis with
>> lymphangitic spread and suggested antibiotics.  On exam, it was  
>> such a
>> linear streak leading away from the splinter, I asked if I could try
>> to
>> wipe it off, even though Dad had already tried.  It came off with
>> alcohol, after which Dad remembered that the child's preschool had
>> served popsicles that day.  At least I could diagnose and remove the
>> splinter.
>>
>>
>> Julie Brown
>> CONFIDENTIALITY NOTICE:  This e-mail message, including any
>> attachments, is for the sole use of the intended recipient(s) and
>> may contain confidential and privileged information protected by
>> law.  Any unauthorized review, use, disclosure or distribution is
>> prohibited.  If you are not the intended recipient, please contact
>> the sender by reply e-mail and destroy all copies of the original
>> message.
>>
>> For more information, send mail to [log in to unmask] with
>> the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>               http://listserv.brown.edu/ped-em-l.html
>
>
> CONFIDENTIALITY NOTICE:  This e-mail message, including any  
> attachments, is for the sole use of the intended recipient(s) and  
> may contain confidential and privileged information protected by  
> law.  Any unauthorized review, use, disclosure or distribution is  
> prohibited.  If you are not the intended recipient, please contact  
> the sender by reply e-mail and destroy all copies of the original  
> message.
>
> For more information, send mail to [log in to unmask] with  
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                http://listserv.brown.edu/ped-em-l.html
>
>
> For more information, send mail to [log in to unmask] with  
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
>
>
> For more information, send mail to [log in to unmask] with  
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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