Question

LOCATION: Hospital Emergency Department PATIENT: Dillon Watkins PHYSICIAN: Paul Sutton, M.D. SUBJECTIVE: 13-year-old white male, no ongoing medical problems, takes no medications, and no known allergies. He presents to the Emergency Room with a jamming injury (catching football) to his left third finger he sustained while playing football. Complains of pain at the PIP joint. NEUROMUSCULOSKELETAL REVIEW OF SYSTEMS: No paresthesias. OBJECTIVE: He has slight swelling and tenderness of the PIP joint. He has full range of motion and the finger is neurovascularly intact. Review of the X-ray of the left third finger was negative for gross bony abnormality. ASSESSMENT: Left third finger sprain. PLAN: Ice, p.r.n. ibuprofen or Tylenol. Follow-up if not noting gradual improvement or any worsening. LOCATION: Hospital Emergency Department PATIENT: Simon Sharp PHYSICIAN: Paul Sutton, M.D. SUBJECTIVE: The patient is a 51-year-old who presents to the emergency room with complaints of diarrhea. He has had a long history of diarrhea. He is a quadriplegic with some movement of his upper extremities but otherwise wheelchair bound. He was hospitalized for pneumonia and paroxysmal atrial fibrillation. He had diarrhea in the hospital and had it when he was discharged. During his outpatient workup for that, they found out he was C-difficile positive. He is on Cipro, Flagyl and vancomycin. The vancomycin was just started recently. He continues to have the diarrhea. He normally has a couple of healthcare workers that come over and help get him ready. When a friend and aide was over today, he noted that he sort of was sitting in some stool today. They cleaned him up and then he had another small bout of diarrhea. There has not been any blood. No black or tarry stools. He occasionally has some abdominal distention or cramping throughout these past weeks. It is not any worse today. It is actually a little bit better today than it was earlier. He has not had any fevers or chills. Appetite has maybe been a little bit down but he is trying to keep hydrated and drinking fluids and Gatorade. He has been trying to watch what he eats but he did have some chili in the last day. They did contact Dr. Naraquist, who recommended coming here and having his electrolytes checked. PAST MEDICAL HISTORY: 1. C-diff positive as noted above. 2. Quadriplegia from previous C5 fracture during an MVC. 3. He has a urostomy. 4. Left gluteal ulcer that he had for quite a long time which is now healed. 5. Tracheal stenosis. 6. Chronic renal insufficiency. 7. Tracheostomy. MEDICATIONS: Please see nurses' notes for meds and allergies. SOCIAL HISTORY: He is not smoking or drinking. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: As noted above. No cough or sore throat. No sinus problems. No chest pain. He has had the abdominal distention as above. He is producing a normal amount of urine. It is normal in color and clear. He is on a bowel program. He states he does not have any rashes or skin breakdown. OBJECTIVE: GENERAL: Exam showed a 51-year-old, alert and oriented, in no acute distress. VITAL SIGNS: Blood pressure 85/59, pulse 64, temperature 36.1 degrees. HEENT: Eyes are clear. Nose/oropharynx is negative. Mucous membranes seem moist. NECK: Supple. HEART: Regular S1, S2. ABDOMEN: Soft. It seems a little bit distended. Active bowel sounds throughout. No real tenderness to palpation. ER COURSE: I did get a basic metabolic panel which showed sodium 131. Potassium was normal at 4. BUN and creatinine were normal at 21 and 0.7, respectively. Glucose 107, CO2 20.4. White count normal, hemoglobin and hematocrit 12.6 and 38.4, respectively. ASSESSMENT: 1. Recurrent C-difficile infectious diarrhea. 2. Hyponatremia. PLAN: The case was discussed with the patient, caregiver and also with Dr. Naraquist. The patient will be discharged. He is in full agreement with that. Continue drinking fluids. To continue with current medication plan. They were reassured that his potassium was normal and Dr. Naraquist mentioned getting a GI referral to Dr. Friendly for further workup and possible colonoscopy. Further care as above. Return if symptoms worsen. NEED CPT CODES, ICD 10 CODES, HCPCS CODES

Answer 1

CPT code 73140- X- ray examination of finger(s).

ICD 10 code S63.613A- Unspecified sprain of left middle finger

CPT Code 99605-99607 - medication therapy management services

ICD 10 code A04.72- Enterocolitis due to clostridium difficile, not specified recurrent.

ICD 10 code G82.54- Quadriplegia. c5-c7 incomplete

ICD 10 code - Z93.6 - urostomy

ICD 10 code J39.8- Other specified diseases of upper respiratory tract ( Tracheal stenosis)

ICD 10 code N 18.9 chronic kidney disease , unspecified

ICD 10 code Z93.0- Tracheostomy status

ICD 10 code A04.71- Enterocolitis due to clostridium difficile, recurrent.

Icd 10 code E87.1- Hypo- osmolality and hyponatremia

CPT code- 80048- basic metabolic panel

CPT code- 45378 - Diagnostic colonoscopy