HIT 251 CODING PRACTICUM (MEDICINE SECTION ENCOUNTERS) What are the CPT and ICD-
ID: 305703 • Letter: H
Question
HIT 251 CODING PRACTICUM (MEDICINE SECTION ENCOUNTERS)
What are the CPT and ICD-10-CM codes?
Polysomnogram sleep study
HISTORY: The patient is being placed in the sleep study for an evaluation to rule out obstructive sleep apnea or other sleep-related problems because she was noted on a 24-hour Holter monitor to have significant bradycardia and sinus pauses during sleep. She did describe some symptoms of EDS, insomnia, and some restlessness. Her Epworth sleepiness scale was 7 consistent with moderate sleepiness.
AGE: 48 HEIGHT: 5'5" WEIGHT: 145 lb ALCOHOL: She drinks about one alcoholic drink per week.
CAFFEINE: She drinks about three cups of coffee per day.
MEDICATIONS: Synthroid and fludrocortisone.
SLEEP TIME STATISTICS: Time in bed, 411 minutes.Total sleep time, 256 minutes. Total nonREM sleep, 20 minutes. Total REM sleep, 46 minutes. Sleep onset, 10 minutes. Sleep efficiency, 62%.
SLEEP DISRUPTION EVENTS: She had 20 arousals, 19 awakenings, for a total of 39.
SLEEP STAGE STATISTICS: The patient was awake for 27.2% of the study. Stage I, 0.4%. Stage II, 42.8%. Stage III, 11.9%. Stage IV, 4.6%. REM sleep, 13.1%. She had a total of two apneas, both central in origin for an apnea-hypopnea index of 0.5%.
OXYGEN SATURATION: Mean, 98% awake. Her minimum saturation during sleep was 91%.Her range was 91% to 98%. Oxygen saturations were greater than 89%, 100% of the time.
CARDIAC EVALUATION: ECG statistics showed her wakefulness heart rate average 53. Her sleep average was 48. She did not have any significant cardiac dysrhythmias noted. As stated previously, there were a total of two apneas throughout the entire night, both central in origin, the longest lasting 16 seconds. They both occurred when the patient was in a nonsupine position.
FINDINGS 1. As stated above, the two central apneas throughout the entire night. 2. ECG was notably bradycardic but no other sinus pauses were noted. 3. There were no periodic leg movements or myoclonus. 4. Snoring was light. 5. The lowest oxygen saturation was 91%.
SUMMARY 1. This is an essentially normal sleep study record. It was an adequate study.The sleep efficiency was 62%,which is an adequate study, and the patient did reach REM sleep 13.1%,which is adequate. 2. While there was bradycardia, there were no significant dysrhythmias or pauses noted. 3. Clinical correlation suggested,but there appears to be no sleep-related disorders accounting for her bradycardia during sleep.
Explanation / Answer
ICD-10-CM Code for Brachycarida is R00.1,,CPT Codes is the current procedural terminology code set is a medical code set maintained by the American Medical A ssociation through the CPT editorial panel they are two of CPT code that is category l,ll,lll, there the code is 99450-99456 it is for special evaluation and management services.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.