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CCS: focused vs complete PE?

Discussion in 'Step III' started by jakesaw, Apr 22, 2007.

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  1. jakesaw

    jakesaw Member

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    First of all, I've picked up a ton of useful step 3 info on these threads...thanks.

    I have one unanswered question though:

    When should I get a complete vs focused PE?

    I think that I'm pretty good with emergency situations, as a focused is done until they're stable, then possibly a more complete exam later (right?).

    My dilemma comes in the office/stable cases. For example, I know that for child abuse a complete PE is mandated. But what about stable patients presenting with "foul-vaginal discharge", "painful swollen big toe", etc...What kind of PE should be done...just a genitalia or extremity?

    And what of stable, office-based cases presenting with a likely more systemic cause, such as RA or SLE---full PE or focused?

    In stable patients I'd just prefer get a complete PE, perhaps deferring only the rectal and breast if reasonable. Will I be penalized for an excessive PE?

    Thanks for any info.

    J/S
  2. Swaydaa

    Swaydaa Senior Member

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    All you have to do is remember what location your at (office, ER, ICU, Floor) . If they start your Case in an ER, a focused exam is all you need to do as you will have dying people and need to do stuff QUICK. I've heard many people talking about extra points with follow up and counseling. Once you get the diagnosis, You can pick up tons of points by adding the appropriate counseling...."quit smoking" "ETOH use" "wearing seatbelt" "Social worker" "domestic abuse" "low fat diet". There is a huge drop down list that pops up when you type in "counseling" which makes it easy to select all the items appropriate to that patient. Good luck!
  3. Swaydaa

    Swaydaa Senior Member

    Joined:
    Mar 15, 2004
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    Location:
    Chicago
    SDN 7+ Year Member
    All you have to do is remember what location your at (office, ER, ICU, Floor) . If they start your Case in an ER, a focused exam is all you need to do as you will have dying people and need to do stuff QUICK. I've heard many people talking about extra points with follow up and counseling. Once you get the diagnosis, You can pick up tons of points by adding the appropriate counseling...."quit smoking" "ETOH use" "wearing seatbelt" "Social worker" "domestic abuse" "low fat diet". There is a huge drop down list that pops up when you type in "counseling" which makes it easy to select all the items appropriate to that patient. Good luck!
  4. Swaydaa

    Swaydaa Senior Member

    Joined:
    Mar 15, 2004
    Messages:
    258
    Location:
    Chicago
    SDN 7+ Year Member
    All you have to do is remember what location your at (office, ER, ICU, Floor) . If they start your Case in an ER, a focused exam is all you need to do as you will have dying people and need to do stuff QUICK. I've heard many people talking about extra points with follow up and counseling. Once you get the diagnosis, You can pick up tons of points by adding the appropriate counseling...."quit smoking" "ETOH use" "wearing seatbelt" "Social worker" "domestic abuse" "low fat diet". There is a huge drop down list that pops up when you type in "counseling" which makes it easy to select all the items appropriate to that patient. Good luck!
  5. jakesaw

    jakesaw Member

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