tci ED Coding & Reimbursement Alert - 2013 Issue 6
You Be the Coder: Headache Or Aneurism? Check These Cranial Nerve Symptoms To Help Make the Diagnosis
Question: There are several symptoms listed but what’s the best diagnosis in this scenario?Hx: present illness; Patient is a 69-year-old mother, who is right handed and states for 4 days now has had a severe headache with visual blurring and diplopia, all right sided. She denied any Hx of seizures, motor sensory deficit, nausea and vomiting. No trauma or speech difficulties. She states she has had sinusitis for years. No current meds, NKA. Physical Examination: HEENT: Right pupil 2mm, reactive. Disconjugated gaze is present. There is right sided ptosis. Oropharynx clear without lesions. Her neck is supple...
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