Harrison Parker, a 69-year-old right-handed male, was referred to me for a neurologic evaluation by his internist, Dr. Brady, for a tremor that has been present for approximately 20 years. Patient states that the tremor began insidiously and has progressed gradually. It now involves both hands and affects his handwriting, drinking coffee and other liquids with a cup, and general work that requires manual dexterity. Other people occasionally notice a tremor in his head. He is otherwise healthy, although he feels his balance is not quite as good as it used to be. A glass of beer or wine markedly decreases the tremor severity. His mother and daughter also have tremor. Patient denies smoking. On examination, he has a rather regular tremor of approximately 8 cycles per second (Hz) with his hands extended and also on finger-nose-finger maneuver. Mild regular “waviness” is seen when writing or drawing spirals. His tone is normal, although when performing voluntary movements with one hand there is a “ratchety” quality felt in the tone of the contralateral arm. Occasional tremor is also noted in the head and voice. Diagnosis: Probable essential tremor (ET) Next diagnostic step: MRI of brain and cervical spine + Labs (CBC + TSH) done in our facility today. Nurse Montana drew blood specimens. Next step in therapy: Primidone or propranolol Be sure to list the codes, one code per box, in the correct order, from top to bottom. Capitalization, punctuation, and spacing can impact whether or not your answer is correct. Follow coding best practices. Determine the most accurate procedure codes, using the CPT code set and modifier(s), if appropriate.
Harrison Parker, a 69-year-old right-handed male, was referred to me for a neurologic evaluation by his internist, Dr. Brady, for a tremor that has been present for approximately 20 years.
Patient states that the tremor began insidiously and has progressed gradually. It now involves both hands and affects his handwriting, drinking coffee and other liquids with a cup, and general work that requires manual dexterity. Other people occasionally notice a tremor in his head.
He is otherwise healthy, although he feels his balance is not quite as good as it used to be. A glass of beer or wine markedly decreases the tremor severity. His mother and daughter also have tremor. Patient denies smoking.
On examination, he has a rather regular tremor of approximately 8 cycles per second (Hz) with his hands extended and also on finger-nose-finger maneuver. Mild regular “waviness” is seen when writing or drawing spirals. His tone is normal, although when performing voluntary movements with one hand there is a “ratchety” quality felt in the tone of the contralateral arm. Occasional tremor is also noted in the head and voice.
Diagnosis: Probable essential tremor (ET)
Next diagnostic step: MRI of brain and cervical spine + Labs (CBC + TSH) done in our facility today.
Nurse Montana drew blood specimens.
Next step in therapy: Primidone or propranolol
Be sure to list the codes, one code per box, in the correct order, from top to bottom. Capitalization, punctuation, and spacing can impact whether or not your answer is correct. Follow coding best practices.
Determine the most accurate procedure codes, using the CPT code set and modifier(s), if appropriate.
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