Q. We had a patient come in with an open fracture of the distal interphalangeal joint of the right index and middle fingers, ICD-9 [International Classification of Diseases, 9th Revision, Clinical Modification] code 816.12. The provider set and splinted them both. Can I bill procedure code 26765 (“Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each”) twice? A. A diagnosis of open fracture means that the skin has been …
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Blurred Vision and Painful Red Eye in a 40-Year-Old Patient
A 40-year-old man presents to an urgent care center with an acutely painful red eye in which he has blurred vision. He notices a bit of a headache and that there are some halos around lights, but he says that he has not experienced nausea or vomiting. When reviewing his medical history with you, he notes that he recently started taking a new antidepressant. View the image taken (Figure 1) and consider what your diagnosis …
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Flashes of Light, Floaters, and Blurred Vision
A 70-year-old man presents with blurred vision and a nasal-field defect in one of his eyes. He reports that before arriving in the emergency department, he saw flashes of light and floaters, accompanied by a shower of black dots blocking his vision. Figure 1 shows what the physician sees when examining the patient’s eye with indirect ophthalmoscopy and scleral depression. Consider what your diagnosis would be.
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Middle East Respiratory Syndrome Coronavirus: An Urgent Care Approach
Charis Royal, BS Urgent message: With recent outbreaks of infectious diseases such as Ebola, being able to quickly and accurately diagnose such diseases is paramount for initiating containment and treatment procedures in a timely manner. Introduction In 2012 a novel coronavirus was discovered in the Arabian Peninsula, with signs and symptoms similar to those of severe acute respiratory syndrome coronavirus (SARS-CoV). This coronavirus was named Middle East respiratory syndrome coronavirus (MERS-CoV) and has infected over …
Read MoreClinical Challenge: September, 2015
Case A patient presents after a fall during a soccer game, reporting severe pain in one thumb and difficulty grasping anything between the thumb and forefinger. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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2015 Urgent Care Buyer's Guide
Delayed Prescribing of Antibiotics for Respiratory Tract Infections
Urgent message: Respiratory tract infections are a common complaint in the urgent care setting. Many patients present with the expectation of receiving antibiotics because they have usually done so. The rise of anti biotic-resistant infections requires that we take a close look at our prescribing habits and the need to reeducate patients on the harm of overusing antibiotics. Delayed prescribing offers a way to both satisfy patients and reduce the use of antibiotics in respiratory …
Read MoreAbstracts in Urgent Care: September, 2015
SEAN M. McNEELEY, MD Adverse Events Unlikely in Patients with Negative Findings on Cardiac Evaluation Key point: Adverse events in patients admitted with negative findings on cardiac evaluation are very infrequent. Citation: Weinstock MB, Weingart S, Orth F, et al. Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission. JAMA Intern Med 2015;175:1207–1212. In this 5-year retrospective study of patients seen in an emergency department for symptoms potentially representing …
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September 2015
Clinical Challenge: September, 2015
A 41-year-old man presents with left-flank pain. His past medical history is unremarkable. An incidental finding is evident on images of the kidney, ureter, and bladder. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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