Billing question
Regarding outpatient codes 99214, 99215.
For a 99214 lets say I have a patient with only GAD. Their anxiety is worse from previous visit. I am managing them with an SSRI. Would the fact their anxiety is worse since previous visit be considered 1 or more chronic illness with "exacerbation or progression"?
For a 99215 lets say I have a patient with Bipolar I. They are taking lithium. Their depression is worse than it was at last visit. Would this be considered a 99215 given "severe...
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Source: Student Doctor Network - December 7, 2022 Category: Universities & Medical Training Authors: yanks26dmb Tags: Psychiatry Source Type: forums
MDM in 2023 E/M guidelines
In the 2023 guidelines for E+M codes on inpatient, it seems that it's both easier and more difficult to justify a high complexity code. It does however seem that one can justify this on the basis of discussing a medication that requires monitoring, even if it isn't started. In my view, this would mean that discussing, say, the option of an atypical antipsychotic which requires lipid/glucose monitoring in a patient who is manic, psychotic or suicidal, would meet criteria in terms of MDM. What...
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Source: Student Doctor Network - December 4, 2022 Category: Universities & Medical Training Authors: SmallBird Tags: Psychiatry Source Type: forums
When ECT fails …then what?
Bipolar I female in 70s. hx MDE with psychosis and catatonia. Stable for decades on lithium and lamictal. But past 5 years like clockwork enters MDE around fall equinox. Every year has responded to ECT beautifully. This time had 6 sessions and nada. She’s been inpatient a couple times like three years ago. Myself and multiple psychiatrists of academic centers all concur she’s definitely a bipolar I and a pretty classic presentation. Got most recent ECT from one of most reputable providers in...
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Source: Student Doctor Network - November 12, 2022 Category: Universities & Medical Training Authors: randomdoc1 Tags: Psychiatry Source Type: forums
Bipolar 2.
I was just curious how confident you guys feel with the bipolar 2 diagnosis in the outpatient setting. I ask, but usually when they present the history is unclear and often fairly vague with some BPD sx thrown in the mix. The challenge behind it is that patients rarely present to me in hypomania, its typically a depressive episode, and patients often have a remote/vague psychiatric hx and arent the best at remembering details. For some patients when i have a lot of information about them...
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Source: Student Doctor Network - October 27, 2022 Category: Universities & Medical Training Authors: annoyedpsychiatrist Tags: Psychiatry Source Type: forums
Your experience with Oxcarbazepine for Bipolar Disorder and other off label uses.
Unfortunately, bibliography is not rich enough about this drug for bipolar disorder. It is a pity that we keep using carbamazepine instead of this one.
I've heard it working on anger outbursts too in bipolar and not only.
Do you use it in your clinical practice?
What's your experience with it? (Source: Student Doctor Network)
Source: Student Doctor Network - October 11, 2022 Category: Universities & Medical Training Authors: Iparksiako Tags: Psychiatry Source Type: forums
Knock-off Palisades Alternative for SI RFA
As the title says, I'm a new private practice doc who recently finished fellowship where we exclusively used boston scientific palisades for our SI RFA's. They were great and made the procedure a breeze. I did my first post-fellowship SI RFA today without the palisade (too expensive) and it was a struggle. Any advice from the wiser docs out there? Can I make my own alternative and autoclave it? I prefer to use bipolar for my SI RFA's. (Source: Student Doctor Network)
Source: Student Doctor Network - August 25, 2022 Category: Universities & Medical Training Authors: AnesthesioPainologist Tags: Pain Medicine Source Type: forums
How to treat compulsive side effects of pramipexole?
Have a bipole who is doing quite well on augmentation with pramipexole - 1mg bid. Only issue is they are experiencing increasing compulsive behaviors in the form of unhealthy eating, excessive masturbating. I can confidently say they are not experiencing a manic episode and this is likely 2/2 the medication. I'd hate to stop it as its having very positive effects on their mood. Any suggestions? (Source: Student Doctor Network)
Source: Student Doctor Network - August 11, 2022 Category: Universities & Medical Training Authors: Psychresy Tags: Psychiatry Source Type: forums
Patient on Clozapine with SBO
I encountered an interesting (perplexing) case:
30-something yo male comes to the hospital for vomiting and abdominal pain and lack of gas / stool for several days. It got so bad he passed out before being brought to the ER. He was just DC from the psychiatric unit less than one month ago for schizoaffective disorder (bipolar type) and when unwell would be manic and paranoid. He failed Latuda. Haldol caused EPS. And was finally stable enough for DC on clozapine after several weeks. History...
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Source: Student Doctor Network - July 26, 2022 Category: Universities & Medical Training Authors: AD04 Tags: Psychiatry Source Type: forums
I graduated with a Biology degree and now wish to be a Clinical Psychologist?
For a while, I wanted to go to med school or PA school, but over the past year, I decided it wasn't for me. I didn't do research in undergrad, as the only research that ever interested me was psychology-based, and the more experienced psych students often took those. I did an independent study on bipolar/schizophrenia, which I presented at my school's psych conference and wrote a long paper that is not published (though I could try publishing it?). Currently, I am applying for research...
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Source: Student Doctor Network - July 25, 2022 Category: Universities & Medical Training Authors: sincerelyflowers Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
bipolar affective disorder terminology
Can someone please help? This is driving me nuts.
Ocassionally on charts I will see "bipolar affective disorder" or "manic depression."
Is this an old term from DSM 3 or something? Or a current one from ICD-10? Does it more closely resemble schizoaffective disorder or is it just bipolar? Does this term just mean "bipolar" with a few extra words thrown in before and after? Or is like here is "bipolar" and "bipolar affective disorder" like how we use bipolar 1 and bipolar 2? (Source: Student Doctor Network)
Source: Student Doctor Network - July 14, 2022 Category: Universities & Medical Training Authors: bluecolourskies Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
Managing bipolar disorder in medical school
Hey there guys! Hope you guys are having a good day. If you've stumbled across this post thanks for taking a moment out of your day to interact.
I've read some articles published by writers on the Student Doctor Network about managing bipolar disorder in medical school, as well as chatting with family friends in medical school who have it too. Does anyone out there have it too, and have any tip of how to manage it during school? I take all my meds, go to therapy every week, follow my...
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Source: Student Doctor Network - June 16, 2022 Category: Universities & Medical Training Authors: california_poppyseed Tags: Pre-Medical (MD) Source Type: forums
Realistic chances to match into Peds as a DO? What to do for 4th year?
Brief overview: Current OMS-III student. Hoping to match into pediatrics residency with hopes of going into neonatology fellowship. Big red flag would be my low COMLEX level 1 score at 418 and advisor has advised me not to take Step 1 since we are moving into P/F the following year.
What happened here was a series of events that did not stack well. I gave birth to a newborn in late January which I took care of 24/7. My partner has Bipolar 1 and his current medications knocks him out at night...
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Source: Student Doctor Network - June 11, 2022 Category: Universities & Medical Training Authors: waddlinpenguin Tags: Medical Students (DO) Source Type: forums
Dosage of Quetiapine for acutely manic patients?
Almost every guidelines I read, suggest that if you want to start Quetiapine for Acutely Ill Manic (or Psychotic in general) patients who have severe behaviour disturbance, you start 200-300mg on day 1, and you move upwards for day 2.
I have a feeling that 200 or 300mg will not be enough for a manic patient and he will be very agitated in the clinic.
What is you experience with it? Are 200 -300 mg enough?
Can you start it on higher doses?
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Other than that, whats your go-to drug...
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Source: Student Doctor Network - June 5, 2022 Category: Universities & Medical Training Authors: Iparksiako Tags: Psychiatry Source Type: forums
TBI: TBH I don ’t know much
Hi all,
Saw a patient this weekend with “bipolar disorder” and in taking history found that he had sustained several TBI’s starting at age 15. Between these and PTSD, he manifested the whole gamut of psychiatric symptoms. I’ve also noticed there have been some adjacent discussions about TBI on other posts.
I’ve realized I haven’t had any training in TBI theory/management besides “if they’re manic give them the antimanics” and “propranolol helps impulsivity.”
Given that I don’t want to do...
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Source: Student Doctor Network - May 17, 2022 Category: Universities & Medical Training Authors: Alemo Tags: Psychiatry Source Type: forums
Confused about Lithium vs Depakote in Bipolar
My understanding is that both medications work better in acute mania than bipolar depression. However CANMAT seems to indicate good efficacy of both in bipolar depression. Though I've heard that VPA is better for mixed episodes. All things being equal how do you weigh starting Li vs VPA in a patient with no contraindications for either. Do you choose one over another based on presenting symptoms? (Source: Student Doctor Network)
Source: Student Doctor Network - April 22, 2022 Category: Universities & Medical Training Authors: yanks26dmb Tags: Psychiatry Source Type: forums
