Question about R/O(rule out)

[luxor]

Can someone give me an answer about when is the best to use R/O in assessment ?

For example,

from A) endometriosis R/O cystoma ovarli

Does it mean "don't think about cystoma ovarli even though it has similar symptom? Or
means "think about cystoma ovarli too?

That is not an appropriate example but please answer using it or you can make other example.
Thank you very much in advance.

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[Winged Scapula]

Can someone give me an answer about when is the best to use R/O in assessment ?

For example,

from A) endometriosis R/O cystoma ovarli

Does it mean "don't think about cystoma ovarli even though it has similar symptom? Or
means "think about cystoma ovarli too?

That is not an appropriate example but please answer using it or you can make other example.
Thank you very much in advance.

You are using R/O when you have a symptom or condition but not necessarily the case for it.

For example, you have a patient with hypertension, headaches, anxiety/nervousness, etc.

You would write: R/O Pheochromocytoma

You have a patient with right lower quadrant pain, nausea, vomiting. You write R/O acute appendicitis

You have a patient with crushing central chest pain radiating down their left arm, shortness of breath, diaphoresis... You write R/O Acute MI

You have a patient with amennorhea, vaginal bleeding, weight gain and abdominal pain. You write R/O ectopic pregnancy...

Get it?

 

[Tired]

I was taught to mention it in your assessment, but all too often people use "rule out MI" or "rule out appendicitis" as a diagnosis, and this is completely inappropriate. "Rule out X" is not a diagnosis, it's an expression of your diagnostic strategy.

I have also been told by coders that if you put it as a dianosis or a reason for ordering a test, it will get bounced back from the insurers.

 

[angel80]

I heard the same thing about radiologic studies. For example, if you order a chest CT with contrast and write re: r/o PE, you can't bill for it. If you write re: chest pain, hypoxia, then you can bill for it. Usually I put both, re: chest pain, hypoxia, r/o PE, so that the radiologist will know what I am worried about.

 

[Blade28]

Hmmm...we don't use "r/o" very often in surgery.

I think it's funny that it's become a noun, as in:

"Patient Smith was admitted overnight for a rule-out."

When what they really mean is:

"Patient Smith was admitted overnight to be ruled out for an MI."

 

[Winged Scapula]

Hmmm...we don't use "r/o" very often in surgery.

Is that because we always know what it is, or because if it hasn't been "ruled in" we won't admit?

Now that I think of it, if I"m not sure of the dx, I won't write R/O but rather "Likely X, Admit for Y and Z treatment"

 

[Winged Scapula]

I have also been told by coders that if you put it as a dianosis or a reason for ordering a test, it will get bounced back from the insurers.

radiologists have told me that as well.

 

[luxor]

Thank you so much for your kind answers.
Gog bless to you all~!

 

[edmadison]

Thank you so much for your kind answers.
Gog bless to you all~!

I appreciate "Gog's" blessing. Maybe it was my training program, but my neck hair stands on end when someone says "baby smith was admitted for a rule-out sepsis work-up". I much prefer "baby smith was admitted for fever and a sepsis evaluation". I also try not to put rule out this or that on a consult request. I think it boxes in the consultant. I usually put something akin to "please evaluate for fracture or please evaluate -- we are concerned about bowel obstruction. I guess this word harping is really irrelevant, but being pedantic is part of my personality.

Ed

 

[gutonc]

When it comes to calling consults or ordering studies, I always use "evaluate Symptom X or Sign Y" as it gives the consultant or reader some clinical background.

And it's true that "rule-out" studies can't be billed but "evaluate" can be.

 

[luxor]

doc, I am still laughing on my typo. hehehe.
I'd better leave it....hehe

 

[Blade28]

Is that because we always know what it is, or because if it hasn't been "ruled in" we won't admit?

Maybe it was my training program, but my neck hair stands on end when someone says "baby smith was admitted for a rule-out sepsis work-up". I much prefer "baby smith was admitted for fever and a sepsis evaluation". I also try not to put rule out this or that on a consult request. I think it boxes in the consultant.

I agree. I don't know, something about the term "rule out" bugs me.

 

[core0]

I agree. I don't know, something about the term "rule out" bugs me.

I tend to do this when I am in a hurry. We have big signs all over the hospital that say "Must put reason for radiology procedure may not use rule out". The funny thing is that if you put something that doesn't make sense they still do it. Ie. CXR reason abnormal LFTs. I am always unsure if I want to put in rule outs. If you put CT abdomen abdominal pain R/O colitis then you get a lot of soft colitis calls. On the other hand if you just put CT abdominal pain they may not comment on the colon.

David Carpenter, PA-C

 

[yaah]

I have to ask, what in blazes is a cystoma ovarli?

 

[buckley]

the way my resident explained to me back when I was an intern was that you put R/O when it is very pertinent that you rule out the disease, i.e. pheochromocytoma or malignancy. It doesn't necessarily have to be the main diagnosis, but it's the diagnosis that you can't affor to miss because it changes your entire mgt. So it's r/o malignancy, but never r/o URTI

 

[Tired]

the way my resident explained to me back when I was an intern was that you put R/O when it is very pertinent that you rule out the disease, i.e. pheochromocytoma or malignancy. It doesn't necessarily have to be the main diagnosis, but it's the diagnosis that you can't affor to miss because it changes your entire mgt. So it's r/o malignancy, but never r/o URTI

Lame. "Rule out" implies that you are looking to exclude it. But what you describe is more, "I think it's probably a pheo, but I haven't confirmed it yet."

In those cases, I usually write "Hypertension, presumtive pheo".

 

[luxor]

Lame. "Rule out" implies that you are looking to exclude it. But what you describe is more, "I think it's probably a pheo, but I haven't confirmed it yet."

In those cases, I usually write "Hypertension, presumtive pheo".

Yea, as you said, "Rule out" implies to exclude something but why do we use it as opposite meaning in assessment?

 

[Blade28]

Lame. "Rule out" implies that you are looking to exclude it. But what you describe is more, "I think it's probably a pheo, but I haven't confirmed it yet."

In those cases, I usually write "Hypertension, presumtive pheo".

There, that's what I meant! Can't believe it took an orthopod to tell me how to work up a pheo.

Most people don't mean "rule out," they mean "I suspect this!"

 

[ScooterBanks]

Don't EVER use "rule out ___" in your orders for radiolographic studies. Always put down a symptom for your reason.

For example, if you think your patient might have appendicitis, don't order a CT and write "rule out appendicitis"...instead order it as "RLQ pain". Trust me, the Radiologist reading the study will definitely check for it, along with other potential causes for RLQ pain.

 

[core0]

Don't EVER use "rule out ___" in your orders for radiolographic studies. Always put down a symptom for your reason.

For example, if you think your patient might have appendicitis, don't order a CT and write "rule out appendicitis"...instead order it as "RLQ pain". Trust me, the Radiologist reading the study will definitely check for it, along with other potential causes for RLQ pain.

Yeah but its really annoying when you put diarrhea and abdominal pain and they don't mention the colon. If you put R/O colitis you at least tell them the thing you want to address (and hopefully they will address the correct body part).

David Carpenter, PA-C

 

[Winged Scapula]

Yeah but its really annoying when you put diarrhea and abdominal pain and they don't mention the colon. If you put R/O colitis you at least tell them the thing you want to address (and hopefully they will address the correct body part).

David Carpenter, PA-C

Exactly. I have seen this countless times...as I'm trying to avoid putting a diagnosis down, but despite thinking "its obvious from the symptoms", I'll see a CT report which won't even mention that area of the abdomen.

 

[core0]

Exactly. I have seen this countless times...as I'm trying to avoid putting a diagnosis down, but despite thinking "its obvious from the symptoms", I'll see a CT report which won't even mention that area of the abdomen.

On the other hand you really worry that they will try to find something that goes along with your R/O and miss something else. In a perfect world they would look at the whole CT in isolation and give you an unbiased assessment. In the real world that rarely happens. I see a lot of "the following things are borderline but I can't see anything obvious, clinical correlation is advised".

David Carpenter, PA-C

 

[carrigallen]

What I like are the pre-op consults for cardiac "clearance". There is no way to "clear" a patient for surgery, particularly if there is already a compelling indication to order the consult. A preferred term is "preoperative cardiac risk assessment".

 

[Winged Scapula]

What I like are the pre-op consults for cardiac "clearance". There is no way to "clear" a patient for surgery, particularly if there is already a compelling indication to order the consult. A preferred term is "preoperative cardiac risk assessment".

Guilty as charged, although in my defense that's what we want when we write cardiac clearance. Who has time to write out, "preoperative cardiac risk assessment?"

I'll try to be better...can I abbreviate "P-O CRA?"

 

[FoughtFyr]

Guilty as charged, although in my defense that's what we want when we write cardiac clearance. Who has time to write out, "preoperative cardiac risk assessment?"

I'll try to be better...can I abbreviate "P-O CRA?"

Try PAME - Pre-anesthesia medical evaluation.

- H

 

[Apollyon]

Instead of "rule out", use "possible", or more info, like "RLQ pain, appy vs ovarian cyst". The pain statement is an affirmative indication, and the "appy vs ovarian cyst" is your medical decision making.

 

[Blade28]

Instead of "rule out", use "possible", or more info, like "RLQ pain, appy vs ovarian cyst". The pain statement is an affirmative indication, and the "appy vs ovarian cyst" is your medical decision making.

Much better!

 

[jonnylingo]

I have also been told by coders that if you put it as a dianosis or a reason for ordering a test, it will get bounced back from the insurers.

True here. Today I wrote CTA r/o PE. This came back from the powers that be, and I had to re-write as CTA re: Chest Pain.

 

[Blade28]

Again, it's because you're not really trying to "rule out" a PE, you're trying to see if the patient has a PE, right? Subtle difference.

Just put CTA for chest pain, or dyspnea, or history of DVT, or whatever.