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In general, higher paying E/M codes (like consultations or initial office visits) require more extensive documentation than lower paying codes (such as office visits with established patients or hospital progress notes). E/M University Coding Tip: The physician MUST choose to use EITHER the 1995 OR the 1997 E/M guidelines. It is NOT acceptable.


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ASSESSMENT: The patient is diabetic and has a prior history of coronary artery disease.
The patient presents today stating that his chest pain started yesterday evening and has been somewhat intermittent.
The severity of the pain has progressively increased.
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He ranks the pain a 7 on a scale of 1-10.
He admits some shortness of breath and diaphoresis.
He states that he has had nausea and 3 episodes here vomiting tonight.
He denies any fever or chills.
He admits prior episodes of similar pain prior to his PTCA in 1995.
He states the pain is somewhat worse with walking and seems to be relieved with rest.
There is no change in pain with positioning.
He states that he took 3 nitroglycerin tablets sublingually over the past 1 hour, which he states has partially relieved his pain.
The patient ranks his present pain a 4 on a scale of 1-10.
The most recent episode of pain has lasted one-hour.
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He appears in moderate discomfort but there is no evidence of distress.
He is alert, and oriented to person place and circumstance.
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The patient ambulates without gait abnormality or difficulty.
Extra-ocular muscles are intact bilaterally.
External auditory canals are clear bilaterally.
Tympanic membranes are clear and intact bilaterally.
There is free range of motion and no tenderness, thyromegaly or lymphadenopathy noted.
Pharynx: Clear, no erythema, exudates or tonsillar enlargement.
Chest: No chest wall tenderness to palpation.
Lungs: Clear to auscultation bilaterally.
Heart: irregularly-irregular rate and rhythm no murmurs gallops or rubs.
Normal PMIAbdomen: Soft, non-distended.
Skin: Warm, diaphoretic, mucous membranes moist, normal turgor, no rash noted.
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Note: Special UK only codes of ‘00’ and ‘01’ are also used. Second 2 digits: – Community Code for previous procedure, ie regime from which goods are being withdrawn (where there is none this code will be ‘00’). Note: If the first 2 digits are ‘00’ or ‘01’ then the second 2 digists will also be UK use only.


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GitHub - 1905-may06-dotnet/training-code: This repository will be used for sharing code, projects and notes
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ASSESSMENT: The patient is a 40-year-old white male who presents with a chief complaint of "chest pain".
ASSESSMENT: The patient is diabetic and has a prior history of coronary artery disease.
The patient presents today stating that his chest pain started yesterday evening and has been somewhat intermittent.
The severity of the pain has progressively increased.
He describes the pain as a sharp and heavy pain which radiates to his neck and left arm.
He ranks the pain a 7 on a scale of 1-10.
He admits some shortness of breath and diaphoresis.
He states that he has had nausea and 3 episodes of vomiting tonight.
He denies any fever or chills.
He admits prior episodes of similar pain prior to his PTCA in 1995.
He states the pain is somewhat worse with walking and seems to be relieved with rest.
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He states that he took 3 nitroglycerin tablets sublingually over the past 1 hour, which he states has partially relieved his pain.
The patient ranks his present pain a 4 on a scale of 1-10.
The most recent episode of pain has lasted one-hour.
Acute Inferior Myocardial Infarction.
ASSESSMENT: The patient is moderately obese but he is otherwise well developed and well nourished.
He appears in moderate discomfort but there is no evidence of distress.
He is alert, and oriented to person place and circumstance.
There is no evidence of respiratory distress.
The patient ambulates without gait abnormality or difficulty.
Extra-ocular muscles are intact bilaterally.
External auditory canals just click for source clear bilaterally.
Tympanic membranes are clear and intact bilaterally.
There is free range of motion and no tenderness, thyromegaly or lymphadenopathy noted.
Pharynx: Clear, no erythema, exudates or tonsillar enlargement.
Chest: No chest wall tenderness to palpation.
Lungs: Clear to auscultation bilaterally.
Normal PMIAbdomen: Soft, non-distended.
Skin: Warm, diaphoretic, mucous membranes moist, normal turgor, no rash noted.
Extremities: No gross visible deformity, free range of motion.
No edema or cyanosis.
He tolerated the TPA well.
He was transferred to the CCU in a stable condition Code-A-Note's Clinical Code Extractor incorporates an advanced clinical domain Natural Language Processing NLP solution to harvest clinical information from unstructured text, and then applies additional filter and data resources from Find-A-Code's digital coding library.
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Defining interactive complexity The interactive complexity code is used when psychiatric services have been complicated by communication difficulties during the visit.
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He admits some shortness of breath and diaphoresis.
He states that he has had nausea and 3 episodes of vomiting tonight.
He denies any fever or chills.
He admits prior episodes of similar pain prior to his PTCA in 1995.
He states the pain is somewhat worse with walking and seems to be relieved with rest.
There is no change in pain with positioning.
He states that he took 3 nitroglycerin tablets sublingually over the past 1 hour, which he states has partially relieved his pain.
The patient ranks his present pain a 4 on a scale of 1-10.
The most recent episode of pain has lasted one-hour.
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He appears in moderate discomfort but there is no evidence of distress.
He is alert, and oriented to person place and circumstance.
There is no evidence of respiratory distress.
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Extra-ocular muscles are intact bilaterally.
External auditory canals are clear bilaterally.
Tympanic membranes are clear and intact bilaterally.
There is free range of motion and no tenderness, thyromegaly or lymphadenopathy noted.
Pharynx: Clear, no erythema, exudates or tonsillar enlargement.
Chest: No chest wall tenderness to palpation.
Lungs: Clear to auscultation bilaterally.
Heart: irregularly-irregular rate and rhythm no murmurs gallops or rubs.
Normal PMIAbdomen: Soft, non-distended.
Skin: Warm, diaphoretic, mucous membranes moist, normal turgor, no rash noted.
Extremities: No gross visible deformity, free range of motion.
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This document read more a collection of notes about the internals of Machinekit.
It is primarily of interest to developers, however much of the information here may also be of interest to system integrators and others who are simply curious about how Machinekit works.
Much of this information is now outdated and has never been reviewed for accuracy.
There will be a chapter for each of the major components of Machinekit, as well as chapter s covering how they work together.
This document is very much a work in progress, and its layout may change in the future.
Those nine axes are referred to as X, Y, Z, A, B, C, U, V, and W.
The linear orthagonal coordinates X, Y, and Z determine where the tip of the tool is positioned.
The angular coordinates A, B, and C determine the tool orientation.
A second set of linear orthagonal coordinates U, V, and W allows tool motion typically for cutting actions relative to the previously offset and rotated axes.
On a Bridgeport this causes no confusion, since movement of the table directly corresponds to movement along the X axis.
However, the shoulder and elbow joints of a robot arm and the linear actuators of a hexapod do not correspond to movement along any Cartesian axis, and in general it is important to make the distinction between the Cartesian axes and the machine degrees of freedom.
In this document, the latter will be called 'joints', not axes.
The GUIs and some other parts of the code may not always follow this distinction, but the internals of the motion controller do.
Joints are distinct from axes, although the two terms are sometimes mis used to mean the same thing.
In Machinekit, a joint is a physical thing that can be moved, not a coordinate in space.
For example, the quill, knee, saddle, and table of a Bridgeport mill are all joints.
The shoulder, elbow, and wrist of a robot arm are joints, as are the linear actuators of a hexapod.
Every joint has a motor or actuator of some type associated with it.
Joints do not necessarily correspond to the X, Y, and Z axes, although for machines with trivial kinematics that may be the case.
Even on those machines, joint position and axis position are fundamentally different things.
In this document, the terms 'joint' and 'axis' are used carefully to respect their distinct meanings.
In particular, GUIs for machines with trivial kinematics may gloss over or completely hide the distinction between joints and axes.
In addition, the ini file uses the term 'axis' for data that would more accurately be described as joint data, such as input and output scaling, etc.
In the Machinekit motion controller, when we refer to a pose we mean an EmcPose structure, containing three linear coordinates and three angular ones.
There are four components contained in the Machinekit Architecture: a motion controller EMCMOTa discrete IO controller EMCIOa task executor which coordinates them EMCTASK and several text-mode and graphical User Interfaces.
The motion controller receives commands from user space modules via a shared memory buffer, and executes those commands in realtime.
The status of the controller is made available to the user space modules through the same shared memory area.
The motion controller interacts with the motors and other hardware using the HAL Hardware Abstraction Layer.
This document assumes that the reader has a basic understanding of the HAL, and uses terms like HAL pins, HAL signals, etc, without explaining them.
For more information about the HAL, see the HAL Manual.
The following figure is a block diagram of a joint controller.
There is one joint controller per joint.
The joint controllers work at a lower level than the kinematics, a level where all joints are completely independent.
All the data for a joint is in a single joint structure.
Joint Controller Block Diagram The above figure shows five of the seven sets of position information that form the main data flow through the motion controller.
It is updated at the traj rate, not the servo rate.
In coord mode, it is determined by the traj planner.
In teleop mode, it is determined by the traj planner?
In free mode, it is either copied from actualPos, or generated by applying forward kins to 2 or 3.
It is updated at the traj rate, not the servo rate.
In coord mode, it is generated by applying inverse kins to 1 In teleop mode, it is generated by applying inverse kins to 1 In free mode, it is copied from 3I think.
A new set of these coords is generated every servo period.
In coord mode, it is generated from 2 by the interpolator.
In teleop mode, it is generated from 2 by the interpolator.
In free mode, it is generated by the free mode traj planner.
Motor coords are generated by adding backlash compensation, lead screw error compensation, and offset for homing to 3.
It is generated the same way regardless of the mode, and is the output to the PID loop or other code notes are used to loop.
It is the input from encoders or other feedback device or from virtual encoders on open loop machines.
It is "generated" by reading the feedback device.
It is generated by subtracting offset, lead screw error compensation, and backlash compensation from 5.
It is generated the same way regardless of the operating mode.
It is updated at the traj rate, not the servo rate.
Ideally, actualPos would always be calculated by applying forward kinematics to 6.
Whatever approach is used, I can see no reason not to do it the same way regardless of the operating mode.
If no forward kins, do Asince otherwise actualPos would never get updated.
This section simply lists all of the commands that can be sent to the motion module, along with detailed explanations of what they do.
The commands are implemented by a large switch statement in code notes are used to function emcmotCommandHandlerwhich is called at the servo rate.
More on that function later.
The ABORT command simply stops all motion.
It can be issued at any time, and will always be accepted.
It does not disable the motion controller or change any state information, it simply cancels any motion that is currently in progress.
That results in each joint stopping as fast as its accel decel limit allows.
The stop is not coordinated.
In teleop mode, the commanded Cartesian velocity is set to zero.
In coord mode, the coord mode trajectory planner is told to abort the current move.
The FREE command puts the motion controller in free mode.
Free mode means that each joint is independent of all the other joints.
Cartesian coordinates, poses, and kinematics are ignored when in free mode.
In go here, each joint has its own simple trajectory planner, and each joint completely ignores the other joints.
Some commands like JOG only work in free mode.
Other commands, including anything that deals with Cartesian coordinates, do not work at all in free mode.
The command handler applies no requirements to the FREE command, it will always be accepted.
I believe the command should not be silently ignored, instead the command handler should determine whether it can be executed and return an error if it cannot.
If the machine is already in free mode, nothing.
Otherwise, the machine is placed in free mode.
The TELEOP command places the machine in teleoperating mode.
In teleop mode, movement of the machine is based on Cartesian coordinates using kinematics, rather than on individual joints as in free mode.
However the trajectory planner per se is not used, instead movement is controlled by a velocity vector.
Movement in teleop mode is much like jogging, except that it is done in Cartesian space instead of joint space.
On a machine with trivial kinematics, there is little difference between teleop mode and free mode, and GUIs for those machines might never even issue this command.
However for non-trivial machines like robots and hexapods, teleop mode is used for most user commanded jog type movements.
The command handler will reject the TELEOP command with an error message if the kinematics cannot be activated because the one or more axes have not been homed.
I believe the command should not be silently ignored, instead the command handler should determine whether it can be executed and return an error if it cannot.
If the machine is already in teleop mode, nothing.
Otherwise the machine is placed in teleop mode.
The kinematics code is activated, interpolators are drained and flushed, and the Cartesian velocity commands are set to zero.
The COORD command places the machine in coordinated mode.
In coord mode, movement of the machine is based on Cartesian coordinates using kinematics, rather than on individual joints as in free mode.
Coord mode is the mode that is used when executing a G-code program.
The command handler will reject the COORD command with an error message if the kinematics cannot be activated because the one or more axes have not been homed.
I believe the command should not be silently ignored, instead the command handler should determine whether it can be executed and return an error if it cannot.
If the machine is already in coord mode, nothing.
Otherwise, the machine is placed in coord mode.
The kinematics code is activated, interpolators are drained and flushed, and the trajectory planner queues are empty.
The trajectory planner is active and awaiting a LINE, CIRCLE, or PROBE command.
If the controller is already enabled, nothing.
If not, the controller is enabled.
Queues and interpolators are flushed.
Any movement or homing operations are terminated.
The amp-enable outputs associated with active joints are turned on.
If forward kinematics are not available, the machine is switched to free mode.
If the controller is already disabled, nothing.
If not, the controller is disabled.
Queues and interpolators are flushed.
Any movement or homing operations are terminated.
The amp-enable outputs associated with active joints are turned off.
If forward kinematics are not available, the machine is switched to free mode.
Can be used to enable a spindle speed controller.
A call to the old extAmpEnable function is currently commented out.
Eventually it will set the amp enable HAL pin true.
Again, useful for spindle speed controllers.
A call to the old extAmpEnable function is currently commented out.
Eventually it will set the amp enable HAL pin false.
Calculations for the specified joint are enabled.
Calculations for the specified joint are enabled.
The old watchdog was a strange thing that used a specific sound card.
A new watchdog interface may be designed in the future.
The old watchdog was a strange thing that used a specific sound card.
A new watchdog interface may be designed in the future.
The PAUSE command stops the trajectory planner.
It has no effect in free or teleop mode.
The RESUME command restarts the trajectory planner if it is paused.
It has no effect in free or teleop mode, or if the planner is not paused.
The STEP command restarts the trajectory planner if it is paused, and tells the planner to stop again when it reaches a specific point.
It has no effect in free or teleop mode.
The SCALE command scales all velocity limits happens. we are the rock slot machines turns commands by a specified amount.
It is used to implement feed rate override and other similar functions.
The scaling works in free, teleop, and coord modes, and affects everything, including homing velocities, etc.
However, individual joint velocity limits are unaffected.
It is normally used to allow a machine to be jogged off of a limit switch after tripping.
The command can actually be used to override limits, or to cancel a previous override.
The command can be issued at any time, and will always be accepted.
I think it should only work in free mode.
Limits on all joints are over-ridden until the end of the next JOG command.
The HOME command initiates a homing sequence on a specified joint.
The actual homing sequence is determined by a number of configuration parameters, and can range from simply setting the current position to zero, to a multi-stage search for a home switch and index pulse, followed by a move to an arbitrary home location.
For more information about the homing sequence, see the homing section of the Integrator Manual.
This ensures that the planner will move constantly until it is stopped by either the joint limits or an ABORT command.
It will also silently ignore the command if the joint is already at or beyond its limit and the commanded jog would make it worse.
This starts the joint moving, and the move will continue until stopped by an ABORT command or by hitting a limit.
The free mode planner accelerates at the joint accel limit at the beginning of the move, and will decelerate at the joint accel limit when it stops.
Normally incremental jogs stop when they have traveled the desired distance, however they also stop when they hit a limit, or on an ABORT command.
It will also silently ignore the command if the joint is already at or beyond its limit and the commanded jog would make it worse.
The free mode trajectory planner will generate a smooth trapezoidal move from the present position to the target position.
The free mode planner accelerates at the joint accel limit at the beginning of the move, and will decelerate at the joint accel limit to stop at the target position.
An absolute jog is a simple move to a specific location, in joint coordinates.
Normally absolute jogs stop when they reach the desired location, however they also stop when they hit a limit, or on an ABORT command.
It will code notes are used to silently ignore the command if the joint is already at or beyond its limit and the commanded jog would make it worse.
The free mode trajectory planner will generate a smooth trapezoidal move from the present position to the target position.
The planner can correctly handle changes in the target position that happen while the move is in progress.
The free this web page planner code notes are used to at the joint accel limit at the beginning of the move, and will decelerate at the joint accel limit to stop at the target position.
The PROBE command instructs the motion controller to move toward a specific point in Cartesian space, stopping and recording its position if the probe input is triggered.
It is anticipated that there will be several more SET commands as more parameters are added.
I would like to find a cleaner way of setting and reading configuration parameters.
The existing methods require many lines of code to be added to multiple files each time a parameter is added.
Much of that code is identical or nearly identical for every parameter.
Many of the wrappers around platform specific code has been removed along with much of the code that is not required by Machinekit.
It is hoped that sufficient compatibility remains with rcslib so that applications can be implemented on non-Linux platforms and still be able to communicate with Machinekit.
This chapter is not intended to be a definitive guide to using libnml or rcslibinstead, it will eventually provide an overview of each C++ class and their member functions.
Initially, most of these notes will be random comments added as the code scrutinized and modified.
Base class to maintain a linked list.
This is one of the core building blocks used in passing NML messages and assorted internal data structures.
Base class for producing a linked list - Purpose, to hold pointers to the previous and next nodes, pointer to the data, and the size of the data.
Provides a block of shared memory along with a semaphore inherited from the Semaphore class.
Creation and destruction of the semaphore is handled by the SharedMemory constructor and code notes are used to />Class for passing NML messages between local processes using a shared memory buffer.
Much of internal workings are inherited from the CMS class.
The Timer class provides a periodic timer limited only by the resolution of the system clock.
The function to get a semaphore can either block until access is available, return after a timeout, or return immediately with or without gaining the semaphore.
The constructor will create a semaphore or attach to an existing one if the ID is already in use.
At the heart of libnml is the CMS class, it contains most of the functions used by libnml and ultimately NML.
Many of the internal functions are overloaded to allow for specific hardware dependent methods of data passing.
Ultimately, everything revolves around a central block of memory referred to as the 'message buffer' or just 'buffer'.
The buffer size must be large enough to accommodate the largest message, a small amount for internal use and allow for the message to be encoded if this option is chosen encoded data will be covered later.
The following figure is an internal view of the buffer space.
CMS buffer The CMS base class is primarily responsible for creating the communications pathways and interfacing to the O.
It seems that the higher level code TASK and above also use ABORT to clear faults.
Whenever there is a persistent fault such as being outside the hardware limit switchesthe higher level code sends a constant stream of ABORTs to the motion controller trying to make the fault go away.
That means that the motion controller should avoid persistent faults.
This needs to be looked into.