A 42-year-old white male was referred to a gastroenterologist by his primary care physician because of a two-month history of gross rectal bleeding. The new patient was seen on Wednesday, and the doctor performed a comprehensive history and exam. Medical decision making was of moderate complexity. The patient was scheduled for a complete diagnostic colonoscopy four days later. The patient was given detailed instructions for the bowel prep that was to be started at home on Friday at 1:00 p.m. On Friday, the patient was registered for outpatient surgery at the hospital, moderate conscious sedation (15 minutes) was administered by the physician performing the procedure, and the flexible colonoscopy was started. The examination had to be halted at the splenic flexure because of inadequate bowel preparation. The patient was rescheduled for Monday and given additional instructions for bowel prep to be performed starting at 3:00 p.m. on Sunday. On Monday, the patient was again registered for outpatient surgery at the hospital, moderate conscious sedation (30 minutes) was again administered by the physician performing the procedure, and a successful total colonoscopy was performed. Diverticulosis was noted in the ascending colon and two polyps were excised from the descending colon using the snare technique. The pathology report indicated the polyps were benign.The patient was referred to a cardiologist for transesophageal echocardiography for cardiac arrhythmia. The patient underwent transesophageal echocardiography on Thursday, and the cardiologist supervised and interpreted the echocardiography, which included probe placement and image acquisition. The report stated the "transesophageal echocardiogram showed cardiac arrhythmia but normal valvular function with no intra-atrial or intraventricular thrombus, and no significant aortic atherosclerosis."
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