Medical Billing And Coding

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A physician performed an aspiration via thoracentesis on a patient in observation status in the hospital. The patient has advanced lung cancer with malignant pleural effusion. Later the same day, due to continued accumulation of fluid, the patient was returned to the procedure room and the same physician performed a repeat thoracentesis.

 

Report diagnosis and procedure codes. Do not report observation codes.

 

Assign the correct codes and modifier for this encounter.

 

ICD-9-CM and CPT Code(s):__________________

 

ICD-10-CM Code(s):________________________

 

A 12-year-old boy presents with his father to the ER due to open wounds to his arm, hand, and upper leg. The injury occurred when the boy fell on a barbed-wire forearm, right hand, and left thigh. Procedure: Suture repair of the following: single-layer closure, 4.0cm, forearm, layered closure, 3.0cm, hand; 6.0 simple repair, thigh.

 

ICD-9-CM Reason for Visit Code(s):_____________________________________

ICD-9-CM and CPT code(s):________________________________________

ICD-10-CM Reason for Visit Code(s):_________________________________

ICD-10-CM Code(s):___________________________________

 

From the health record of a patient seen in the emergency room/observation area for an allergic reaction:

Discharge Summary

Date of Discharge: 01/08/XX

Chief Complaint: Allergic reaction to Bactrim, resulting in angioedema and mild respiratory distress.

Hospital Course: Fifty-six-year-old male admitted for angioedema after taking Bactrim for an ear infection. The patient had mild respiratory distress and marked swelling of his hands, face, and his oropharynx. The patient was given IV steroids in the Emergency Room and was admitted overnight for observation. The patient’s swelling rapidly improved and by the morning after his admission he was back to baseline. He had no complaints of shortness of breath and desired to go home.

Condition on Discharge: Good. Activity: As tolerated. Diet: As tolerated.

Medications: Home medications only including:

1. Celebrex 200 mg one b.i.d.

2. Isosorbide 30 mg once a day.

3. Atenolol 25 mg per day.

4. Lipitor 10 mg per day.

Follow-Up: Will be as needed with primary care physician if ear problem returns and/or respiratory distress.

Emergency Assessment

Chief Complaint: Swelling, itching, and change in voice.

Present Illness:  This is a 56-year-old white male with a history of allergic reaction to an antibiotic in the past, who presents today after taking his second dose of Bactrim this morning at home. He then had acute onset of swelling, redness, itching, and change in voice; also states that he was slightly short of breath but no wheezing. He denies any nausea, vomiting, fevers, chills.

Past Medical History: Coronary arter disease, MI 2 years ago, is currently take Celebrex, Isosorbide, Atenolol, Lipitor, and Bactrim that he just started on his morning.

Physical Examination:  Appears very red, swollen diffusely with erythematous rash, macular type rash. Blood pressure is 145/77, heart rate of 120, respiration rate 18 and 02; saturation is 96%. On room air. HEENT: He does have swollen eyelids, both upper and lower eyelids, with also some facial swelling and some uvular swelling as well as some lateral pharyngeal and uvualr swelling, which appears to be allergic in nature. His tongue appears also slightly swollen, does not have any neck swelling, also has an erythematous rash. Lungs: Clear to auscultation with no wheezing noted. Abdomen: Soft, nontender.

Ed Course: Received Benadryl 25 mg IV, Pepcid 20 mg IV, Solu-Medrol 125 mg IV. At this point, his voice was still changing, and decision was made to admit the patient to the hospital for observation and then to observe and given a second dose of Solu-Medrol and Benadryl. Consultation between patient’s private physician.

Select the correct codes for this observation patient.

a. 961.0, 786.09, 995.1, 693.0, E857, E849.0

b. 995.20, E931.0, E849.0

c. 995.1, 786.09, E931.0, E849.0

d. 995.1, 786.09, 693.0, E930.9, E849.0

 

ICD-10-CM Code(s):_____________________________

 
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HSCI 430 Assignment

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This week you read about organization dynamics that influence health disparities in diverse populations. Review the questions below and reflect on what you learned. Answer the questions by reflecting on what you learned and synthesizing that information to create solutions. 

1. Imagine you are the CEO of a health care clinic in a rural area. Over the past five years, there have been increasing complaints about the lack of diversity in age among the clinic staff. In particular, complaints have skyrocketed regarding the young staff and lack of cultural sensitivity to the aging population. The board of trustees is concerned and called a meeting with you to discuss this. During the meeting, they blamed you for not ensuring better age diversity in staff. Now you must respond and remedy the situation. You were told to create policies and practices to increase diversity.

a. Identify two policies (i.e. rules) and practices (i.e. procedures) the clinic will begin implementing that will help in the recruitment and retention of older staff.

b. Describe how and why these policies and practices would be beneficial to the clinic.

c. Then, describe how the same policies might benefit employees from other groups, for example, individuals of a different age, gender, race, ethnicity, religion, and so on. In other words, how might these policies and practices benefit those who are different from the older staff?

2. Refer to Figure 3.1 in your text. How do you think the social factors that contribute to disparities in workforce for minorities can be overcome? Hypothesize one micro, one mezzo (meso), and one macro level practice that can be done to change the workforce and career outcomes shown in the figure. You should come up with a total of three ideas.

If you need clarity about the difference between micro and macro, here is an article that provides an excellent breakdown using the field of social work: https://dworakpeck.usc.edu/news/do-you-know-the-difference-between-micro-mezzo-and-macro-level-social-work

Micro idea:

Mezzo idea:
Macro idea:

3. Review the healthcare organization checklist from chapter three in your text. If you work in a health care organization, use the assessment checklist in this chapter to evaluate the organization’s responsiveness to diversity. If you do not work in a health care organization, use the checklist to evaluate a health clinic that you are a patient at. Another option is to evaluate your place of employment or your academic institution. Though all items on the list may not fully apply, it is still ok to use these organizations to complete the assignment. Later in the course you will complete an organizational assessment (ORGANX) so it is important for you to become familiar with evaluating organizations now.

a. What are the organization’s areas of strength?

b. Which areas need the most improvement?

 
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BIO – Evaluate The Following Lac Operon Partial Diploids

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1. (1 point) Evaluate the following lac operon partial diploids. Indicate whether the production of functional β-galactosidase from lacZ and of permease from lacY is “inducibleâ€, “constitutiveâ€, “absent†or “noninducible†for each partial diplod
a. F’ I+-p+o+Z+Y+ X F- I+p+o+Z-Y-
b. F’ I+-p+ocZ+Y- X F- I+p+o+Z-Y+ c. F’ I+-p+ocZ-Y+ X F- Isp+o+Z+Y+
2~3 Describe the effects on attenuation and on tryptophan synthesis of the following mutations of the two tryptophan codons (UGGUGG) in the attenuator region of operon.
2. (1 point) The tryptophan codons are mutated to UAGUGG. 3. (1 point) The tryptophan codons are mutated to UUGUUG.
4. (1 point) What would be the phenotype of a null mutation in the CRP protein gene in the regulation of Lac operon and why?
5. (1point) What would be the phenotype of a “constitutively expressed†mutation in the CRP protein gene in the regulation of Lac operon (i.e. CRP proteins are always highly expressed) and why?
6. (2 points) A repressible operon system, like the trp operon, contains three genes, G, Z, and W. Operon genes are synthesized when the end product of the operon synthesis pathway is absent, but there is no synthesis when the end product is present. One of these genes is an operator, one is a regulatory protein, and the other is a structural enzyme involved in synthesis of the end product. In the table below, “+†indicates that the enzyme is synthesized by the operon, and “-“ means that no enzyme synthesis occurs. Use this information to determine which gene corresponds to each operon function.
Present
G+Z+W+   +
G-Z+W+   + G+Z-W+   – G+Z+W-      + G-Z+W+/G+Z-W-      + G+Z-W+/G-Z+W-      + G-Z-W-/G+Z+W+      + G+Z+W-/G-Z-W+      +
7. (1 point) Gene A is maternally imprinted (silenced) while Gene B is paternally imprinted when imprinted silencing occurs. A Mom with Genes A and B imprinted and a Dad with an imprinted Gene A have a daughter and a son. The children then marry individuals known not to be silenced for either gene. What is the imprint status of the daughter and son respectively? If each marriage results in the birth of a daughter and a son, what would you expect the imprint status of genes A and B to be for the grandchildren?
8 ~ 9. On a rare occasion, human can be born with a condition known as “uniparental disomyâ€. This happens when an individual inherited both copies of a chromosome from one parent but no copies from the other parent. For example, abnormal sperm that lacks chromosome 15 can fertilize an egg that contains two copies of chromosome 15. This is known as maternal uniparental disomy 15. Alternatively, there are cases of paternal disomy 15 (an abnormal sperm with two copies of chromosome 15 fertilizes an egg with no copies).
8. (1 point) If a female is born with paternal disomy 15, would you expect her to be normal or have Angelman syndrome (AS) or have Prader-Willi syndrome (PWS)? And explain why?
9. (1point) Would you expect her to produce normal offspring or offspring affected with AS or PWS?

 
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Essential difference between apes and hominins

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1.  

Pigeon breeders prize certain looks of their pigeons. They know that pairing certain pigeons results in offspring that exemplify the looks of their parents. Which of Darwin’s four observations applies to this this example?

    Observation 1
    Observation 2
    Observation 3
    Observation 4

1. Which of the following is an essential difference between apes and hominins?

    The amount of hair
    Apes are kept in zoos
    Relative strength
    The way they walk

 

 

Question 8

Pine trees that are too tall or too short do not do as well as pine trees that are average in height. The short trees do not get as much light as tall or average trees. The tall trees are more likely to break off in storms. Tell how this is an example of stabilizing selection. Be sure to define stabilizing selection in your answer.

 

 

 

QUESTION 9

1. There is a moth in England called the peppered moth. Before Britain’s industrial revolution, these moths were usually salt and pepper colored. Because of their coloring, they blended in well with the tree trunks on which they tended to rest. The coloring helped them hide from the birds that ate them. During the British industrial revolution, industry expelled a lot of soot from the burning of coal into the environment. This soot darkened the tree trunks, and it was noted that black-colored moths were becoming predominant. The idea is that with soot in the environment, black-colored moths fared better than light-colored moths. There is some debate as to whether this is actually the case or not, but for the sake of this question, let’s assume it is. In your own words, explain the concepts from the four observations discussed in 12.2 using the moth as an example. In other words, how does the moth illustrate the first observation, the second observation, etc.? Your response must be at least 200 words in length.

 

 

QUESTION 10

1. Explain how homology is different from convergent evolution and give examples. Briefly define homology and convergent evolution in your explanation. Your response must be at least 200 words in length.

 
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