Question 1 - MyCred | Online Presentation Portfolios



Case Study Question part 1Question 1 0 out of 25 pointsMr. Gervais has recently experienced gripping abdominal pain, episodes of diarrhea, and urgency to defecate. He states that these episodes “get worse every time” and his stool “ looks almost slimy.” Diagnostic workup to rule out irritable bowel syndrome, gastroenteritis, and colitis was completed. Stool culture to identify group- A shigella bacteria was taken, since it is quite possibly Shigella dysenteriae. Mr. Gervais was advised to increase his fluid intake and pay close attention to hand washing.Selected Answer: B. examination (for) T88.9XXs screening (for) Z11.8Correct Answer: A. examination (for) T65.91XS screening (for) Z11.0Question 2 0 out of 25 pointsMs. Rowland is seen today for ulcerations in the vulvar area. She states that these are “painful, especially when urinating.” On visual examination the ulcers appear to be due to herpes simplex, type 2. A sample of the exudates was taken for smear and stain analysis to confirm the diagnosis herpetic ulceration of the vulva. Ms. Rowland was advised to abstain from all sexual activity.Selected Answer: C. Examination (for) S60.519A Screening (for) Z11.59 Correct Answer: A. Examination (for) L08.89 Screening (for) Z11.8Question 3 0 out of 25 pointsThe patient is seen today for cervical examination. The cervix is inflamed and friable, and considerable exudates are present. Samples of the exudates were taken for agar culture and sensitivity testing. Presumptive diagnosis, acute gono-coccal cervicitis; presumptive bacteria, Neisseria gonorrhoeae. She will begin an antibiotic course of treatment, until the C & S results are available.Selected Answer: C. Examination (for)S??.93XA Screening (for)Z11.2Correct Answer: D. Examination (for) L?8.89 Screening (for) Z11.3 Question 4 25 out of 25 pointsA 62-year-old female presents to Acute Surgical Care for a sigmoidoscopy. The physician inserts a flexible scope into the patient's rectum and determines therectum is clear of any polyps. The scope is advanced to the sigmoid colon, and a total of three polyps are found. Using the snare technique, the polyps are removed. The remainder of the colon is free of polyps. The flexible scope is withdrawn. The polyps were benign.Selected Answer: A. D12.7Correct Answer: A. D12.7Case Study Questions Part 2Question 1 25 out of 25 pointsPREOPERATIVE DIAGNOSIS: Bronchogenic carcinoma, right upper lobe. POSTOPERATIVE DIAGNOSIS: Occluded right upper lobe posterior and superior segments. PROCEDURE: 1. Flexible fiberoptic bronchoscopy with radiation catheter placement, right upper lobe. 2. Placement of radiation beads. ANESTHESIA: One percent topical lidocaine, 4% nebulized lidocaine, 25 mg of Demerol, and IV incremental doses of Versed. PROCEDURE: With the patient in the supine position under supplemental oxygen, the flexible fiberoptic bronchoscope was passed through the left nostril without difficulty. The upper airway vocal cords were within normal limits. The trachea was within normal limits. The carina was sharp and within normal limits. The bilateral endobronchial tree was observed in detail and all airways were patent, other than the superior and posterior segments of the right upper lobe, which were occluded by tumor. Using fluoroscopic guidance, a radiation catheter was placed in the superior segment of the right upper lobe. The patient tolerated the procedure well. Only mild oozing of blood occurred with less than 5 cc estimated blood loss. Vital signs remained stable. Oxygen saturation remained stable. After observation in the endoscopy suite recovery area, the patient was transferred to the radiation department in stable condition and radiation beads were loaded into the catheter.Selected Answer: D. Bronchogenic carcinoma, right upper lobe, occluded right upper lobe posterior and superior segments C34.10, J98.4 Flexible fiberoptic bronchoscopy with radiation catheter placement right upper lobe, placement of radiation beads Implantation Correct Answer: D. Bronchogenic carcinoma, right upper lobe, occluded right upper lobe posterior and superior segments C34.10, J98.4 Flexible fiberoptic bronchoscopy with radiation catheter placement right upper lobe, placement of radiation beads Implantation Question 2 25 out of 25 pointsPREOPERATIVE DIAGNOSIS: Cholelithiasis. POSTOPERATIVE DIAGNOSIS: Cholelithiasis. SPECIMEN SUBMITTED: Gallbladder and stone. GROSS DESCRIPTION: Specimen received in one container labeled “ gallbladder.” Specimen consists of a 9-cm gallbladder measuring 2 cm. in average diameter. The serosal surface demonstrates diff use fibrous adhesion. The wall is thickened and hemorrhagic. The mucosa is eroded and there is a single large stone measuring 2 cm in diameter within the lumen. Representative sections are submitted in one cassette. MICROSCOPIC DIAGNOSIS: Gallbladder, hemorrhagic chronic cholecystitis with cholelithiasis.Selected Answer: B. Gallbladder, hemorrhagic chronic cholecystitis with chole-lithiasis Cholelithiasis K80.18 Correct Answer: B. Gallbladder, hemorrhagic chronic cholecystitis with chole-lithiasis Cholelithiasis K80.18 Question 3 25 out of 25 pointsPREOPERATIVE DIAGNOSIS: Chronic cholecystitis and cholelithiasis. POSTOPERATIVE DIAGNOSIS: Cholecystitis, cholelithiasis, and common duct stone. OPERATION PERFORMED: Cholecystectomy and common bile duct exploration. INDICATIONS: The patient is a 48- year-old female who was admitted to the hospital with a chronic history of right upper quadrant pain and with associated dyspepsia. FINDINGS: Surgical intervention revealed numerous cholesterol stones. The initial cystic duct cholangiogram failed to reveal clear passage of dye into the duodenum. There was a concentric defect in the terminal common bile duct. After 1 mg of glucagon was given, cholangiograms were repeated and the common duct was open.Selected Answer: C. Cholecystitis, cholelithiasis and common duct stone K80.64 Cholecystectomy and common bile duct exploration Cholecystectomy, exploration 0F9430Z Correct Answer: D. Cholecystitis, cholelithiasis and common duct stone K80.64 Cholecystectomy and common bile duct exploration Cholecystectomy, exploration 0F9430Z Question 4 25 out of 25 pointsADMITTING DIAGNOSIS: Morbid obesity. DISCHARGE DIAGNOSIS: Morbid obesity. PROCEDURES: 1. Open Roux- en- Y gastric bypass. 2. Removal of gastroplasty ring. 3. Liver biopsy. 4. G tube placement. HOSPITAL COURSE: The patient was admitted for open Roux- en-Y gastric bypass, removal of gastroplasty ring, and liver biopsy. The patient did very well post operatively. By the fourth postoperative day, she was tolerating bypass soft diet. She was discharged home with pain medications and discharge instructions. Activities of daily living as tolerated.Selected Answer: C. Morbid obesity E66.01 Open Roux- en- Y gastric bypass Roux- en- Y operation; 0D16079 Correct Answer: C. Morbid obesity E66.01 Open Roux- en- Y gastric bypass Roux- en- Y operation; 0D16079 Case Study Part 3 ? Question 1 25 out of 25 pointsOPERATIVE REPORT-PREOPERATIVE DIAGNOSIS: Upper gastrointestinal bleeding. POSTOPERATIVE DIAGNOSIS: Multiple serpiginous ulcers in the gastric antrum and body, not bleeding. FINDINGS: The video therapeutic double-channel endoscope was passed without difficulty into the oropharynx. The gastroesophageal junction was seen at 42 cm. Inspection of the esophagus revealed no erythema, ulceration, exudates, stricture, orother mucosal abnormalities. The stomach proper was entered. The endoscope was advanced to the second duodenum. Inspection of the second duodenum, firstduodenum, duodenal bulb, and pylorus revealed no abnormalities. Retroflexion revealed no lesion along the cardia or lesser curvature. Inspection of the antrum, body, and fundus of the stomach revealed no abnormality, except there were multiple serpiginous ulcerations in the gastric antrum and body. They were not bleeding. They had no recent stigmata of bleeding. Photographs and biopsies were obtained. The patient tolerated the procedure well.Selected Answer: C. K25.9Correct Answer: C. K25.9? Question 2 25 out of 25 pointsOPERATIVE REPORT DIAGNOSIS: Malignant tumor, thyroid. PROCEDURE: Thyroidectomy, total. The patient was prepped and draped. The neck area was opened. With careful radical dissection of the neck completed, one could visualize the size of the tumor. The decision was made to do a total thyroidectomy. The pathology report later indicated that the tumor was malignant.Selected Answer: D. C73Correct Answer: D. C73? Question 3 25 out of 25 pointsOPERATIVE REPORT-PREOPERATIVE DIAGNOSIS: Obstructed ventriculoperitoneal shunt in patient with obstructive hydrocephalus. PROCEDURE PERFORMED: Revision of shunt. Replacement of ventricular valve and peritoneal end. Entire shunt replacement. PROCEDURE: Under general anesthesia, the patient's head, neck, and abdomen were prepped and draped in the usual manner. An incision was made over the previous site where the shunt had been inserted in the posterior right occipital area. This shunt was found to be non functioning and was removed. The problem was that we could not get the ventricular catheter out without producing bleeding, so it was left inside. The peritoneal end of the shunt was then pulled out through the same incision. Having done this, I placed a new ventricular catheter into the ventricle. I then attached this to a medium pressure bulb valve and secured this with 3-0 silk to the subcutaneous tissue. We then went to the abdomen and made an incision below the previous site, and we were able to trocar the peritoneal end of the shunt by making a stab wound in the neck and then connecting it up to the shunt. This was then connected to the shunt. Pumping on the shunt, we got fluid coming out the other end. I then inserted this end of the shunt into the abdomen by dividing the rectus fascia,splitting the muscle, and dividing the peritoneum and placing the shunt into the abdomen. One 2-0 chromic suture was used around the peritoneum. The wound was then closed with 2-0 Vicryl, 2-0 plain in the subcutaneous tissue, and surgical staples on the skin. The stab wound on the neck was closed with surgical staples. The head wound was closed with 2-0 Vicryl on the galea and surgical staples on the skin. A dressing was applied. The patient was discharged to the recovery room.Selected Answer: D. G91.1Correct Answer: D. G91.1? Question 4 25 out of 25 pointsA new patient is seen in the office with complaints of a fever, chills, and difficulty breathing. The patient states that he has not been well for several weeks now and has progressively gotten weaker. He has not been able to work for the past week and before that was frequently absent from work over the course of 2 weeks. He is uncertain how long fever has been present but believes that it has been approximately 4 days. He does not have a thermometer at home and does not know what his temperature has been. He has been sleeping in a living room recliner because when he lies down, he has increased difficulty breathing. The detailed history and detailed examination centered on the respiratory and cardiovascular systems. The upper respiratory findings included URI, nasal discharge, andpharyngeal erythema. A rapid test pack was used to diagnose the viral infection. Chest x-ray showed patchy bilateral infiltrates. The physician diagnosed the patient with influenza. The medical decision making complexity was low.Selected Answer: A. J10.1Correct Answer: A. J10.1Steps to Proper CodingSavannah HeimCodingAugust 3, 2017When it comes to proper coding, there are a select number of steps that should occur to make sure that coding is done properly and that there are not any errors. It is important to keep your coding accurate and up to par in order to make sure that the patients are not charged for services they did not receive and also to make sure that the physicians get the appropriate reimbursement for their care. During the coding process, it is crucial to maintain organization, use critical thinking and problem-solving skills, and also applying knowledge learned throughout experiences. The first step that should occur when coding is identifying the reason for the patients visit. This could be signs, symptoms or diagnoses and conditions that are documented. Something important to remember is that there might not be a diagnosis listed, especially for an outpatient but coding the symptoms is appropriate (Edwards, 2017, para 2). The next step would be moving on to the manual. It’s crucial to refer to the alphabetic index in order to locate the correct terms and codes in the tabular list (Edwards, 2017, para 3). After referring to the tabular list, the next step would be to determine the main term, which is usually found in boldface type.After completing those three steps, the correct direction is in place. For the case studies that were provided for the portfolio project, it was important to read through the notes that were provided. That helped with determining the direction for the codes that were needed. This is where step four comes into play. All of the information provided allowed the coder to find the proper notes under the main terms to see which ones were the proper choice (Edwards, 2017, para 5). This was essential to step five. This is where modifiers come into place. They don’t necessarily affect code assignment but they are important for the coder to identify. Once these steps have been completed, it is time to assign a temporary code and follow that up by refer to the tabular list to make sure there aren’t any other instructions that were missed! The next step is to go over the guidelines to be sure to consult with things such as reimbursement prompts and age. The final step is assigning the code! If all of these steps have been completed, the codes assigned will be the most accurate codes for the cases (Edwards, 2017).When I personally coded the case studies, I struggled at first. But after each week, I found out what worked best for me. I finally aced the last case study which was a great accomplishment for me since I have had such a hard time with this class. For the case studies, I referred to the ICD-10 manual. I followed the guidelines and chose the correct codes. When I questioned what I procedure was, I searched what they were and used the gained knowledge to apply the best codes possible. Another source that was extremely helping to my coding process, was actually a website that I use often for work. When I am unaware of a procedure or surgery that a patient is having, I refer to path.. I believe that this is an excellent source of information for what diagnoses are so that you can have an understanding as to why a certain patient is being diagnosed and what codes should go along with it. The resources I used when discussing the steps was a blog that physicians used to give advice to each other. The reason I chose this was because it broke the steps down into easily comprehensible steps for people to follow. It was originally just three steps but I made them into more simple steps that were just a tad bit easier to follow, especially for those who are not use to coding. References:Edwards, B. (2017). Three Steps to Selecting ICD-10 Codes Accurately | Physicians Practice. [online] . Available at: ................
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