1. Ann Borden | SURGEON: | Mohomad Almaz, MD | DIAGNOSIS: | Right carpal tunnel syndrome | PROCEDURE PERFORMED: | Right carpal tunnel release | 2. | | | 3.
PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this
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LOCATION: Outpatient, Hospital
PATIENT: Judy Rain
SURGEON: Mohamad Almaz, MD
PREOPERATIVE DIAGNOSIS: Chondromalacia, left knee
POSTOPERATIVE DIAGNOSIS: Chondromalacia, left knee, due to sudden overexertion
PROCEDURE PERFORMED: Arthroscopy, left knee, with debridement of chondromalacia
PROCEDURE: While under a spinal anesthetic the patient's knee was examined. She had a small effusion in her knee. Physical exam of her left knee showed her skin intact. Her collateral ligaments were intact. The Lachman's test was negative as was the pivot shift. McMurray's test was negative. She has a range of motion 0 to at least 125 degrees flexion. Her left knee was then prepped with Betadine and draped in a sterile fashion.
An Esmarch bandage was used to exsanguinate the leg and a tourniquet time ended up being 27 minutes. Three portals were used for this procedure. The first was placed along the superior anterolateral aspect and a third along the inferior anteromedial aspect of the knee. We distended the knee with Lactated Ringer's solution. We examined the suprapatellar pouch and the medial and lateral gutters. She had significant chondromalacia starting al the patellofemoral joint. We did use shavers to trim and debride some of the chondromalacia on the trochlea. We then moved to the medial compartment and noted large areas of chondromalacia. We used a combination of basket forceps and the shaver to try to
The new job title could be a medical coder 1. I choose this new title because the medical coder is a health care professional who analyzes the medical records, medical charts and assigns the appropriate codes. Most of the job’s responsibilities of a medical coder are required for the inpatient and the outpatient coder’s jobs. For example, medical coder’s responsibilities are: reading and analyzing patient records, determining the correct codes for patient records, interacting with physicians and assistants to ensure accuracy, using codes to bill insurance providers, and maintaining patient confidentiality and information security. In addition, the minimum required certification of this job is CPC or CCS and RHIT with at least 4 years of experience. Those certifications are given to a Coder who can read and assign correct diagnosis International Classification of Diseases or ICD-10-CM, Current Procedural Terminology or CPT, supply Healthcare Common Procedure Coding System or HCPCS code for a wide variety of clinical cases and services, and read and assign PCS codes. The skills of this job are same as the skills of the
Saphenous vein was retracted in a dorsal postion, linear incision made in the periosteum. The calcaneo and the talonavicular joint were carefully exposed. Cartillage, or what was remaining of cartilage was removed. There were extreme osteoarthritic thoughout. Essentially 5%-10% of cartilage remained. The osteophytes were carefully excised with osteotome, the joint was prepared with microfracture using an osteotome on both sides of the joint.
The most important element in becoming a Medical Billing and Coding Specialist is the training and certification need to enter the field and for advancement. You will need a program that provides an understanding of anatomy, physiology and medical terminology. This program should also navigate the three topics: ICD, CPT and HCPCS. These codes help you document the conditions of a patient and describe the procedure performed on the patient. When you have completed your training there are several certifications you can test for. The American Health Information Management Association (AHIMA) offer certification for the Certified Coding Associate (CCA). You will need AHIMA membership and an exam fee ($199- $299), a high school diploma or
occurred on Sunday. She states she was seen by the “eye doctor earlier today” and
My career that I am researching for my junior project is Medical Coding and Billing. Medical Coding and Billing are two different jobs. Medical Coding is when a patient has any medical procedure or exam such as going to the doctor for the stomach virus or even going to the hospital for a broken bone. They work with the insurance companies by putting a specific number into the computer. There’s CPT Codes which stands for Current Procedural Terminology which is “ Codes to better understand the services their doctor provided, to double check their bills or negotiate lower pricing for their healthcare services. (About Health, 2014).”
When I was younger I use to pretend to be a doctor or nurse. It was always fun to go around and check to see who had a heart beat, who was bleeding, and who was hurt. I knew that I wanted a career in the medical field, but was unsure if I really wanted to be a doctor or a nurse. I thought the only career was to be a doctor or nurse. Of course, the medical profession is larger than that. It includes office staff, EMT’s, nurses, physician assistants, and several other kinds of physicians. While the opportunities are endless in this career field, I have decided that being a doctor or nurse was not what I really wanted to do. It takes too long; the schooling alone is longer than four years. I was not
Discuss the general differences between facility and non-facility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? (Hint: your book is incorrect.)
The first patient I witnessed was a 25 year old female. Pertinent patient medical history is anxiety, depression, and sleep dysfunction. The referring diagnosis is Chondromalacia of the right patella, which is also known as runner’s knee, is a condition where the cartilage on the undersurface of the kneecap deteriorates and softens. The physician who referred the patient, Victor N. Egwu, MD, orders the PT to evaluate and treat three times per week for four weeks. Right knee ROM and strengthening exercises should be done to treat patient. The PT evaluation justification history includes 1-2 person factors examination is addressing three or more elements. The clinical presentation is stable. The clinical decision-making is low co-morbidities.
Aniya presented to Children’s Hospital Emergency department on 8/4/2017 as a level II trauma after she had been reportedly hit by a train. Per EMS Aniya was attempting to jump on the train and fell and the train “ran over” her R leg, where there was a deep leg laceration below the knee. She was admitted to the hospital. She was taken to the OR for irrigation and debridement of the right knee joint and right knee would as well as VAC-assisted closure of right knee wound. She was taken back to the OR on 8/6/17 for another irrigation, debridement and VAC change. On 8/8/17 she was taken to the OR again and diagnosed with complex degloving injury of the right medial knee region. She received skin grafting to the tight lower extremity and application
PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal
12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,
Healthcare is one of the biggest and most important fields throughout the world. Within healthcare, there are several careers such as medical billing and coding which contribute for a better healthcare. Medical billing and coding plays an important behind-the-scenes that role in the health care system. The majority of medical billing and coding “specialists rely on their knowledge of anatomy, medical terminology, health conditions, and medications to assign diagnostic and procedural codes for each patient encounter” (Ewing, 1999).
The American Academy of Professional Coders or AAPC was founded to provide education and professional certification to medical coders. They have been around since 1988. Certifications truly demonstrate that a professional medical coder has working knowledge. The AAPC offers training and a vast wealth of resources and information. They also have a network of about 165,000 members and the point you in the right direction towards gainful employment.
Health History: A 25-year-old male injured his left knee in a recent skiing accident. The patient stated that he lost his balance because the inner edge of his right ski got caught while skiing. This resulted in the right leg being externally rotated followed by and audible “pop” as he lost footing. By evening, the right knee joint had become swollen, causing intense pain. The primary care physician referred the case to an orthopedist.
The patient stated that he began experiencing painful swelling in his right knee over a decade ago. A large mass grew around the knee and he underwent a total knee arthroplasty. Not long after the arthroplasty of his right knee, he began experiencing similar symptoms in his left knee and right elbow.