ADULT MEDICINE. Agenda
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1 ADULT MEDICINE Code Set 3 in the Series Answers to the Assignment PMG, Inc. 700 School Street Pawtucket, RI P: F: E: PMGConsulting@gopmg.com Agenda Coding for Adult Medicine Examples Next Steps 1
2 Speaker: Ray Jorgensen, MS, CPC, CHBME Raymond T. Jorgensen is a Co-Founder & Partner at PMG, Inc. (PMG). Ray is responsible for oversight of consulting operations as well as coding, reimbursement, and payer related issues for the out-sourced billing component of PMG s services (more than 1.2 million annual encounters). He has personally trained thousands of providers from over 35 states on coding, billing, and reimbursement in addition to authoring several books and dozens of articles. Ray s health care experience and education is unique in that he was schooled by the payers. Having worked for Blue Cross and Blue Shield as well as United HealthCare Corporation, primarily in professional relations and contracting, Ray has an understanding and perspective on the payer s objectives and process unlike other medical business consultants groomed from the provider side. He continues to travel nationally working with clients and strategic partners to enhance opportunities for the success of CHCs around coding, billing, and reimbursement. BA from The College of the Holy Cross (Worcester, MA) MS from Northeaster University (Boston, MA( CPC from the American Academy of Professional Coders (Salt Lake City, UT) CHBME from the Healthcare Billing & Management Association (Laguna Cliffs, CA) Disclaimer 1. The coding guidelines, interpretations, and recommendations set forth as part of this training session are presented as a guide only. Attendees understand and recognize that actual coding decisions are the sole liability and responsibility of the provider(s) and respective billing staff. PMG, Inc. does not accept any liability or responsibility in this regard. 2. The presentation today may include discussion about a particular commercial product/service and the presenter has significant financial interest/relationship with the organization that provides this product/service. 2
3 f g h a These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease explains a patient s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring A B C D Personal history Counseling Aftercare Follow-up e for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. E Family history c d b cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase to explain continuing surveillance following completed treatment of a disease, condition, or injury used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems F G H Contact/exposure Status codes Screening 2. Long Term Anticoagulant therapy 3
4 3. Visit to change surgical dressing 4. Patient who had surgical removal of a malignant neoplasm of the ovary one year ago, followed by chemotherapy, seen in follow-up, there is no evidence of recurrence (1 of 3) 4
5 4. Patient who had surgical removal of a malignant neoplasm of the ovary one year ago, followed by chemotherapy, seen in follow-up, there is no evidence of recurrence (2 of 3) 4. Patient who had surgical removal of a malignant neoplasm of the ovary one year ago, followed by chemotherapy, seen in follow-up, there is no evidence of recurrence (3 of 3) 5
6 5. Encounter for blood pressure check without abnormal findings (1 of 2) 5. Encounter for blood pressure check without abnormal findings (2 of 2) 6
7 6. Chest x-ray is performed on a patient with a fever and cough to rule out pneumonia 7. Chest x-ray is performed as part of a routine physical exam, no symptoms are present 7
8 8. Screening for HPV 9. Screening for cholesterol 8
9 10. Mild intermittent asthma with acute exacerbation in patient exposed to second hand smoke. Patient is wheezing and short of breath 11. Exposure to HIV 9
10 12. Family history of stroke 13. Personal history of breast cancer, in situ 10
11 14. Pre-operative clearance in patient with heart disease 15. Agranulocytosis due to AIDS 11
12 16. Positive HIV test in patient with no related symptoms, patient counseled at visit to discuss result (1 of 2) 16. Positive HIV test in patient with no related symptoms, patient counseled at visit to discuss result (2 of 2) 12
13 17. Type 2 diabetic with diabetic cataract, patient uses insulin regularly. (1 of 2) 17. Type 2 diabetic with diabetic cataract, patient uses insulin regularly. (2 of 2) 13
14 18. Type 1 diabetes with ketoacidosis 19. Congestive heart failure due to hypertension (1 of 2) 14
15 19.Congestive heart failure due to hypertension (2 of 2) 20. Congestive heart failure with hypertension (1 of 2) 15
16 20. Congestive heart failure with hypertension (2 of 2) 21. Angina pectoris with essential hypertension (1 of 2) 16
17 21. Angina pectoris with essential hypertension (2 of 2) 22. Accelerated hypertension with chronic kidney disease stage 3 (1 of 2) 17
18 22. Accelerated hypertension with chronic kidney disease stage 3 (2 of 2) 23. Chronic Pain in right knee (1 of 2) 18
19 23. Chronic Pain in right knee (2 of 2) 24. Acute MI of infer posterior wall, congestive heart failure, hypertension (1 of 3) 19
20 24. Acute MI of infer posterior wall, congestive heart failure, hypertension (2 of 3) 24. Acute MI of infer posterior wall, congestive heart failure, hypertension (3 of 3) 20
21 25. Influenza with digestive manifestations 26. Crescendo angina due to coronary arteriosclerosis (1 of 2) 21
22 26. Crescendo angina due to coronary arteriosclerosis (2 of 2) Next Steps Complete Homework Assignment on next page Fill in complete first and last name as you wish it to appear on your CEU certificate Scan completed homework and to: 1.5 CEUs will be ed to the address provided on completed homework 22
23 Full First and Last Name: Organization Name address Ecourse 3/Set 3 ICD 10 Coding for Adult Medicine Submit Homework online or at: PMGConsulting@gopmg.com MIPCA 1. Match the following These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease explains a patient s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase to explain continuing surveillance following completed treatment of a disease, condition, or injury used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems A B C D E F G H Personal history Counseling Aftercare Follow-up Family history Contact/exposure Status codes Screening Page 1 of 3
24 Full First and Last Name: Organization Name address Ecourse 3/Set 3 ICD 10 Coding for Adult Medicine Submit Homework online or at: PMGConsulting@gopmg.com MIPCA 2. Long term use of Anticoagulant therapy 3. Visit to change surgical dressing 4. Patient who had surgical removal of a malignant neoplasm of the ovary one year ago, followed by chemotherapy, seen in follow-up, there is no evidence of recurrence. 5. Encounter for blood pressure check without abnormal findings 6. Chest x-ray is performed on a patient with a fever and cough to rule out pneumonia 7. Chest x-ray is performed as part of a routine physical exam, no symptoms are present 8. Screening for HPV 9. Screening for cholesterol 10. Mild intermittent asthma with acute exacerbation in patient exposed to second hand smoke. Patient is wheezing and short of breath. 11. Exposure to HIV 12. Family history of stroke 13. Personal history of breast cancer, in situ Page 2 of 3
25 Full First and Last Name: Organization Name address Ecourse 3/Set 3 ICD 10 Coding for Adult Medicine Submit Homework online or at: PMGConsulting@gopmg.com MIPCA 14. Pre-operative clearance in patient with heart disease 15. Agranulocytosis due to AIDS 16. Positive HIV test in patient with no related symptoms, patient counseled at visit to discuss results 17. Type 2 diabetic with diabetic cataract, patient uses insulin regularly 18. Type 1 diabetes with ketoacidosis 19. Congestive heart failure due to hypertension 20. Congestive heart failure with hypertension 21. Angina pectoris with essential hypertension 22. Accelerated hypertension with chronic kidney disease stage Chronic Pain in right knee 24. Acute MI of inferoposterior wall, congestive heart failure, hypertension 25. Influenza with digestive manifestations 26. Crescendo angina due to coronary arteriosclerosis Page 3 of 3
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