Intro to CPT Coding

Answer all 20 questions and send them back to me- must make sure ALL answers are correct and get it back to me in the next 3 hours
 
1.   Modifier -78 indicates a/an
    
   A. unplanned return to the OR.
   B. emergency room procedure.
   C. ambulance service.
   D. distinct dental procedure.
 
2.   Modifier -92 indicates a/an
    
   A. anesthesia administration.
   B. multiple service.
   C. mandated procedure.
   D. laboratory test included a kit or a transportable instrument.
 
 
3.   An unrelated procedure in the postoperative period is indicated with modifier
    
   A. -81.
   B. -47.
   C. -52.
   D. -79.
 
 
4.   Modifier -33 indicates a
    
   A. preventive service.
   B. reduced anesthesia.
   C. bilateral procedure.
   D. blood pressure screening.
 
 
5.   A surgical procedure named after a person is called a/an
    
   A. synonym.
   B. antonym.
   C. eponym.
   D. pseudonym.
 
 
6.   Staged or related procedures are indicated with
    
   A. add-on code 65239.
   B. modifier -58.
   C. add-on code A1C.
   D. modifier -51.
 
 
7.   Right and left triangles indicate a
    
   A. code correction.
   B. change in the text description.
   C. deleted code.
   D. new modifier.
 
 
8.   Modifier -77 indicates a
    
   A. required service.
   B. multiple procedure.
   C. repeat procedure performed by another physician.
   D. bundled service.
 
 
9.   Modifier -59 indicates a/an _______ procedure.
    
   A. reduced
   B. abbreviated
   C. distinct
   D. bilateral
 
 
10.   Appendix E includes a list of
    
   A. medical supplies.
   B. CPT codes exempt from modifier -51.
   C. commonly prescribed medications.
   D. clinical examples.
 
11.   A significant separately identifiable E/M service is indicated with a/an
    
   A. add-on code 52.
   B. modifier -23.
   C. modifier -25.
   D. optional code 2523.
 
 
12.   Dr. Brown stops a surgical procedure due to the patient’s reaction to anesthesia. What modifier code is appended to the CPT code?
    
   A. -53 for discontinued procedure
   B. -13 for abbreviated service
   C. -1 for reduced time
   D. -97 for reduced anesthesia service
 
 
13.   Vascular families can be found in Appendix
    
   A. G.
   B. L.
   C. A.
   D. M.
 
 
14.   What function does the times symbol (×) indicate?
    
   A. Code deletion
   B. Each
   C. Single
   D. Multiple
 
 
15.   The modifier for the assistant surgeon is
    
   A. -59.
   B. -74.
   C. -32
   D. -82.
 
 
16.   Codes 22305–22325 demonstrate an example of a/an
    
   A. multiple code set.
   B. range of codes.
   C. alternate code set.
   D. single code span.
 
17.   Modifier -54 indicates
    
   A. specialized services were provided.
   B. only the surgical care portion.
   C. bilateral procedures were performed.
   D. two surgeons worked simultaneously.
 
18.   When general anesthesia is administered in lieu of local or regional anesthesia, the coder would assign
    
   A. modifier -23.
   B. modifier -77.
   C. code 95222.
   D. code 99059.
 
19.   The triangle symbol in CPT indicates a
    
   A. new code for a procedure or service.
   B. code that requires a modifier.
   C. code has been changed or modified in some way.
   D. code that requires a descriptor.
 
20.   The codes that are widely used for services and procedures are found in Category
    
   A. IV.
   B. III.
   C. II.
   D. I.
    
                                     

Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.

Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 250-500 word reflection to incorporate the following:

1. What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
2. What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
3. What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Rubric:

Spiritual and Emotional:

1. Complete the “EHS Personal Assessment” from the Emotionally Healthy website.
2. Reflect on your own results. Analyze the structure and assumptions behind the assessment.

Burnout:

1. Refer to the “Are You Heading for Caregiver Burnout?” quiz.
2. Complete the survey and reflect on your own results. Analyze the structure and assumptions behind the assessment.

Part II: Reflection

Using the results from the resources, write a 200-250 word reflection on your results and how you plan to combat compassion fatigue and burnout, and how you plan to promote your own spiritual growth.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Refer to the GCU Introduction, The Death of Ivan Ilych by Tolstoy and the three concepts of the “healing environment” found in chapters 7-9 of Called to Care: A Christian Worldview for Nursing. What is the phenomenology of illness and disease (i.e. the personal “what it is like”)? Cite references from your reading to support your answer.

What is a personal analysis of your own experience with illness and disease and how several factors colored that experience? How can you relate to The Death of Ivan Ilych?

 Discussion: Group Management for Just Culture

The concept of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible; they make mistakes. In a just culture, ‘hazardous’ human behavior such as staff errors, near–misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems—not to identify and punish the individual.
—Pepe & Caltado, 2011

This Discussion examines the opportunities of managers in working with groups to promote change that facilitates the delivery of safe, high–quality care.

To Prepare

• Review the information on just culture presented in the Learning Resources.
• For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).
• Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.
• Compare the findings of the Regulatory Decision Pathway  to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?
• Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?
• How might role conflict and/or ambiguity have contributed to the situation?

Post a description of an adverse event in your organization and your analysis of the issue using the Regulatory Decision Pathway. Explain how role conflict or ambiguity might have influenced this situation. Apply the principles of just culture as you explain how you, as the group’s manager, would handle the situation.

http://sidneydekker.com/wp-content/uploads/2013/01/JustCultureCritique.pdf

http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

**************Below is a paper to use as reference!!!!!!!!!

PLEASE USE THIS AS A REFERENCE ONLY.

Adverse Event

            Adverse events are a part of the healthcare environment and how an event is dealt with can affect patient safety.  The regulatory pathway and just culture are a means of improving the quality of care and safety culture (Russell & Radtke, 2014).  Health care employees need to trust in their organization that an adverse event can be reported so that the organization and employee can learn from the event, and that it is not just a means to place blame.

            An adverse event that took place in the cardiac catheterization lab was a procedure was done on the wrong patient.  A patient that was to have a pacemaker instead ended up having a diagnostic catheterization.  This event involved a patient identification issue by the nurse.  The hospital’s patient identification policy and time out policy were not adhered to by the nurse and then the catheterization team.   The incident was reported to the state, and there were several event meetings with the nurse and physician.  As a result of the investigation, all staff in the catheterization lab were re-educated to the patient identification and time out policy.  All staff had to sign an individual affidavit that they understood the policy.  The nurse was given a written warning.  This event would not have happened if the nurse and catheterization team had adhered to policy.           

Regulatory Decision Pathway

 Using the regulatory decision pathway, the nurse did not intend to harm the patient deliberately.  The nurse asked the patient if she was Ms. X and the patient said yes.  The identification policy is to check the patient’s identification band for name and medical record number against a second identifier.  This was not done.  There were no significant circumstances involving the system that led to the error.  The nurse did not conceal the error or falsify the record.  The nurse did not disregard or consciously take a substantial risk.  She thought she had the correct patient.  There were no similar or serious errors by this nurse.  A reasonably prudent nurse would not have done the same in similar circumstances as the patient identification policy would have been adhered to.  According to the regulatory decision pathway, this was at-risk behavior by the nurse (Russell & Radtke, 2014).

            The catheterization team which included the physician, nurse, physician assistant, and technician contributed to this adverse event.  The team did not follow the time out process policy where everything stops, and patient identification is reconfirmed with other parameters.  Again, following the regulatory decision pathway, the catheterization team demonstrated at-risk behavior.  At-risk behavior involves unsafe practice and carelessness which is shown by the nurse and catheterization team not adhering to policy (Russell & Radtke, 2014). 

Role Conflict

 The cardiac catheterization lab is very fast-paced, and the nurses can feel the stress of the workload.  The procedure area and recovery room was very busy and crowded that day.  Role conflict could have contributed to the situation as there is constant pressure to keep moving.  Role conflict could have contributed in the time-out process not taking place in the procedure room.  Nurses have to initiate the time out process when the physician arrives, and some physicians are not very cooperative in the process.  Since the adverse event, patient identification and the time out policy are strictly adhered to.

Just Culture

 Quality improvement and work environment improvement are a part of just culture (Lockhart, 2015).  Just culture is safety issues, improving processes, and not about punishing individuals (Pepe & Cataldo, 2011).  As the group’s manager using the principles of culture, I would have done firm counseling stressing the significance of the incident, but as this was the nurse’s  first risky behavior, I would not have done a formal written warning with the threat of being fired if it happens again.   Doing a staff meeting and re-educating the policies was appropriate.  Patient identification and the time out process are now part of the cardiac catheterization lab’s monthly quality assurance surveys.  All new employees are well educated in the two policies and must sign an attestation that they understand by the end of orientation.  This adverse event led to improved processes in the cardiac catheterization lab which is the goal of just culture (Pepe & Cataldo, 2011).     

References

Lockhart, L. (2015).  Does your organization have a just culture?  Retrieved from http://www.NursingMadeIncrediblyEasy.com doi-10.1097/01.NME.0000457286.16594.92

Pepe, J., & Cataldo, P. J. (2011).  Manage risk, build a just culture.  Health Progress.  Retrieved from http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

Russell, K. A. & Radtke, B. K. (2014).  An evidence-based tool for regulatory decision-making: regulatory decision pathway.  Journal of Nursing Regulation, 5(2), 5-9. https://class.waldenu.edu/bbcswebdav/institution/USW1/201810_27/MS_NURS/NURS_6201/readings/USW1_NURS_6201_Russell.pdf