Testing DreamWorld Analysis Report

Testing DreamWorld Analysis Report. University of North Carolina BUS 342-11D Exam 2 University of North Carolina BUS 342-11D Exam 2_2016

Question Exam 2_2016 Question 1 Among GCC economies, which of the following has the the lowest per capita oil and gas production?Bahrain

Oman

Saudi Arabia

Kuwait

Question 2 Among the following countries, which one has the lowest female labor participation rate?

UAE

Bahrain

Kuwait

Saudi Arabia

SEE FULL ANSWER HERE

Question 3 Among the following economies, which one is not an OECD member?

Romania

Slovakia

Poland

Hungary

Question 4 Commercial shariah is similar to Western business laws in most aspects.

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True

False

Question 5 During 2000-2007, absolute poverty in Russia fell by more than 50%.

True

False

Question 6 GCC economies’ development can be attributted to the genuinely entrepreneurial class in these economies.

True

False

Question 7 How many economies in the GCC region have a “full-fledged” democracy?

2

3

0

1

Question 8 In 1997, black market accounted for higher share of retail activity in Tajikistan than in Ukraine.

True

False

Question 9 In GCC economies, bureaucrats are not involved in busineses.

True

False

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Testing DreamWorld Analysis Report

 
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Pathophisiology Assignment

Pathophisiology Assignment. Instructions

· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.

It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.

 

 

· Reason for Consultation: Desaturation to 64% on room air 1 hour ago with associated shortness of breath.

History of Present Illness: Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found to be mildly dyspneic.  Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, blood pressure 138/38.  O2 sat was 64% on room air.  The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m.  She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home.  Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia.  She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago.  She reported that she has 2 to 3 treatments left.  She denied any chest pain or previous history of CHF. Review of her vital signs showed that she had been having intermittent fevers since yesterday morning.  Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems.  The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.

Review of Systems:  Constitutional:  Negative for diaphoresis and chills.  Positive for fever and fatigue. HEENT:  Negative for hearing loss, ear pain, nose bleeds, and tinnitus.  Positive for throat pain secondary to her laryngeal cancer.   Eyes:  Negative for blurred vision, double vision, photophobia, discharge and redness.   Respiratory:  Positive for cough and shortness of breath. Negative for hemoptysis and wheezing.   Cardiovascular:  Negative for chest pain, palpitations, orthopnea, leg swelling and PND.   Gastrointestinal:  Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool and melena.   Genitourinary:  Negative for dysuria, urgency, frequency, hematuria and flank pain.   Musculoskeletal:  Negative for myalgias, back pain and falls.  Skin:  Negative for itching and rash.   Neurological:  Negative for dizziness, tingling, tremors, sensory change and speech changes.   Endocrine/hematologic/allergies:  Negative for environmental allergies or polydipsia.  Does not bruise or bleed easily.   Psychiatric:  Negative for depression, hallucinations and memory loss.

Past Medical History:

1.    Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric bypass surgery, which she had approximately 3 years ago.

 

2.    Laryngeal cancer

 

3.    Hypertension

 

4.    Hypercholesterolemia

 

5.    Pneumonia

 

6.    Arthritis

 

7.    Hypothyroidism

 

8.    Atrial fibrillation

 

9.    Acute renal failure

 

10.Chronic kidney disease, stage IV – 4 months ago a renal biopsy was completed, which showed focal acute tubular necrosis and patchy tubular atrophy, moderate to severe interstitial fibrosis with patchy acute and chronic interstitial nephritis, normal cellular glomeruli with no white microscopic evidence of a primary glomerulopathy. Baseline creatinine is 1.9.

 

11.Peptic ulcer disease

 

12.Skin cancer

 

13.Anemia

 

14.Osteoporosis

 

Past Surgical History:

 

15.Gastric bypass 4 years ago

 

16.Closure of mesenteric defect.

 

17.Radical neck resection on 1 year ago.

 

Family History:

 

18.Mother had diabetes diagnosed at age 55 and high blood pressure. Deceased.

 

19.Father had heart disease diagnosed at age 60. Deceased.

 

20.She had a sister with diabetes, thyroid disease, CKD, on dialysis, with unknown etiology.

 

Social History: She denies any smoking or alcohol use.  She denies any drug use.

 

Medications:

 

21.Calcitriol 0.5 mcg PO every other day

 

22.Vitamin B12 2500 mcg sublingual every Monday and Thursday

 

23.Docusate sodium 100 mg PO BID

 

24.Fentanyl patch 100 mcg every 72 hours

 

25.Gabapentin 800 mg PO BID

 

26.Levothyroxine 50 mcg daily

 

27.Multivitamin 1 PO Daily

 

28.Oxybutynin 5 mg PO BID

 

29.Hydrocodone 5/325 1-2 tablets every 6 hours PRN pain

 

Allergies: She is allergic to Cipro, which causes Uticaria and hives, contrast dye, honey and bee venom, adhesive, and sulfas, which causes hives

 

Physical Examination:  Vital signs:  38.6, 120, 20, 138/38, 64% on room air.  She is maintaining O2 sat of 91 to 92 on 4 liters nasal cannula.   Constitutional:  She is somnolent.  Oriented to person and place.  Appears ill and mildly dyspneic. Head:  Normocephalic and atraumatic.  Nose:  Midline, right and left maxillary and frontal sinuses are nontender bilaterally.  Oropharynx:  Clear and moist. No uvula swelling or exudate noted.   Eyes:  Conjunctivae, EOM and lids are normal.  PERL. Right and left eyes are without drainage or nystagmus.  No scleral icterus. Neck:  Normal range of motion and phonation.  Neck is supple.  No JVD.  No tracheal deviation present.  No thyromegaly or thyroid nodules.  No cervical lymphadenopathy noted bilaterally. Cardiovascular:  rapid rate, S1 and S2 without murmur or gallop.  Brachial, radial, dorsalis pedis, and posterior tibial are 2+/4+ bilaterally. Chest: Respirations are regular and even with mild dyspnea. Lungs are coarse and with some rales in the posterior bases. Abdomen:  Soft.  Bowel sounds are active, nontender, no masses noted.  No hepatosplenomegaly noted.  No peritoneal signs.   Musculoskeletal:  Full range of motion of the bilateral shoulders, wrists, elbows. Neurologic:  Somnolent.  Cranial nerves II-XII are intact. Skin:  Warm and dry.   Psychiatric:  Mood and affect are normal.  Calm and cooperative.  Behavior, judgment is intact.

 

Laboratories and Diagnostics:  WBC 7.2, Neutrophil 63%  Creatinine 2.0, BUN 45, Na 144, Potassium 4.4  BNP 242 Lactate 1.0 All other labs are unremarkable Chest x-ray: Right lower lobe infiltrate  EKG: NSR, no ST or T wave changes

 

One hour after your saw Mrs. X, you get a call from the RN to report that her BP is now 75/40, pulse is 140, RR is 34 and dyspneic, temperature is 39.6 and she is minimally responsive.  Mrs. X is transferred to the MICU.

 

Upon re-evaluation of Mrs. X you note that she is obtunded, struggling to breath, using accessory muscles and O2sats are 85% on a Non-rebreather. She is intubated and placed on a ventilator. A central line is placed and confirmation obtained via CXR. A foley is placed and fluid resuscitation has begun.

 

WBC 20 Hgb 12 HCT 36 Platelets 98,000 Na 148 Chloride 110 Potassium 5.6 Glucose 190 Creatinine 3.0 BUN 68 Albumin 3.0 Anion Gap 21 Lactate 5.2 Procalcitonin 15, INR is 1.0, aPTT 23 ABG (prior to intubation) pH 7.28, PCO2 36, HCO3 17

 

EKG: Atrial Fibrillation with RVR at 156 CVP 3

 

Answer the following questions:

 

30.What are 4 plausible differential diagnoses for Mrs. X’s hypoxemia that are specific to her clinical scenario? How would each diagnosis cause a hypoxemia?

 

31.What is your final diagnosis for the hypoxemia?

 

32.What are the most likely organisms to cause the diagnoses you identified in question 2?

 

33.Upon initial evaluation what category of sepsis was Mrs. X?

 

34.Upon re-evaluation what category of sepsis was Mrs. X?

 

35.Why is a gram negative bacteremia more serious than one caused by a gram positive organism?

 

36.What is the most likely source of Mrs. X sepsis?

 

37.What is a CVP and what does a value of 3 indicate? Why is Mrs. X CVP 3?

 

38.What is a Procalcitonin and what is its purpose?

Pathophisiology Assignment

 
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UMUC Biology Lab 3: Cell Structure And Function

UMUC Biology Lab 3: Cell Structure And Function.

Your Full Name:

UMUC Biology 102/103
Lab 3: Cell Structure and Function
INSTRUCTIONS:

• On your own and without assistance, complete this Lab 3 Answer Sheet electronically and submit it via the Assignments Folder by the date listed in the Course Schedule (under Syllabus).
• To conduct your laboratory exercises, use the Laboratory Manual located under Course Content. Read the introduction and the directions for each exercise/experiment carefully before completing the exercises/experiments and answering the questions.
• Save your Lab 3 Answer Sheet in the following format:  LastName_Lab3 (e.g., Smith_Lab3).
• You should submit your document as a Word (.doc or .docx) or Rich Text Format (.rtf) file for best compatibility.

Pre-Lab Questions

1. Identify three major similarities and differences between prokaryotic and eukaryotic cells.

 

2. Where is the DNA housed in a prokaryotic cell? Where is it housed in a eukaryotic cell?

 

3.  Identify three structures which provide support and protection in a eukaryotic cell.

Experiment 1: Cell Structure and Function
The structure of a cell dictates the majority of its function. You will view a selection of slides that exhibit unique structures that contribute to tissues function.

Materials:
Onion (allium) Root Digital Slide Images

Procedure
1. Examine the onion root tip digital slide images on the following pages. Then, respond to the Post-Lab Questions.

Onion Root Tip: 100X

Onion Root Tip: 1000X

Onion Root Tip: 1000X

 

Onion Root Tip: 100X. Each dark circle indicates a different nucleus.

Onion Root Tip: 1000X

Post-Lab Questions
1. Label each of the arrows in the following slide image: A=Chromosomes, B=Nucleus, C=Cytoplasm, D=Cell Wall
2. What is the difference between the rough and smooth endoplasmic reticulum?

 

3. Would an animal cell be able to survive without a mitochondria? Why or why not?

 

 

4. What could you determine about a specimen if you observed a slide image showing the specimen with a cell wall, but no nucleus or mitochondria?

 

5. Hypothesize why parts of a plant, such as the leaves, are green, but other parts, such as the roots, are not. Use scientific reasoning to support your hypothesis.

Experiment 2: Osmosis – Direction and Concentration Gradients
In this experiment, we will investigate the effect of solute concentration on osmosis. A semi-permeable membrane (dialysis tubing) and sucrose will create an osmotic environment similar to that of a cell. This selective permeability allows us to examine the net movement of water across the membrane. You will begin the experiment with a 30% sucrose solution, and perform a set of serial dilutions to create lower concentration solutions. Some of the sucrose concentrations will be membrane permeable; while others will not be permeable (can you determine why this is?).

Materials
(3) 250 mL Beakers
(1) 10 mL Graduated Cylinder
(1) 100 mL Graduated Cylinder
Permanent Marker
*8 Rubber Bands (2 blue, 2 green, 2 red, and 2 yellow)
60 g Sucrose (Sugar) Powder, C12H22O11
4 Waste Beakers (any volume)
*Paper Towels
*Scissors
*Stopwatch
*Water
*(4) 15 cm. Pieces of Dialysis Tubing
*Contains latex. Please handle wearing safety gloves if you have a latex allergy.

*You Must Provide

*Be sure to measure and cut only the length you need for this experiment. Reserve the remainder for later experiments.

Procedure
1. Use the permanent marker to label the three 250 mL beakers as 1, 2, and 3.
2. Cut four strips of dialysis tubing, each 15.0 cm long. Fill Beaker 3 with 100 mL of water and submerge the four pieces of dialysis tubing in the water for at least 10 minutes.
3. After 10 minutes, remove one piece of tubing from the beaker. Use your thumb and pointer finger to rub the tubing between your fingers; this will open the tubing. Close one end of the tubing by folding over 3.0 cm of one end (this will become the bottom). Fold it again and secure with a yellow rubber band (use
4. Tie a knot in the remaining dialysis tubing just above or just below the rubber band. This will create a seal and ensures that solution will not leak out of the tube later in the experiment.
5. To test that no solution can leak out, add a few drops of water to the tubing and look for water leakage. If any water leaks, tighten the rubber band and/or the knot in the tubing. Make sure you pour the water out of the tubing before continuing to the next step.
6. Repeat Steps 4 – 5 with the three remaining dialysis tubes, using each of the three remaining rubber band colors.
7. Reconstitute the sucrose powder according to the instructions provided on the bottle’s label (your kit contains 60 g of sucrose in a chemical bottle) . This will create 200 mL of a 30% stock sucrose solution.
8. Use Table 2 to create additional sucrose solutions that are 30%, 15% and 3% concentrated, respectively. Use the graduated cylinder and waste beakers to create these solutions. Set these solutions aside.
Table 2: Serial Dilution Instructions
Sucrose Solution mL of Stock Sucrose Solution Needed mL of Water Needed
30% 10  0
15% 5  5
3% 1  9
3% 1  9
9. Pour 150 mL of the remaining stock sucrose solution into Beaker 1.
10. Use some of the remaining stock sucrose solution to create an additional 200 mL of a 3% sucrose solution into Beaker 2.
Hint: Use your knowledge of serial dilutions to create this final, 3% sucrose solution.
11. Measure and pour 10 mL of the remaining 30% sucrose solution into the dialysis bag with the yellow rubber band. Seal the top of this tubing with the remaining yellow rubber band.
12. Measure and pour 10 mL of the 15% sucrose solution in the bag with the red rubber band, and seal the top of the dialysis tubing with the remaining red rubber band. 10 mL of the 3% sucrose solution in the bag with the blue rubber band, and seal the dialysis tubing with the remaining blue rubber band. The final 10 mL of 3% sucrose solution in the bag with the green rubber band. Seal the dialysis tubing with the remaining green rubber band.
13. Verify and record the initial volume of solution from each bag in Table 3.

Figure 8: The dialysis bags are filled with varying concentrations of sucrose solution and placed in one of two beakers.
14. Place the yellow, red, and blue banded tubing in Beaker 2. Place the green banded tubing in Beaker 1 (Figure 8).
15. Hypothesize whether water will flow in or out of each dialysis bag. Include your hypotheses, along with supporting scientific reasoning in the Hypotheses section at the end of this procedure.
16. Allow the bags to sit for one hour. While waiting, pour out the water in the 250 mL beaker that was used to soak the dialysis tubing in Step 1. You will use the beaker in Step 19.
17. After allowing the tubing to sit for one hour, remove them from the beakers.
18. Carefully open the tubing. The top of the tubing may need to be cut off/removed as they tend to dry out over the course of an hour. Measure the solution volumes of each dialysis bag using the 100 mL graduated cylinder. Make sure to empty and dry the cylinder completely between each sample.
19. Record your data in Table 3.
Table 3: Sucrose Concentration vs. Tubing Permeability
Band Color Sucrose % Initial Volume (mL) Final Volume (mL) Net Displacement (mL)
Yellow
Red
Blue
Green
Hypothesis:

Post-Lab Questions
1. For each of the tubing pieces, identify whether the solution inside was hypotonic, hypertonic, or isotonic in comparison to the beaker solution in which it was placed.

2. Which tubing increased the most in volume? Explain why this happened.

 

3. What do the results of this experiment this tell you about the relative tonicity between the contents of the tubing and the solution in the beaker?
4. What would happen if the tubing with the yellow band was placed in a beaker of distilled water?

5. How are excess salts that accumulate in cells transferred to the blood stream so they can be removed from the body? Be sure to explain how this process works in terms of tonicity.

6. If you wanted water to flow out of a tubing piece filled with a 50% solution, what would the minimum concentration of the beaker solution need to be? Explain your answer using scientific evidence.

7. How is this experiment similar to the way a cell membrane works in the body? How is it different? Be specific with your response.

Your Full Name:

UMUC Biology 102/103

Lab 3: Cell Structure and Function

INSTRUCTIONS:

 

· On your own and without assistance, complete this Lab 3 Answer Sheet electronically and submit it via the Assignments Folder by the date listed in the Course Schedule (under Syllabus).

· To conduct your laboratory exercises, use the Laboratory Manual located under Course Content. Read the introduction and the directions for each exercise/experiment carefully before completing the exercises/experiments and answering the questions.

· Save your Lab 3 Answer Sheet in the following format: LastName_Lab3 (e.g., Smith_Lab3).

· You should submit your document as a Word (.doc or .docx) or Rich Text Format (.rtf) file for best compatibility.

Pre-Lab Questions

 

 

1. Identify three major similarities and differences between prokaryotic and eukaryotic cells.

 

 

 

2. Where is the DNA housed in a prokaryotic cell? Where is it housed in a eukaryotic cell?

 

 

 

3. Identify three structures which provide support and protection in a eukaryotic cell.

 

Experiment 1: Cell Structure and Function

The structure of a cell dictates the majority of its function. You will view a selection of slides that exhibit unique structures that contribute to tissues function.

concept_tab_l

Materials:

Onion (allium) Root Digital Slide Images

 

 

Procedure

1. Examine the onion root tip digital slide images on the following pages. Then, respond to the Post-Lab Questions.

Onion Root Tip: 100X
Onion Root Tip: 100X

 

 

Onion Root Tip: 1000X
Onion Root Tip: 1000X

 

 

Onion Root Tip: 1000X
Onion Root Tip: 1000X

 

 

 

 

Onion Root Tip: 100X. Each dark circle indicates a different nucleus.
Onion Root Tip: 100X. Each dark circle indicates a different nucleus.

 

 

Onion Root Tip: 1000X
Onion Root Tip: 1000X

 

 

Post-Lab Questions

1. Label each of the arrows in the following slide image: A=Chromosomes, B=Nucleus, C=Cytoplasm, D=Cell Wall

Lab3_Experiment1_PostLabQuestion1

 

2. What is the difference between the rough and smooth endoplasmic reticulum?

 

 

 

 

3. Would an animal cell be able to survive without a mitochondria? Why or why not?

 

 

 

 

 

4. What could you determine about a specimen if you observed a slide image showing the specimen with a cell wall, but no nucleus or mitochondria?

 

 

 

 

5. Hypothesize why parts of a plant, such as the leaves, are green, but other parts, such as the roots, are not. Use scientific reasoning to support your hypothesis.

 

 

Experiment 2: Osmosis – Direction and Concentration Gradients

In this experiment, we will investigate the effect of solute concentration on osmosis. A semi-permeable membrane (dialysis tubing) and sucrose will create an osmotic environment similar to that of a cell. This selective permeability allows us to examine the net movement of water across the membrane. You will begin the experiment with a 30% sucrose solution, and perform a set of serial dilutions to create lower concentration solutions. Some of the sucrose concentrations will be membrane permeable; while others will not be permeable (can you determine why this is?).

concept_tab_2

Materials

(3) 250 mL Beakers (1) 10 mL Graduated Cylinder (1) 100 mL Graduated Cylinder Permanent Marker *8 Rubber Bands (2 blue, 2 green, 2 red, and 2 yellow) 60 g Sucrose (Sugar) Powder, C12H22O11 4 Waste Beakers (any volume) *Paper Towels *Scissors

 

*Stopwatch *Water *(4) 15 cm. Pieces of Dialysis Tubing *Contains latex. Please handle wearing safety gloves if you have a latex allergy. *You Must Provide *Be sure to measure and cut only the length you need for this experiment. Reserve the remainder for later experiments.

 

Procedure

1. Use the permanent marker to label the three 250 mL beakers as 1, 2, and 3.

2. Cut four strips of dialysis tubing, each 15.0 cm long. Fill Beaker 3 with 100 mL of water and submerge the four pieces of dialysis tubing in the water for at least 10 minutes.

3. After 10 minutes, remove one piece of tubing from the beaker. Use your thumb and pointer finger to rub the tubing between your fingers; this will open the tubing. Close one end of the tubing by folding over 3.0 cm of one end (this will become the bottom). Fold it again and secure with a yellow rubber band (use

4. Tie a knot in the remaining dialysis tubing just above or just below the rubber band. This will create a seal and ensures that solution will not leak out of the tube later in the experiment.

5. To test that no solution can leak out, add a few drops of water to the tubing and look for water leakage. If any water leaks, tighten the rubber band and/or the knot in the tubing. Make sure you pour the water out of the tubing before continuing to the next step.

6. Repeat Steps 4 – 5 with the three remaining dialysis tubes, using each of the three remaining rubber band colors.

7. Reconstitute the sucrose powder according to the instructions provided on the bottle’s label (your kit contains 60 g of sucrose in a chemical bottle) . This will create 200 mL of a 30% stock sucrose solution.

8. Use Table 2 to create additional sucrose solutions that are 30%, 15% and 3% concentrated, respectively. Use the graduated cylinder and waste beakers to create these solutions. Set these solutions aside.

Table 2: Serial Dilution Instructions
Sucrose Solution mL of Stock Sucrose Solution Needed mL of Water Needed
30% 10 0
15% 5 5
3% 1 9
3% 1 9

9. Pour 150 mL of the remaining stock sucrose solution into Beaker 1.

10. Use some of the remaining stock sucrose solution to create an additional 200 mL of a 3% sucrose solution into Beaker 2.

Hint: Use your knowledge of serial dilutions to create this final, 3% sucrose solution.

11. Measure and pour 10 mL of the remaining 30% sucrose solution into the dialysis bag with the yellow rubber band. Seal the top of this tubing with the remaining yellow rubber band.

12. Measure and pour 10 mL of the 15% sucrose solution in the bag with the red rubber band, and seal the top of the dialysis tubing with the remaining red rubber band. 10 mL of the 3% sucrose solution in the bag with the blue rubber band, and seal the dialysis tubing with the remaining blue rubber band. The final 10 mL of 3% sucrose solution in the bag with the green rubber band. Seal the dialysis tubing with the remaining green rubber band.

13. Verify and record the initial volume of solution from each bag in Table 3.

Figure 8: The dialysis bags are filled with varying concentrations of sucrose solution and placed in one of two beakers.
Figure 8: The dialysis bags are filled with varying concentrations of sucrose solution and placed in one of two beakers.

14. Place the yellow, red, and blue banded tubing in Beaker 2. Place the green banded tubing in Beaker 1 (Figure 8).

15. Hypothesize whether water will flow in or out of each dialysis bag. Include your hypotheses, along with supporting scientific reasoning in the Hypotheses section at the end of this procedure.

16. Allow the bags to sit for one hour. While waiting, pour out the water in the 250 mL beaker that was used to soak the dialysis tubing in Step 1. You will use the beaker in Step 19.

17. After allowing the tubing to sit for one hour, remove them from the beakers.

18. Carefully open the tubing. The top of the tubing may need to be cut off/removed as they tend to dry out over the course of an hour. Measure the solution volumes of each dialysis bag using the 100 mL graduated cylinder. Make sure to empty and dry the cylinder completely between each sample.

19. Record your data in Table 3.

Table 3: Sucrose Concentration vs. Tubing Permeability
Band Color Sucrose % Initial Volume (mL) Final Volume (mL) Net Displacement (mL)
Yellow        
Red        
Blue        
Green        

Hypothesis:

 

Post-Lab Questions

1. For each of the tubing pieces, identify whether the solution inside was hypotonic, hypertonic, or isotonic in comparison to the beaker solution in which it was placed.

 

 

2. Which tubing increased the most in volume? Explain why this happened.

 

 

 

3. What do the results of this experiment this tell you about the relative tonicity between the contents of the tubing and the solution in the beaker?

4. What would happen if the tubing with the yellow band was placed in a beaker of distilled water?

 

5. How are excess salts that accumulate in cells transferred to the blood stream so they can be removed from the body? Be sure to explain how this process works in terms of tonicity.

 

6. If you wanted water to flow out of a tubing piece filled with a 50% solution, what would the minimum concentration of the beaker solution need to be? Explain your answer using scientific evidence.

 

7. How is this experiment similar to the way a cell membrane works in the body? How is it different? Be specific with your response.

UMUC Biology Lab 3: Cell Structure And Function

 
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Medical Coding By Sheila McCray

Medical Coding By Sheila McCray.

Study Guide

Medical Coding By

Sheila McCray

 

 

About the Author

Sheila D. McCray, MS, CCS, CCS-P, has worked in the healthcare industry since 1987 as a medical claims examiner, medical tran- scriptionist, medical transcription quality assurance editor, medical coder, healthcare instructional designer, and healthcare subject matter expert. She has also worked as an online adjunct professor for several online universities, teaching a variety of healthcare courses.

As a healthcare instructional designer, Sheila regularly writes, reviews, and revises courses about healthcare topics. She’s the owner of Avidity Medical Design, an instructional design consulting practice specializing in curriculum development for the healthcare sector.

Copyright © 2016 by Penn Foster, Inc.

All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515.

Printed in the United States of America

All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text should not be regarded as affecting the validity of any trademark or service mark.

 

 

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INSTRUCTIONS TO STUDENTS 1

LESSON ASSIGNMENTS 7

LESSON 1: DIAGNOSIS CODING WITH ICD-10-CM 9

LESSON 2: PROCEDURE CODING WITH ICD-10-PCS 31

LESSON 3: EVALUATION AND MANAGEMENT AND ANESTHESIA CODING 51

LESSON 4: SURGICAL CPT CODING, PART 1 63

LESSON 5: SURGICAL CPT CODING, PART 2 73

LESSON 6: SURGICAL CPT CODING, PART 3 81

LESSON 7: SIMILARITIES AND DIFFERENCES BETWEEN HCPCS LEVEL II AND CPT 89

GRADED PROJECT 95

CHAPTER REVIEW ANSWERS 101

 

 

INTRODUCTION As the healthcare industry continues to grow at an amazing rate, and with the Affordable Care Act (ACA) being signed into law in March 2010, many insurance companies, physicians’ offices, hospitals, and other healthcare organizations urgently need qualified medical coders. Medical coders play a key role in the healthcare industry for several reasons. First, medical coders optimize physician and hospital reimbursement through precise coding that adheres to coding guidelines and reflects the content of a patient’s medical record. Second, because medical coders must ask questions to clarify any areas of ambiguity in the medical record prior to selecting their codes, they help keep the medical record up to date. As questions are clarified, the record is updated with documents that explain the areas questioned by the medical coder. Third, medical coders assign codes that reflect new diseases, disorders, therapies, treatments, and medical devices. Medical coders select codes that are also used for statistical research on diseases and disorders. These codes are used to gauge the effectiveness of medical treatments throughout the United States.

In this course, you’ll learn how to assign diagnosis and pro- cedure codes using ICD-10-CM and ICD-10-PCS. You’ll also learn about the HCPCS Level I and Level II code set, which is used to assign codes for physician reimbursement in the out- patient setting. You’ll learn about assigning codes for office visits, surgeries, radiology procedures, medical devices, equipment, injections, supplies, and many other outpatient services.

OBJECTIVES When you complete this course, you’ll be able to

ďż˝ Describe the purpose of coding and the documentation used in coding

ďż˝ Assign ICD-10 codes using the ICD-10 coding manual

ďż˝ Correctly apply coding guidelines using ICD-10

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ďż˝ Assign codes to different body systems using ICD-10

ďż˝ Review coding for ICD-10

ďż˝ Assign codes for services and procedures using CPT and HCPCS Level II

ďż˝ Describe the relationship between HCPCS Level I and HCPCS Level II

ďż˝ Outline the types of services and procedures described in the CPT

ďż˝ Describe the types of patients seen in the outpatient setting

YOUR TEXTBOOK The textbook for your Medical Coding course is Step-by-Step Medical Coding. This textbook gives an overview of ICD-10- CM and ICD-10-PCS. It also covers CPT coding. Your textbook is divided into chapters. The table of contents, found on pages xxiii–xxx of Step-by-Step Medical Coding, out- lines the topics presented in each chapter. Take a few moments now to examine the table of contents to get a better feel for the topics and concepts you’ll be learning about. Next, read the preface on pages ix–xiv, which describes the depth, range, and purpose of the material presented. Now, look through the rest of your textbook. You’ll see that every chap- ter begins with a set of chapter topics and learning objectives, followed by a brief introduction to the topics you’ll explore. Read the learning objectives twice: once before you read each chapter, and again after you finish reading. This two-step learning approach reinforces your understanding of the major concepts covered in the chapter, and also confirms that you truly understand the material.

Instructions to Students2

CPT stands for Current Procedural Terminology. ICD stands for International Classification of Diseases. The number following the acronym ICD refers to the version. For example, ICD-10 is the tenth revision.

 

 

The back portion of Step-by-Step Medical Coding includes several helpful study resources. The textbook’s glossary on pages 755–769 defines important terms. You’ll find a detailed index on pages 787–802.

If you’re ever unsure about where to find specific codes that are referenced in the chapters, use the handy Coder’s Index on pages 775–786. This index lists the pages where you can find specific codes referenced in each of the chapters. The references to the ICD-10-CM codes begin on page 782.

Once you’ve explored the Step-by-Step Medical Coding text- book, you can use the textbook’s resources to refer to any topic that you want to review. Your textbook’s companion website provides Encoder practice exercises, extra coding cases, and an extra chapter on nursing homes, durable medical equipment (DME), and home health. Go to the intro- ductory pages of your textbook or click the link on your student portal for more information.

Please note that the textbook goes into much more detail about the ICD-10 coding system than we’ll be covering in the study guide. Remember to code to the highest level of speci- ficity when assigning your ICD-10 codes. The ICD-10 codes are listed in the answer section of the study guide.

In the later part of your course, you’ll turn your attention to HCPCS Level I and Level II. Take a few minutes now to review the chapters listed in Unit 3, the area of the text that covers CPT and HCPCS coding. Take some extra time to review the concepts and the guidelines for coding presented in this course. It will be well worth it in the long run! Re-read the chapters in your textbook until you feel certain that you understand every CPT guideline presented.

There are three types of exercises in the textbook: Quick Checks, Exercises, and Chapter Reviews. You should com- plete Quick Checks and Exercises as you come upon them during your reading. You can find Quick Check answers in Appendix C (pages 744–747) and Exercise answers in Appendix B (pages 723–743). You’ll be instructed on when to complete the Chapter Reviews in the instructions for each lesson assignment in this study guide. Answers to the Chapter Reviews are given at the end of this study guide.

Instructions to Students 3

 

 

Instructions to Students

Note: The questions found in the Chapter Reviews may include directions to find ICD-9-CM codes for diagnoses. Because ICD-10 has replaced ICD-9 as the standard coding system, you won’t have an ICD-9 book in which to find these codes; therefore, code for CPT and ICD-10 codes only.

YOUR STUDY GUIDE Use this study guide as a companion to your textbook. The study guide also includes a lesson study plan that helps you explore ICD-10 fundamentals quickly and easily.

This study guide is divided into lessons, each with a practical overview of the topic, and several study assignments. Each reading assignment in Step-by-Step Medical Coding includes a series of practical coding exercises, which you’ll need to com- plete as you work through the textbook assignments. At the end of each lesson, you must complete an online, multiple- choice examination. Submit each examination for grading as soon as you complete it.

COURSE MATERIALS This part of your program includes the following materials:

1. This study guide, which offers an introduction to your textbook, plus

ďż˝ A lesson assignments page, which lists the study assignments in your textbook and lesson exams

ďż˝ Explanatory material, which emphasizes the main points of the instruction to support the chapter material covered in Step-by-Step Medical Coding

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Important: If you don’t fully understand ICD-10 coding concepts

now, you won’t be able to apply the concepts later on when you start

to assign medical codes to diagnoses and procedures using each of

these code sets. Therefore, it’s very important that you take the time

to learn each concept before moving on to the next.

 

 

Instructions to Students 5

2. Your program textbook, Step-by-Step Medical Coding, which contains your assigned readings, exercises and answers

3. ICD-10-CM Professional Edition for Physicians

4. ICD-10-PCS

5. CPT

Make sure you have all of these materials before starting the course.

A STUDY PLAN Take the time to review the material as many times as you need to. Your effort will be well worth it in the long run!

Each of your textbook assignments helps you develop a solid foundation in diagnosis and procedural coding. Using codes for both diagnosis of diseases and the procedures used to treat them facilitates payment for health services, research into quality and cost, and planning for future healthcare needs. You’ll learn a great deal of technical information, so take your time as you move through each chapter.

To get the most out of this course, you’ll need to schedule several study periods over the course of the week. Devote at least one to three hours each day to reading, learning, and mastering each set of coding concepts. Again, it’ll be well worth it! If you devote the time to your studies now, as you move through the course, you’ll feel less stressed and frus- trated when you start to code. You’ll also begin to gain confidence for the intermediate and advanced medical coding scenarios that will come later.

Work through this study guide one assignment at a time. Keep your ICD-10-CM and ICD-10-PCS references handy as you review each lesson. You’ll need them to complete the lesson exercises. Once you’ve finished all of the assignments included in each lesson, you’ll be ready to complete the exam.

 

 

Instructions to Students6

To get the most out of your studies, follow these steps to complete your assignments:

Step 1: Carefully note the pages where your assigned reading begins and ends. These pages are iden- tified in the Lesson Assignments section of this study guide.

Step 2: Skim through the assigned pages (in both the study guide and the textbook) for a general idea of their content. Try to develop an overall per- spective on the concepts and skills being taught and practiced in each assignment.

Step 3: Carefully read through the study guide’s assigned pages. These pages contain back- ground information about the material covered in the textbook.

Step 4: Read the assigned pages in your textbook, and take notes on any important concepts or terms.

Step 5: When you’ve mastered all of the material for each assignment, proceed to your next study guide assignment. Repeat steps 1–4 for the remaining assignments in each lesson.

Step 6: Once you’ve finished all the assignments, Quick Checks, Exercises, and Chapter Reviews in each lesson, proceed to the examination. Take your time with the exam. As you work, feel free to refer to your textbook, the study guide, and any notes you’ve taken.

Step 7: Repeat steps 1–6 for the remaining lessons in your study guide.

Remember: At any point in your studies, you can email your instructor for additional clarification. Now look over your les- son assignments and begin your study of medical coding with Lesson 1, Assignment 1.

Remember to regularly check your student portal. Your instructor may

post additional resources that you can access to enhance your learn-

ing experience.

 

 

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Lesson 1: Diagnosis Coding With ICD-10-CM For Read in the Read in the

study guide textbook

Assignment 1 12–16 Pages xviii-xxii

Assignment 2 17–22 Chapter 2, pages 26–40

Assignment 3 22–25 Chapter 2, pages 41–50

Assignment 4 25–27 Chapter 3

Assignment 5 27–29 Chapter 4

Examination 480822 Material in Lesson 1

Lesson 2: Procedure Coding With ICD-10-PCS For Read in the Read in the

study guide textbook

Assignment 6 31–47 Chapters 5–7

Assignment 7 47–50 Chapter 27

Examination 480823 Material in Lesson 2

Lesson 3: Evaluation and Management and Anesthesia Coding For Read in the Read in the

study guide textbook

Assignment 8 Pages 54–56 Chapter 8

Assignment 9 Pages 56–57 Chapter 10

Assignment 10 Pages 58–60 Chapter 11

Assignment 11 Page 61 Chapter 12

Examination 480824 Material in Lesson 3

Lesson 4: Surgical CPT Coding: Part 1 For: Read in the Read in the

study guide: textbook:

Assignment 12 Page 64 Chapter 13

Assignment 13 Page 65 Chapter 14

Assignment 14 Pages 66–67 Chapter 15

 

 

Lesson Assignments8

Assignment 15 Pages 67–68 Chapter 16

Assignment 16 Pages 68–72 Chapter 17

Examination 480825 Material in Lesson 4

Lesson 5: Surgical CPT Coding: Part 2 For: Read in the Read in the

study guide: textbook:

Assignment 17 Pages 74–75 Chapter 18

Assignment 18 Page 75 Chapter 19

Assignment 19 Pages 76–77 Chapter 20

Assignment 20 Pages 78–80 Chapter 21

Examination 480826 Material in Lesson 5

Lesson 6: Surgical CPT Coding: Part 3 For: Read in the Read in the

study guide: textbook:

Assignment 21 Pages 82–83 Chapter 22

Assignment 22 Pages 83–84 Chapter 23

Assignment 23 Page 85 Chapter 24

Assignment 24 Page 86 Chapter 25

Assignment 25 Pages 87–88 Chapter 26

Examination 480827 Material in Lesson 6

Lesson 7: Similarities and Differences between HCPCS Level II and CPT For: Read in the Read in the

study guide: textbook:

Assignment 26 Pages 90–93 No Readings

Graded Project 48082800 Materials in Lessons 1-7

 

 

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Diagnosis Coding with ICD-10-CM Medical coders review the documents in the patient’s medical record and abstract (collect clinical data) or retrieve informa- tion from specific documents. They then assign numeric or alphanumeric codes to each piece of data they retrieve.

Medical coders must use their skills in research, reasoning, and interpretation of medical coding guidelines to ensure that physicians and hospitals are reimbursed accurately and com- pletely for the services that they provide.

This part of your program will introduce you to this exciting field. You’ll learn all about ICD-10 medical coding and the steps involved in assigning diagnosis and procedure codes using this code set. The material that follows will lead you step-by-step through a wide range of ICD-10 coding exam- ples, offering invaluable tips and suggestions that you can use along the way. You’ll also find Quick Checks and Exercises in your textbook. Be sure to complete all of these additional practice tools to help you fine-tune your coding skills, master the fine points of ICD-10 coding, and learn about a wide range of medical terms. Doing so will further sharpen your skills, strengthen your ability to accurately interpret these terms, and, in turn, translate these terms into accurate code.

By choosing to learn medical coding, you’re embarking on a journey that essentially means learning a new language. Although this new language may seem a bit complicated and overwhelming at first, it becomes easier once you learn the basics of ICD-10 coding (and with lots and lots of practice). Your confidence will increase as you learn the basics and then apply what you learn to basic coding scenarios.

The important thing to remember is that you don’t ever have to feel lost. The coding steps, along with the coding guide- lines, tell you exactly what you need to do. If you do feel yourself getting off track though, connect with other students in the program on the Medical Billing and Coding Academic Space on the Penn Foster Community. You can see if other students are encountering the same difficulties and learn

 

 

Medical Coding10

how they’ve overcome these difficulties. You can also create study groups and find study buddies to help make your learning experience even better.

Your instructor is also a valuable resource. You can connect with your instructor on the Medical Billing and Coding Academic Space. It’s always much better to ask for help, rather than become frustrated and try to figure things out on your own. As you move forward, you’ll find yourself becoming more comfortable with the medical terms, processes, and pro- cedures that coders use every day. Just remember not to put too much pressure on yourself to master coding overnight. When you begin to code, don’t expect to get every single code right—you won’t. The key to learning medical coding is being willing to make mistakes. Experienced coders had to make many coding errors along the way to gain the experience they now have. When you make an error in your code selection, retrace your steps and find out where you went wrong, so the next time you’ll be less likely to make the same mistake. Remember that a mistake is never a mistake if you learn from it! Keep this in mind as you move forward through your coding courses.

By the time you finish Medical Coding, you’ll have gained many of the skills you need to accurately assign ICD-10 codes.

As a medical coder, you’ll use the ICD-10-CM (often called ICD-10 or I-10), to assign different codes depending on the circumstances surrounding the patient encounter. The patient encounter is the episode of care that takes place on one or more specific dates, when the physician evaluates the patient and provides treatment. During the encounter, the patient relates the symptoms or chief complaint that brought the patient to the office, clinic, or hospital. Based on the patient’s reported symptoms, as well as the results of any examinations, x-rays, laboratory reports, or specialist consul- tations, the physician will determine the most likely cause of the patient’s symptoms, or diagnosis. If the patient comes in complaining of coughing, sneezing, and congestion, the physician may ultimately determine that the patient has influenza. As a coder, you’d assign the diagnosis code for flu, along with codes that pertain to the service or treatment pro- vided in relation to the patient’s flu. Likewise, if the patient is

 

 

Lesson 1 11

seen because of difficulty walking due to a swollen ankle, an x-ray may reveal a fracture, in which case the physician’s diagnosis would be ankle fracture. The physician may also determine that the patient has more than one diagnosis, in addition to the one that brought him or her to the office. The physician may determine that in addition to the fractured ankle, the patient has several chronic conditions that require treatment. Examples of chronic conditions include hyperten- sion, diabetes mellitus, and any conditions that require ongoing treatment or monitoring and regularly prescribed medication. You’d assign diagnosis codes for the fractured ankle and the chronic conditions that require ongoing treatment.

As a medical coder, you’ll use the ICD-10-CM to look up the patient’s diagnosis (or diagnoses if there’s more than one). After you find the diagnosis, you’ll review the code descrip- tions, follow any additional instructions that are provided in the ICD-10-CM regarding code assignment, and then assign your code. You’ll then follow the same process to assign sub- sequent diagnosis codes. If you’re working as an inpatient coder, you’ll also use the ICD-10-CM to assign procedure codes for inpatient surgical procedures.

OBJECTIVES When you complete this lesson, you’ll be able to

ďż˝ Define the process of medical coding

ďż˝ Explain the tools used by medical coders

ďż˝ Outline the skills necessary for a successful career in medical coding

ďż˝ Summarize examples of medical coding certifications

ďż˝ Describe other careers in medical coding

ďż˝ Summarize the history of medical coding

ďż˝ Explain the process of general equivalence mapping

ďż˝ Summarize how to use ICD-10-CM

 

 

Medical Coding12

ďż˝ Explain the guidelines for the first-listed diagnosis

ďż˝ Explain the steps for accurate coding

ďż˝ Locate and assign codes in ICD-10-CM

ďż˝ Summarize key concepts of multiple coding, acute and chronic condition coding, and laterality coding

ASSIGNMENT 1 Read through the following material in your study guide. Then, read the Introduction in your textbook, Step-by-Step Medical Coding.

Introduction to Medical Coding Recent changes in healthcare have created a great demand for medical coders. An older population; advances in techno – logy; an increased demand for healthcare services; and an increase in the number of medical tests, treatments, and pro- cedures means that the number of people seeking healthcare services has increased. Additionally, the increased use of outpatient facilities means that the government is exerting greater control and becoming more involved with services provided to Medicare and Medicaid patients. These changes in healthcare have resulted in an increased demand for certi- fied medical coders.

Prominent healthcare organizations in the field of medical coding include the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Both of these organizations offer credentials in medical coding. Certifications offered by both organizations are nationally recognized and accepted by healthcare employ- ers worldwide. Most coders choose to sit for one of four certifications: the CPC-A, CPC, CCS, or CCS-P.

The CPC-A and the CPC are both offered by the AAPC. CPC (Certified Professional Coder) indicates that you’ve completed the necessary educational requirements and now have experi- ence in the field. In CPC-A, the A stands for apprentice. The CPC-A demonstrates that you’ve completed the necessary

 

 

Lesson 1 13

educational requirements for a career in coding, but haven’t yet obtained the required experience in reviewing, abstract- ing, interpreting, and correctly assigning codes. After you earn the required two years of full-time coding experience, the A is dropped from the credential and you become a CPC.

CCS and CCS-P are certifications offered by AHIMA. CCS (Certified Coding Specialist) demonstrates that you’ve gained proficiency in assigning codes to inpatient as well as outpatient medical records. CCS-P indicates that a coder is adept at coding medical records in the outpatient setting, such as in the physician’s office, emergency room, or clinic. Although many coders do, it isn’t necessary to earn more than one credential to demonstrate proficiency in a certain area of coding. At least one credential is needed to gain entry into the field of medical coding.

Success in medical coding means being able to convert medical terms into standardized numeric and alphanumeric codes for physician and hospital reimbursement. The rule of thumb for medical coding is: If it wasn’t documented, it wasn’t done.

While coders are primarily concerned with correct interpreta- tion of coding guidelines, accurate code assignment, and optimized reimbursement for physicians and hospitals, medical coding also involves ethical concerns. Medical coders must ensure that the codes they select accurately reflect what’s in the patient’s medical record. All diagnosis and procedure codes should be assigned based strictly on the content of the medical record.

Coders use standardized code sets to assign codes for diag- noses, procedures, drugs, medical devices, supplies, and equipment. (You’ll learn more about the code set used for drugs, medical devices, supplies, and equipment later in Medical Coding). Accurate and complete coding helps mini- mize turnaround in terms of medical claims processing, and as a result, it helps expedite reimbursement for physicians and hospitals. In addition to increasing the likelihood of faster claims turnaround, accurate and complete coding also minimizes the likelihood of fraud. Medical coders are required by law to assign codes based only on the documentation in the medical record. Assigning codes that aren’t supported by

 

 

Medical Coding14

the medical record to increase reimbursement constitutes fraud and can result in civil and criminal penalties for healthcare facilities.

Proficiency in medical coding means learning both how to determine the specific piece of data that requires a code assignment and the rules for assigning your codes.

Coders use two types of tools to assign codes: textbooks and encoders. Encoders are coding software programs that you can use to locate and assign diagnosis and procedure codes. However, when you test for a medical coding certification such as the CPC-A, you’ll be required to use your coding textbooks to assign codes. The textbooks that you’ll use in this course are

ďż˝ The International Classification of Diseases, 10th Revision, Clinical Modification (commonly referred to as ICD-10-CM)

ďż˝ The International Classification of Diseases, 10th Revision, Procedure Coding System (commonly referred to as ICD-10-PCS)

Being a Coder To be successful in medical coding, you must be

� Detail oriented. In medical coding, the old adage “little things mean a lot” is especially true. The descriptions for two codes may be identical except for one word. That one word may be the difference in choosing code A vs. code B. If you’re good at picking up on the little things, then you’ll enjoy coding.

� A detective. If you like being a sleuth and researching coding guidelines to understand how, when, and where you should assign a specific code, then you’ll like med- ical coding.

Note: As you proceed through your assigned reading, be sure to

complete the Quick Checks and Exercises, which will reinforce the

reading material.

 

 

Lesson 1 15

� A good storyteller. Much of coding involves reading the medical record and then painting a mental picture in your mind of what took place, as if you were right there in the doctor’s office or emergency room. If you can visualize what occurred based on what you read in the medical record, you’ll love medical coding.

� Analytical. If you’re good at analyzing pieces of infor- mation from different documents in the same record and finding contradictory information, then medical coding is a great career choice for you. Maybe you’re working on a medical chart for a patient who was admitted to the hospital. Dr. Brown’s report indicates that the patient has diabetes, which is well controlled on insulin, but Dr. Smith’s report indicates that the patient has diabetes, but it isn’t well controlled on insulin. These are two dif- ferent doctors saying two different things about the same patient’s diabetes, and hence, these two statements would translate into two different diabetes codes for the same admission. You would need to determine which statement is correct so that you can assign the right code.

In the previous example, you’d need to send a query to the hospital to determine whether the patient’s diabetes is con- trolled or out of control. You’d then assign your diabetes code based on the answer you receive from the hospital, and the answer would be placed in the patient’s medical record so that the record is kept up to date.

You develop each of these skills as you proceed through Medical Coding, as well as the courses that follow.

In addition to being able to accurately review and abstract clinical data from the medical record, good computer skills are essential to your success as a medical coder for several reasons.

1. If you work from home, you’ll need to set up a connec- tion to your employer’s office or the hospital client to which you’re assigned in order to access medical charts.

Your company’s IT department or the hospital’s technical support department will help you do this. You may need to access and navigate specific websites and download certain programs to sign in to the system and begin to

 

 

Medical Coding16

code your charts. The setup process should be relatively simple, but you’ll need to be able to follow the directions provided by the IT person to set up the website links on your computer and begin coding.

2. On a daily basis, you’ll log in to the website provided by your company, retrieve charts, open reports within each chart, and review the documents to locate your codes.

3. You’ll also need to go online to research medical or surgical terms that pertain to a specific diagnosis or pro- cedure. This is why it’s important to complete courses in medical terminology, anatomy, and physiology in addi- tion to your coursework in medical coding.

Once you start working as a coder, you’ll find that the oppor- tunities in coding are plentiful, from coding for doctors’ offices and hospitals to educating new coders. You’ll likely have more than one kind of coding position during your career. You might initially start working as a medical coder and later become a medical coding auditor, for example. A medical coding auditor reviews the charts coded by the med- ical coders, pinpoints errors, and provides feedback on making corrections. The auditor also provides references to supplemental coding documents to help coders improve their accuracy. You might become a medical coding supervisor, overseeing a team of medical coders and assigning accounts. Or, you may choose to specialize in one particular area of medical coding, such as cancer registry, where you review medical records and capture diagnoses for cancer patients, and obtain a medical coding certification in cancer registry.

Now that you’ve completed Assignment 1, it’s time to review the Introduction to Step-by-Step Coding. As you review the Introduction, you’ll learn more about the anticipated job growth in the medical coding field, as well as the salaries for credentialed medical coders, categorized by region, job responsibility, workplace, work setting, and job level.

 

 

Lesson 1 17

ASSIGNMENT 2 Read through the following material in your study guide. Then, read Chapter 2, pages 26–40, of your textbook, Step-by-Step Medical Coding.

History of ICD-10 Medical Coding In order to understand the history of ICD-10-CM in relation to medical coding, it’s necessary to understand how ICD-10 evolved and why it’s necessary for accurate coding.

The United States started using ICD-10 to report mortality in 1999, but didn’t fully adopt ICD-10 until October 1, 2015. However, the United Kingdom actually began using the ICD-10 in 1995, along with 200 other countries, that used all or part of ICD-10. The World Health Organization (WHO) still main- tains the ICD, although they stopped supporting the ICD-9 in 2012. The Centers for Medicare and Medicaid Services (CMS) along with the American Hospital Association (AHA) and the National Center for Health Statistics (NCHS) are responsible for maintaining the ICD-10-CM and ICD-10-PCS. ICD-10-PCS replaced ICD-9-CM Volume 3 as the component used to assign procedure codes for patients having surgery in the hospital. We’ll cover ICD-10-PCS later in this course.

ICD-10-CM was created for several reasons. First, ICD-9-CM had run out of room to expand. New diseases and new disor- ders are constantly being discovered, and the ICD-9-CM code set didn’t have room for any new codes. Since the ICD-9-CM code structure didn’t include sufficient detail about the patient’s condition, these codes needed to be revised for greater specificity and more comprehensive coverage of each element of the patient’s diagnosis.

ICD-10 is a new and improved version of the old ICD-9 code set. The ICD-10 is like a huge rubber band that can stretch to put more detail into each code, thereby eliminating the need for multiple codes while simultaneously improving specificity. The reason that more information can be packed into each ICD-10 code is because of its revised structure. ICD-10 incorporates common fourth- and fifth-character sub- classifications in one code. For example, a patient who is

 

 

Medical Coding18

diagnosed with abusing alcohol and also having mood disor- ders because of the alcohol abuse can now be assigned to one code in ICD-10, rather than two codes in ICD-9. Each ICD-10 code can accommodate six characters, and even expand to seven characters, whereas ICD-9 codes only con- tained four digits and could only expand to a maximum of five characters. In a case involving a patient with complications resulting from diabetes mellitus, for example, the coder would have had to assign two codes: one for the diabetes mellitus and one for the complication resulting from it. However, ICD-10 can expand to combine everything in one code.

Symptoms can be combined with the diagnosis in the same code. Injury codes can be expanded to include more details, such as whether the patient is being seen the first time for the injury, whether it’s a subsequent visit, or whether the visit is due to a sequel, an aftereffect of a disease or injury.

The structure of ICD-10-CM is similar to the structure of the old ICD-9-CM, but the new ICD-10 code set includes two additional chapters: one pertaining to diseases of the eye, and one pertaining to diseases of the ear. ICD-10 also adds infor- mation pertaining to ambulatory and managed care visits.

In summary, improvements offered with ICD-10-CM include

ďż˝ Adding information that pertains to ambulatory and managed care visits

ďż˝ Expanded codes pertaining to injury

ďż˝ Extensive injury code expansion to increase the speci- ficity of each code

ďż˝ Combining diagnoses and symptoms in one code, thereby reducing the number of codes required to report a condition

ďż˝ Adding a sixth character to the diagnosis code

ďż˝ Incorporating subclassifications of fourth and fifth characters

ďż˝ Updating codes for diabetes mellitus and making them more specific

ďż˝ Making code assignment more specific

 

 

Lesson 1 19

Unlike ICD-9-CM, the category codes in the ICD-10-CM begin with a letter. The following sample illustrates the structure of the ICD-10-CM system:

Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)

Chapter 2: Neoplasms (C00-D49)

Chapter 3: Diseases of the Blood and Blood-Forming Organs (D50-D89)

Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)

Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)

General Equivalence Mapping (GEM) You may wonder how to confirm whether you have the cor- rect ICD-10-CM equivalent code that matches the code that you would have chosen in the earlier ICD-9-CM code set. The general equivalence mapping (GEM) files were developed to help you map ICD-10 codes back to the old ICD-9 code set and vice-versa. General equivalence mapping is bidirectional, meaning that you can map the new ICD-10 codes back to the original ICD-9 codes, and map the original ICD-9 codes to the new ICD-10 codes.

Mapping ICD-9 codes to ICD-10 codes is called forward mapping. When you map ICD-10 codes back to their original ICD-9 codes, the process is called backward mapping. One thing to keep in mind: when you review the GEM files to determine the equivalent mapping codes, you’ll notice that the GEM files don’t include decimals. Remember this when you map your codes. You’ll have to mentally insert the deci- mal point so that you understand the code that you’re seeing in the GEM file. For example, in ICD-9-CM, the diagnosis code for salmonella meningitis was 003.21. When you locate this ICD-9-CM code in your GEM file, you’ll see 00321, with- out the decimal. The new equivalent ICD-10-CM code is A02.21. So the old ICD-9-CM code 003.21 maps directly to the new ICD-10-CM code, which is A02.21. This is an

 

 

Medical Coding20

example of forward mapping. If you found the ICD-10-CM code first, and then found the old ICD-9-CM code second, you would have done backward mapping.

There’s one GEM file for forward mapping and one GEM file for backward mapping. The GEM file for forward mapping has three columns in this order: ICD-9, ICD-10, and Flag. The GEM file for backward mapping also has three columns: ICD-10, ICD-9, and Flag. It all depends on the direction that you’re going in terms of mapping your codes.

Medical Coding By Sheila McCray

 
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