Exam 8 Medicine, Anesthesia and EM Paper Version

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University of Kansas *

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1000

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Medicine

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Dec 6, 2023

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51 Points 1. The antibiotic CR Bicillin was administered intramuscularly (injection). (This is not an immunization/vaccination). The code will come from code range 96360-96379 2. Electroconvulsive therapy. 3. Colon motility study of 7 hours with recordings and interpretation and report. 4. Fluorescein angiography with interpretation and report. 5. A 12-year-old presented for a diagnostic analysis of his cochlear implant including programming. 6. The patient had a catheter inserted into the arterial system from the femoral artery and then into the left ventricle for a left ventriculography. Report only the physician portion of the service. (think which modifier will be needed) 7. Moderate (conscious) sedation performed by the same physician that performs the surgery on a 10-year-old patient, initial 15 minutes 8. A bronchodilation responsiveness spirometry was done before and after an aerosol bronchodilator was administered. 9. Electroencephalogram recording for a patient in a coma. 10. Neurofunctional testing during brain mapping, by physician with test review. 11. This patient is diagnosed with psoriasis and presents to the clinic for laser treatment to 375 sq. cm. pg. 1 EXAM 8 MEDICINE, ANESTHESIA AND E&M
12. Postoperative follow-up visit 4 weeks after a surgery that has a 90-day global period. 13. Home visit for stoma care and maintenance of a patient’s colostomy. 14. Transcranial Doppler study of the intracranial arteries, limited study. 15. The patient presents for a serial tonometry with multiple measurements of intraocular pressure over an extended time period, same day, with interpretation and report. 16. ESRD-related services per day for one encounter (less than a month), for a patient who is 17 years old. 17. Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision, corneal lens for aphakia, both eyes. 18. Hearing test using pure tone audiometry; air only. 19. Electrocardiogram with 15 leads including the interpretation and report. 20. Pulmonary stress test. 21. Hot packs applied to two areas . 22. Catheter placement into the coronary arteries for coronary angiography with injections, imaging, supervisions, and interpretation. 23. Audiologic function screening test for pure tone, air only. pg. 2 EXAM 8 MEDICINE, ANESTHESIA AND E&M
24. Therapeutic IV infusion under the direct supervision of the physician of 45 minutes’ duration. 25. Total body plethysmography for determination of lung volumes. 26. Biofeedback training for urethral sphincter 27. Anesthesia for diagnostic arthroscopic procedure of the knee joint. 28. Anesthesia for bilateral vasectomy. 29. Anesthesia for tracheobronchial reconstruction. 30. Anesthesia for burr holes. 31. Anesthesia for radical hysterectomy. 32. Daily hospital management of epidural, continuous drug administration. 33. Anesthesia for debridement of third-degree burns of right arm, 6% body surface area. 34. Anesthesia for percutaneous liver biopsy. 35. Anesthesia for total hip replacement, open procedure. 36. Anesthesia for repair of cleft palate. 37. Anesthesia for Strayer procedure. 38. Anesthesia for a biopsy of the clavicle. 39. An established patient is one who has received professional service from the physician or another physician of the exact same specialty and subspecialty in the same group within the past ____________________ years. 40. A new patient presents to the physician’s office at which time the physician provides a high complexity MDM and 60 minutes are spent with the patient. pg. 3 EXAM 8 MEDICINE, ANESTHESIA AND E&M
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41. Online visit for an established patient, 10 minutes 42. A 40-year-old established patient presents to the physician office for a preventive care exam. 43. History and exam of the normal newborn infant born in a hospital setting. 44. A 7-year-old female presents to the Emergency Room complaining of ear pain x 3 days. A detailed history is then taken. She had associated fever of 101 F yesterday. Mom treated her with Tylenol. The fever this AM is 99 F. She has had some chills and cough as well as some difficulty breathing. No nausea or vomiting. No prior history of Otitis. Brother was sick earlier this week. The physician performed a detailed exam. The physician diagnosed the patient with Otitis Media and an Upper Respiratory Infection and prescribed an antibiotic. The MDM is stated to be moderate. 45. CC: Patient presents for a physical SUBJECTIVE: Sally is a new 42-year-old female patient who presents today for a routine physical examination OBJECTIVE: BP 120/80. Pelvic exam: normal external genitalia. Vagina without discharge except for a scant amount of white discharge that appears normal. Cervix: Multiparous, clear. Bimanual exam is unremarkable. All systems are within normal limits. ASSESSMENT: 1. Normal BP. 2. Normal pelvic exam. PLAN: Return in 1 year or as needed. 46. CC: Dizziness SUBJECTIVE: This 46-year-old female established patient has a Home Visit today reporting feeling ill yesterday, and she has developed some dizziness. She feels like things stick in her throat and that her throat is “sticky.” She has a past history of hypothyroidism and taking Synthroid 0.125 mg q day. Her last TSH was last year and the level appeared to be normal at 0.49. pg. 4 EXAM 8 MEDICINE, ANESTHESIA AND E&M
OBJECTIVE: The patient appears to be in good health and in good spirits. Her BP is 120/81. Afebrile. HEENT normal. Neck is supple. No palpable masses are noted. No thyromegaly, tenderness, or nodes. TSA is elevated at 9.9. ASSESSMENT: Hypothyroidism (MDM was low). PLAN: Increase Synthroid to 0.15 mg q day. Recheck in 2 months. 47. CC: This established patient presents to the office today with complaints of rectal bleeding and itching of 2 weeks’ duration. OBJECTIVE: This is a 50-year-old male in apparent good health. His BP is 119/78. Rectal examination showed a Grade I hemorrhoid in the 2 o’clock position approximately 2 cm across. The area around the hemorrhoid was slightly inflamed and a small amount of blood was noted. ASSESSMENT: Hemorrhoid. PLAN: Discussed conservative treatment options with the patient and explained surgical option. He wants to try the more conservative approach of stool softeners, warm and sitz baths. I discussed with him the importance of improved bowel habits. He is to return for a recheck in 2 months. The medical decision making was of straightforward complexity. 19 minutes were spent with the patient. 48. What are the 3 key components for Non-Office Visit E&M (using the 1995/1997 guidelines)? (3 points) List them in the order they appear on the audit tool. pg. 5 EXAM 8 MEDICINE, ANESTHESIA AND E&M