Patient returns for follow up of her osteoporosis on anabolic therapy. She continues on TERIPARATIDE shots daily and will complete her two years of that in August of this year. She remains on VITAMIN D reduced to once a week 50,000 units. O: Vital signs are recorded. Despite the above, she seems to be in good spirits today. Moderate kyphotic posture of the thoracic spine noted. Lungs clear, cardiac exam regular rate and rhythm. Vitamin D level was over 40 last time, having been undetectable in March. A: Postmenopausal osteoporosis exacerbated by Vitamin D deficiency and suspected calcium malabsorption. Seems to be stable at this point in that regard. P: 1. CBC, comprehensive metabolic panel. May be able to back off further on her VITAMIN D. 2. When she returns next time in September will obtain DXA to compare with the one she had a year ago. 3. She will complete her two years of TERIPARATIDE injections in August. Select the diagnosis code(s).

The patient had hip replacement surgery three days ago. The provider documents the patient has had a “iatrogenic cerebrovascular infarction due to recent hip replacement surgery during her current hospital stay.” Assign the appropriate ICD-10-CM code for the cardiovascular event.

A client presents to the ED with acute abdominal pain, fever, nausea and vomiting. During the client’s examination, the lower left abdominal quadrant is palpated, causing the the client to report pain in the RLQ. This positive sign suggests the client may be experiencing which acute abdominal problem? 

Which of the following is FALSE regarding Atherosclerosis?

Name the part indicated by the Black arrow  

Which of the following elements would NOT be taken into consideration for risk adjustment?

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?

Sex: Female. Age: 69 years-old. Nurse Note: Patient presents today with wanting to get back on track. Also wants to go back on synthroid, also wants to lose weight, otherwise no other complaints. Subjective CC: Stopped meds, feels tired, gained 20 pounds in a year. HPI: above ROS: Constitution: Reports weight change, but denies chills, fatigue and fever, tired. Eyes: Denies visual disturbance. Cardiovascular: Denies chest pain and palpitations. Respiratory: Denies cough, dyspnea and wheezing. Gastrointestinal: Denies constipation, diarrhea, dyspepsia, dysphagia, hematochezia, melena, nausea and vomiting. Genitourinary: Denies dysuria, frequency, hematuria, incontinence, nocturia and urgency. Musculoskeletal: Denies arthralgia and myalgia. Skin: Denies rashes, no pain or bleed. Neuro: Denies neurologic symptoms. Psych: Denies symptoms other than stated above. Stress caring for others. Current Meds: None. Allergies: NKDA PMH: Mammogram: (5/2008). Pelvic/Pap Exam: (5/2008). Blood Test: (5/2007). Bone Density Test: never within 10 years. Dental: (4/2008). Eye Exam: (2/2007) Reviewed and updated. Family History: Father: Hypertension; MI. Mother: Hypertension. Reviewed and updated. Social History: Highest level of education completed is 12th grade. Marital status: Married. Lives with spouse and grandson. Household pets include fish. Personal Habits: Cigarette Use: None. Alcohol: Rare. Daily Caffeine: Consumes on average three cups of coffee per day. Reviewed and updated. Objective BP: 142/84 P: 68 T: 98.5 RR: 16 HT: 65″ 5’5″ WT: 2241b BMI: 37.3 LMP: HYSTERECTOMY Exam: Constitution: Appears overweight. No signs of apparent distress present. Neck: Palpation reveals no lymphadenopathy. No masses appreciated. Thyroid exhibits no thyromegaly. No JVD. Respiratory: Respiration rate is normal. No wheezing. Auscultate good airflow. Lungs are clear bilaterally. Cardiovascular: Rate is regular. Rhythm is regular. No heart murmur appreciated. Extremities: No clubbing, cyanosis or edema. Abdomen: Bowel sounds are normoactive. Palpation of the abdomen reveals no CVA tenderness. Muscle guarding, rebound tenderness or tenderness. No abdominal masses. No palpable hepatosplenomegaly. Skin: Skin is warm and dry. Assessment #1: Hypothyroidism Plan for #1: Lab: Comp Metabolic Panel I/P TSH (Ultra-Sensitive) Urinalysis Routine T4 Assessment #2: Obesity Plan for #2: Follow-up: Fasting labs then return one month to review and do annual GYN then. At that visit, will arrange biopsy face/temple lesion, order mammogram and she’s considering screen c scope.

Patient Name: JS Male. Physician: HO, MD Report Type: HOSPITAL CONSULTATION REPORT Admit Date: 4/26/XX. Discharge Date: 4/30/XX. DATE OF INPATIENT CONSULTATION: 4/27/XX. CHIEF COMPLAINT: Pulmonary emboli. HISTORY OF PRESENT ILLNESS: I am seeing this patient today in Consultation regarding the recurrent pulmonary emboli. The patient is a 42 year-old gentleman who has a history of recurrent pulmonary emboli. He had his first pulmonary emboli in 05/20XX. The patient was on Coumadin when he was involved in an accident on 10/01/XX. He sustained second-degree burns to more than 50 percent of his body. The patient was hospitalized for several months. He did not have any skin grafts. There was a question of him developing a heparin antibody during that admission. The patient has been on Coumadin for the past three months. Over the last several days, he has developed some pain behind his left knee and some chest discomfort. He brought himself to the emergency department where an ultrasound of his leg revealed a clot in the left thigh, a CT angiogram revealed bilateral pulmonary emboli. He has been given Coumadin 10 milligrams and Arixtra 7.5 milligrams SubQ daily. At this time, he is feeling well. He is not complaining of any leg pain or chest pain. He denies any hemoptysis. REVIEW OF SYSTEMS: Significant for the leg pain and chest discomfort. The further review of systems including the general, eyes, ears and throat, cardiac, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurological, hematological and emotional systems is otherwise negative, except for that stated above. ALLERGIES: The patient has a possible allergy to HEPARIN with a possible heparin antibody. MEDICATIONS: The patient is not on any medications at this time. PAST MEDICAL HISTORY: Significant only for his previous pulmonary emboli and his severe second-degree burn to more than 70 percent of his body. SURGICAL HISTORY: The patient has no prior surgical history. SOCIAL HISTORY: The patient is single, never married. He does not smoke tobacco or drink alcohol. He has his own consulting firm. FAMILY HISTORY: The patient states there is no family history of blood clots. PHYSICAL EXAMINATION: His BP is 133/68, pulse 89, respirations 16, temperature 96.5. The patient is a well-nourished, well-developed white male, in no acute distress, consistent with his stated age of 42. The HEENT examination reveals no oral lesions, no oropharyngeal lesions, no neck masses, no thyromegaly. Heart examination reveals a regular rate and rhythm without murmur or gallop. There are no palpable heaves or thrills. Chest examination is clear to auscultation. There are no wheezes or crackles heard. Abdominal examination reveals positive bowel sounds. The abdomen is soft and non-tender. There is no palpable hepatosplenomegaly, no palpable masses. Lymphatic examination reveals no cervical, axillary, inguinal or epi-trochlear lymph nodes palpable. Skin examination reveals the scars from his burns. There are no nodules or rashes seen. No nodules palpated. Neurologically, his deep tendon reflexes are plus 2/4 in the upper and lower extremities. Motor and sensory are intact. Extremity examination reveals full range of motion in the upper and lower extremities, without cyanosis or edema. The patient is alert and oriented times three and has a normal affect. PERTINENT LABORATORY VALUES: Include hemoglobin of 14.0, WBC of 7.7, platelets of 134,000. Sodium was 139, potassium 4.0, chloride 103, bicarb 29, BUN of 20, creatinine 1.12. The protime is 11.5 seconds and the activated partial thromboplastin time is 30 seconds. CT angiogram reveals bilateral pulmonary emboli. Doppler ultrasound reveals a clot in the left lower extremity. IMPRESSION: 1. Deep venous thrombosis with bilateral pulmonary emboli with a history of a previous pulmonary embolus in 05/2007. 2. Possible heparin antibodies while hospitalized. 3. History of second-degree burns. PLAN: 1 Arixtra 10 milligrams SubQ daily, especially given his possible history of heparin antibody. 2.The patient does require very large doses of Coumadin. He was on 17.5 milligrams alternating with 15 milligrams before he was removed from Coumadin. We will dose him at 17.5 milligrams today. 3. CBC and protime in the morning. 4. The patient will require lifelong anticoagulation as this is his second pulmonary emboli. I appreciate this opportunity to participate in this patient’s care. Please do not hesitate to contact me if you have any further question regarding my care of the patient. Select the diagnosis code(s).

Diagnoses must be based on face-to face encounters between members and an MD, PA, or NP and status conditions like a below knee amputation, must be assessed and documented in order for payment adjustments to be received. How often should a provider see and assess a patient in a calendar year to validate amputation status?