Please answer all questions CORRECTLY, and return back to me.

1.   A 38-year-old patient is admitted to the hospital due to a lesion in her right breast, and a painful lump and nipple discharge from the left breast. The physician places a percutaneous needle localization device in the right breast under ultrasound guidance, excises the right breast lesion, and then excises the lactiferous duct fistula in the left breast. What CPT codes should be assigned? SENSORY ADVANCED CODING

   A. 19129-RT, 19284-RT, 19122-LT   B. 19125-RT, 19285-RT, 19112-LT   C. 19127-RT, 19283-RT, 19132-LT   D. 19122-RT, 19275-RT, 19142-LT
 

2.   A 92-year-old female patient experiences difficulty hearing in her left ear. She is prescribed a BICROS hearing aid that she can wear behind the ear. What HCPCS code is assigned?

   A. V5250   B. V5320   C. V5220   D. V5240 

3.   A 57-year-old patient is admitted to the hospital for a hip arthroscopy procedure. The patient is a normal healthy patient with no systemic disease. What CPT code should be assigned?

   A. 01612-P1   B. 01402-P1   C. 01202-P1   D. 01312-P1 

4.   An 80-year-old patient is admitted to the hospital with congestive heart failure. What ICD-10-CM code should be assigned?

   A. K15.0   B. L50.5   C. K52.9   D. I50.9 

5.   A 44-year-old female patient comes to the hospital for removal of a 4 cm malignant lesion from the arm. During the course of the procedure, the patient undergoes a 14 sq. cm adjacent tissue transfer from the right leg, as well as a 20 sq. cm split-thickness skin graft from the left arm. What CPT codes are assigned?

   A. 14021, 15100-51   B. 14045, 15400   C. 14032, 15207   D. 14044, 15350 

6.   A patient has a breast localization device placed through the skin using stereotactic guidance in order to treat two lesions. What codes would be assigned? SENSORY ADVANCED CODING

   A. 19285, 19286   B. 19287, 19288   C. 19283, 19284   D. 19296, 19297 

7.   A 19-year-old patient is diagnosed with acne vulgaris. The physician performs laser dermabrasion of the facial skin. What codes are assigned?

   A. L50.5, 0HB1XZZ   B. L70.0, 0HD1XZZ   C. L70.5, 0HA1XZZ   D. L70.6, 0HQ1XZZ 

8.   Implantation of a patient-activated cardiac event recorder is assigned to code

   A. 33286.   B. 33282.   C. 33285.   D. 33284. 

9.   A 27-year-old patient is diagnosed with a chalazion on the upper left eyelid, which is excised using an external approach. What ICD-10 diagnosis and procedure codes are assigned?

   A. H04.16, 08BQXZZ   B. H02.14, 08BTXZZ   C. H00.14, 08BPXZZ   D. H07.19, 08BRXZZ 

10.   A 77-year-old patient is diagnosed with an ear infection. She receives an injection of 40 mg of gentamicin sulfate. What HCPCS code should be assigned?

   A. J1452   B. J1472   C. J1675   D. J1580 

11.   A patient undergoes a transcanal labyrinthectomy. What code would be assigned?

   A. 69930   B. 69915   C. 69955   D. 69905 

12.   A 92-year-old patient is diagnosed with senile cataracts and bilateral sensorineural hearing loss. The physician performs a bilateral cataract extraction. What ICD-10 codes are reported?

   A. H27.9, H90.3, 08KJ3ZZ, 08MK3ZZ   B. H26.9, H90.3, 08EJ3ZZ, 08LK3ZZ   C. H25.9, H90.3, 08DJ3ZZ, 08DK3ZZ   D. H21.9, H90.3, 08PJ3ZZ, 08NK3ZZ 

13.   Mr. Oliver is an elderly gentleman who has been having problems with his vision for the previous three weeks. He is diagnosed with keratoconus, as well as hypertension with stage III chronic kidney disease, and diabetes mellitus, for which he takes long-term insulin. The anesthesiologist provided general anesthesia for this patient with severe systemic disease. After the administration of anesthesia, the surgeon performs an endothelial keratoplasty. Prior to performing the endothelial keratoplasty, the surgeon performs backbench preparation of the allograft. Code this scenario (including the anesthesiology service).

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   A. 65756, 65757, 00144-P3; H18.609, E11.65, R46.89, Z79.4   B. 65754, 65727, 00134-P1; H18.609, E11.40, I12.9, N18.4, Z79.899   C. 65756, 65757, 00144-P3; H18.609, E11.9, I12.9, N18.3, Z79.4   D. 65757, 65787, 00142-P2; H18.229, E11.51, I12.0, N18.9 

14.   A 47-year-old female patient is seen for a worrisome lesion on the back of her hand. What ICD-10-CM code should be assigned?

   A. L94.9   B. L98.9   C. L91.5   D. L97.4 

15.   Breast reconstruction with transverse rectus with a TRAM flap would be assigned to code

   A. 19370.   B. 19342.   C. 19369.   D. 19316. 

16.   Ms. Nelson comes to the emergency room due to sustaining multiple lacerations after being pushed into a glass door during a physical altercation with her husband at a hotel. She sustained a 5 cm laceration on her right hand and a 7 cm cut on her neck. She also has a 5.0 benign lesion removed from her left arm. The physician performs a simple repair on the lacerations on her hand and neck. Code this scenario.

   A. 11443, 12008-59; S61.209A, S31.652A, Y04.0XXA, W45.8XXA, V97.29XA   B. 11422, 12007-59; S51.809A, S61.351A, W86.8XXA, Y04.0XXA   C. 11409, 12005-59; S58.119A, S11.22XA, X19.XXXA, V95.13XA   D. 11406, 12004-59; S61.401A, S11.90XA, Y04.0XXA, W45.8XXA, Y92.29 

17.   Biopsy of the lacrimal gland is assigned to code

   A. 68520.   B. 68811.   C. 68815.   D. 68510. 

18.   A patient comes to the emergency room complaining of lightheadedness and difficulty hearing. The physician examines her and determines that she has Ménière’s disease. The physician performs an endolymphatic sac decompression (excision of the right inner ear using an open approach). What ICD-10 diagnosis and procedure codes are assigned? SENSORY ADVANCED CODING

   A. H81.03, 09BF0ZZ   B. H83.03, 09BK0ZZ   C. H81.03, 09BD0ZZ   D. H82.03, 09BG0ZZ 

19.   A physician performs a biopsy of the cornea. What code should be assigned?

   A. 65420   B. 65410   C. 65419   D. 65415 

20.   Injection of contrast medium for dacryocystography is assigned to code

   A. 68853.   B. 68854.   C. 68850.   D. 68851.

ANALYSIS AND EVALUATION OF ORGANIZATIONAL PERFORMANCE

Review the performance dashboard for a health care organization, as well as relevant local, state, and federal laws and policies. Then, write a report for senior leaders in the organization that communicates your analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement.

Maintaining standards and promoting quality in modern health care are crucial, not only for the care of patients, but also for the continuing success and financial viability of health care organizations.

In the era of health care reform, health care leaders must understand what quality care entails and how quality in health care connects to the standards set by relevant federal, state, and local laws and policies.

An understanding of relevant benchmarks that result from these laws and policies, and how they relate to quality care and regulatory standards, is also vitally important. ANALYSIS AND EVALUATION OF ORGANIZATIONAL PERFORMANCE

· Health care is a dynamic, complex, and heavily regulated industry. For this reason, you will be expected to constantly scan the external environment for emerging laws, new regulations, and changing industry standards.

You may discover that as new policies are enacted into law, ambiguity in interpretation of various facets of the law may occur. Sometimes, new laws conflict with preexisting laws and regulations, or unexpected implementation issues arise, which may warrant further clarification from lawmakers.

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Adding partisan politics and social media to the mix can further complicate understanding of the process and buy-in from stakeholders.

How many health care laws can you name that affect your practice in your current or future workplace?

How do they impact your daily work?

How many regulatory agencies oversee the types of services your health care organization provides?

Which regulatory agencies apply to your workplace setting?

Are you familiar with the process of complying with those agencies in order to maintain certification?

You might be overwhelmed as you consider these broad questions.

· As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. ANALYSIS AND EVALUATION OF ORGANIZATIONAL PERFORMANCE

You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend or family member, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

What local, state, or federal health care policies or laws set benchmarks and standards reflected in performance dashboards common in your professional area of practice?

· What are the potential challenges or opportunities for health care organizations or interprofessional teams in meeting prescribed performance benchmarks and standards? Factors you might consider include the organization’s mission, its size and resources, operational policies and procedures, and the population the organization serves. 

· Preparation

For this assessment, you may choose one of the following three options for a performance dashboard to use as the basis for your benchmark evaluation.

Option 1: Dashboard and Health Care Benchmark Evaluation Simulation

If you decide to use one of the simulation dashboards for your evaluation, review both dashboards, as well as the relevant local, state, and federal laws and policies linked in each dashboard. Choose one of the dashboards and consider the metrics within it  that are falling short of the prescribed benchmarks.

Option 2: Actual Dashboard From a Professional Practice Setting

If you choose an actual dashboard from a professional practice setting for your evaluation, be sure to add a brief description of the organization and setting that includes:

· The size of the facility that the dashboard is reporting on.

· The specific type of care delivery.

· The population diversity and ethnicity demographics.

· The socioeconomic level of the population served by the organization.

Note: Ensure that your data is Health Insurance Portability and Accountability Act (HIPAA) compliant. Do not use any easily identifiable organization or patient information.

Option 3: Hypothetical Dashboard Based on a Professional Practice Setting

If you have a sophisticated understanding of dashboards that are relevant to your own practice, you may also construct a hypothetical dashboard for your evaluation, based on that setting.

Your hypothetical dashboard must present at least four different metrics, at least two of which must be under-performing the relevant benchmark set forth by a federal, state, or local laws or policies. In addition, be sure to add a brief description of the organization and setting that includes:

· The size of the facility that the dashboard is reporting on.

· The specific type of care delivery.

· The population diversity and ethnicity demographics.

· The socioeconomic level of the population served by the organization.

Note: Ensure that your data is HIPAA compliant. Do not use any easily identifiable organization or patient information. ANALYSIS AND EVALUATION OF ORGANIZATIONAL PERFORMANCE

Report Requirements

Structure your report in such a way that it would be easy for a colleague or supervisor to locate the information they need. Be sure to cite relevant local, state, or federal health care laws or policies when evaluating metric performance against prescribed benchmarks.

Cite an additional 2–4 credible sources to support your analysis and evaluation of the challenges in meeting the benchmarks, the potential for performance improvement, and your advocacy for ethical action.

Note: The tasks outlined below correspond to grading criteria in the scoring guide.

In your report, be sure to:

· Evaluate dashboard metrics against the benchmarks set by local, state, or federal health care laws or policies.

9. Which metrics are below the mandated benchmarks in the organization? Evaluate weaknesses within the entire set of benchmarks.

9. What are the local, state, or federal health care laws or policies that set these benchmarks?

. Analyze challenges that meeting prescribed benchmarks can pose for the organization or for an interprofessional team.

10. What are the specific challenges or opportunities that the organization or interprofessional team might have in meeting the benchmarks? For example, consider:

1. The strategic direction of the organization.

1. The organization’s mission.

1. Available resources:

3. Staffing.

3. Operational and capital funding.

3. Physical space.

3. Support services (any ancillary department that supports a specific care unit in the organization, such as a pharmacy, cleaning services, and dietary services).

1. Cultural diversity in the organization.

1. Cultural diversity in the community.

1. Organizational processes and procedures.

10. How might these challenges be contributing to benchmark underperformance?

. Evaluate a benchmark underperformance in the organization or interprofessional team that has the potential for greatly improving overall quality or performance.

11. Which metric is underperforming its benchmark by the greatest degree?

11. Which benchmark underperformance is the most widespread throughout the organization or interprofessional team?

11. Which benchmark affects the greatest number of patients?

11. Which benchmark affects the greatest number of staff?

11. How does this underperformance affect the community the organization serves?

11. Where is the greatest opportunity for improvement in the overall quality or performance of the organization or interpersonal team—and ultimately in patient outcomes?

. Advocate for ethical action in addressing the benchmark underperformance that has the potential for greatly improving overall quality or performance. ANALYSIS AND EVALUATION OF ORGANIZATIONAL PERFORMANCE

12. At which group of stakeholders should your advocacy be directed? Which group could be expected to take the appropriate action to improve the benchmark metric?

12. What are some ethical actions that the stakeholder group could take that support improved benchmark performance?

12. Why should the stakeholder group take action?

. Communicate your findings and recommendations in a professional and effective manner.

13. Ensure that your report is well organized and easy to read.

13. Write clearly and logically, using correct grammar, punctuation, and mechanics.

. Integrate relevant sources to support your arguments, correctly formatting source citations and references using current APA style.

14. Did you cite relevant local, state, or federal health care laws or policies when discussing the mandated benchmarks?

14. Did you cite an additional 2–4 credible sources to support your analysis, evaluation, and advocacy?

The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering.

It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches. Depressive Disorders

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder.

You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

                                               “Captain of the Ship” – Depressive Disorder

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners.

To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population.

The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role. Depressive Disorders

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.

                                              Learning Objectives

Students will:

· Recommend psychopharmacologic treatments based on therapeutic endpoints 

  for clients with depression disorders

· Recommend psychotherapy based on therapeutic endpoints for clients with 

  depression disorders

· Identify medical management needs for clients with depression disorders

· Identify community support resources for clients with depression disorders

· Recommend follow-up plans for clients with depression disorders

                                                        Assignment (Project)

To prepare for this Assignment:

• Select an adult or older adult client with a depressive disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

• Describe the HPI and clinical impression for the client. Recommend psychopharmacologic  treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.) Depressive Disorders
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for      your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. Recommend a plan for follow-up intensity and frequency and collaboration with other providers including PCP or medical provider

                                                               Tip for the Assignment

This week assignment, you will ‘captain the ship’ you are the provider and writing the diagnostic work-up and treatment plan for a patient with DEPRESSIVE DISORDER. You will develop plans for a patient that you have worked with in your practicum. 

A few comments about the ‘Captain of the Ship’ assignment. The spirit of the assignment is that you are directing the client’s care, not simply writing a paper about depressive disorder.

When you are the team leader, it’s important to provide authoritative direction for other providers. In your treatment plan, it’s good to outline your collaboration with client’s other providers. Later in the quarter, you will have another opportunity to complete ‘Captain of the Ship’ project.

I have attached an excellent example of a different Captain of the Ship project with this assignment and. Note that this assignment is on depressive disorder, not on Obsessive Compulsive.

 

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                                                              Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 8, “Mood Disorders” (pp. 347–386)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

• Chapter 12, “Psychotherapy of Mood Disorders”
• Chapter 14, “Pharmacological and Somatic Treatments for      Major Depressive Disorder”

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Depressive Disorders”

o Major Depressive Disorder

o Persistent Depressive Disorder (dysthymia)

o Premenstrual Dysphoric Disorder

o Substance/Medication-Induced Depressive Disorder

o Depressive Disorder Due to Another Medical Condition

o Other Specified Depressive Disorder

o Unspecified Depressive Disorder

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Grieve, S. M., Korgaonkar, M. S., Koslow, S. H., Gordon, E., Williams, L. M. (2013). Widespread reductions in gray matter volume in depression. NeuroImage: Clinical, 3, 332-339. doi:10.1016/j.nicl.2013.08.016

Lach, H. W., Chang, Y-P., & Edwards, D. (2010). Can older adults with dementia accurately report depression using brief forms? Reliability and validity of the Geriatric Depression Scale. Journal of Gerontological Nursing, 36(5), 30–37. doi:10.3928/00989134-20100303-01

Steffens, D. C., McQuoid, D. R., & Potter, G. G. (2014). Amnestic mild cognitive impairment and incident dementia and Alzheimer’s disease in geriatric depression. International Psychogeriatrics, 26(12), 2029–2036. doi:10.1017/S1041610214001446

Drug Enforcement Administration. (n.d.). Drug schedules. Retrieved June 14, 2016, from https://www.dea.gov/druginfo/ds.shtml  Depressive Disorders

                                                            Required Media

Hagen, B. (Producer). (n.d.-b). Managing depression [Video file]. Mill Valley, CA: Psychotherapy.net.

                                                        Optional Resources

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

• Chapter 15, “Brain Stimulation Treatments for Mood      Disorders”

Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. doi:10.1037/neu0000319

Anderson, N. D., Damianakis, T., Kröger, E., Wagner, L. M., Dawson, D. R., Binns, M. A., . . . Cook, S. L. (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140(6), 1505–1533. doi:10.1037/a0037610

Inoue, J., Hoshino, R., Nojima, H., Ishida, W., & Okamoto, N. (2016). Additional donepezil treatment for patients with geriatric depression who exhibit cognitive deficit during treatment for depression. Psychogeriatrics, 16(1), 54–61. doi:10.1111/psyg.12121

Sachs-Ericsson, N., Corsentino, E., Moxley, J., Hames, J. L., Rushing, N. C., Sawyer, K., . . . Steffens, D. C. (2013). A longitudinal study of differences in late- and early-onset geriatric depression: Depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging & Mental Health, 17(1), 1–11. doi:10.1080/13607863.2012.717253

Shallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N., Palfrey, A., Ford, B. Q., . . . Mauss, I. B. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964–975. doi:10.1037/ccp0000050

Wanklyn, S. G., Pukay-Martin, N. D., Belus, J. M., St. Cyr, K., Girard, T. A., & Monson, C. M. (2016). Trauma types as differential predictors of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and their comorbidity. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 48(4), 296–305. doi:10.1037/cbs0000056 Depressive Disorders

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