Medical Coding Basics Cardiology Part 3
Boyd: You have three questions around this:Won't you want to code the afib as a history because of the current issuesé Alicia: No. He says he doesn't have it andthere isn't a code for a history of afib, so we can't do that. Boyd: Next question: On your first case examplethat had hyperlipidemia listed in the problem list, it was not talked about in the bodyof the report, but he did order a lipid profile in the plan; so would it be wrong to codethat tooé Alicia: In the problem list, again, you'renot going to use the problem list; you can't
code off of the problem list. He is takingmedication, but he really doesn't address it anywhere else in there. He doesn't putit in the assessment, he does call for a lipid panel, you are correct. Now, if I was doingrisk adjustment, absolutely I'd pull that because it does carry an RxHCC, but it doesn'tcarry a standard HCC. Again, could youé Maybe, but no. I don't think so because he didn'tput in the diagnoses. Boyd: Next question: How did you know whatto code as DX 1st, 2nd, and thirdé Alicia: That's a really good question andthat gets to be really fun sometimes. With something like this where you have hyperplasia,hypertension and palpitations, none of this
actually probably would trump the other. Meaning,is one worse than the other or noté Hyperplasia, maybe, but in that case either of these couldbe the first listed diagnosis. These are all outpatient charts, you're not being reimbursedbased on the diagnosis, and there are no rules here, guidelines to tell you that you needto code one in front of the other. So, that's not going to matter for that one. For theother one, same thing. But some coders and some s, if it doesn't matter, thenthey'll start at the top of the body and go down. I've seen them do that.But usually the most severe gets coded first, that's a rule of practice. But who's tosay that their sleep apnea in this one is
a more severe condition than their very highcholesterol, maybe or something. But with these, absolutely, it does not matter. Now,if they have diabetes and hypertension and cholesterol, I'd put the diabetes firstbecause the diabetes tends to affect the overall body; so I would probably code that first.But usually you go from top to bottom or just in the order that the physician wrote themand let the guidelines indicate otherwise.
To Sleep Perchance to Dream Crash Course Psychology 9
Comedian Mike Birbiglia was having troublewith sleep. Though not with the actual sleeping part onenight, while staying in a hotel, he dreamed that a guided missile was on its way to hisbed, and in his dream, he jumped out the window to escape it. Unfortunately, he also did this not in hisdream. From the second floor. And the window wasnot open. This little episode cost him 33 stitches anda trip to a sleep specialist. Mike now sleeps in zippedup mummy bags forhis own safety.
The lesson hereé Sleep is not some break timewhen your brain, or your body, just goes dormant. Far from it. In truth, sleep is just anotherstate of consciousness. And only in the past few decades have we begun to really plumbits depths from why we sleep in the first place, to what goes on in our brains whenwe do, to what happens when we can't sleep. And there is a lot that science has to sayabout your dreams! Talk about weird! It's like Sigmund Freudmeets Neil Gaiman. So, even though it may seem like you'redead to the world, when you sleep, your perceptual window remains slightly open.
And kinda like Mike Birbiglia's hotel roomwindow, a trip through it can make for a pretty wild ride. But for your safety and enjoyment, I'm hereto guide you through this state of consciousness, where you'll learn more than a few thingsabout human mind, including your own. And here's hoping you won't need any stitcheswhen we're through. INTRO Technically speaking, sleep is a periodic,natural, reversible and near total loss of consciousness, meaning it's different thanhibernation, being in a coma, or in say, an
anesthetic oblivion. Although we spend about a third of our livessleeping, and we know that it's essential to our health and survival, there still isn'ta scientific consensus for why we do it. Part of it probably has to do with simplerecuperation, allowing our neurons and other cells to rest and repair themselves. Sleepalso supports growth, because that's when our pituitary glands release growth hormones,which is why babies sleep all the time. Plus, sleep has all kinds of benefits for mentalfunction, like improving memory, giving our brains time to process the events of the day,and boosting our creativity.
But even if we're not quite sure of allthe reasons why we sleep, technology has given us great insight into how we sleep. And for that we can thank little Armond Aserinsky.One night in early 1950s Chicago, eightyearold Armond was tucked into his bed by his father.But this night, instead of getting a kiss on the forehead, little Armond got some electrodestaped to his face. Armond's dad was Eugene Aserinsky, a gradstudent looking to test out a new electroencephalograph, or EEG machine, that measures the brain'selectrical activity. That night, as his son slept peacefully, hewatched the machine go bonkers with brain
wave patterns, and after making sure thathis machine wasn't somehow broken discovered that the brain doesn't just quot;power downquot;during sleep, as most scientists thought. Instead, he had discovered the sleep stagewe now call REM or rapid eye movement, a perplexing period when the sleeping brain is buzzingwith activity, even though the body is in a deep slumber. Aserinsky and his colleague Nathaniel Kleitmanwent on to become pioneers of sleep research. Since then, sleep specialists armed with similartechnology have shown that we experience four distinct stages of sleep, each defined byunique brainwave patterns.