www.memphis.edu/hss/.../MS-ClinicalNutrition-MedicalTerm
www.memphis.edu/hss/.../MS-ClinicalNutrition-MedicalTerm
Shian Thorpe English Summary “Does IM Make U Dum?” By Martha Brockenbrough is about the use of abbreviations and grammar. The author says the use of emoticons, facial expressions and punctuation marks are good for having a conversation with your friends it helps you communicate quickly and clearer. She also says when it is not okay to use abbreviations. Like if you are writing something to someone you want to impress like a teacher or boss.…
The Current Procedural Terminology, or CPT for short, was first introduced by the American Medical Association (AMA) in 1966. And throughout the years there have been many updates, revisions, and subsequent editions. In 1983 CPT became part of the Healthcare Common Procedure Coding System or HCPCS to report Medicare Part B physician’s services. In 1986 Medicaid required HCPCS for reporting and by 1986 the Omnibus Budget Reconciliation Act required CPT codes for any outpatient hospital surgical procedures. In 1996 after the start of the Health Insurance Portability and Accountably Act (HIPAA), both CPT and HCPCS were named the procedural code sets for physician services, physical and occupational therapy services, radiological procedures, clinical…
| IT will develop a stop gap measure within the electronic medical record templates that prohibits the use of all unacceptable abbreviations.Staff transcribing orders will obtain clarification by the prescribing licensed practitioner if unacceptable abbreviations are used.Orders received by pharmacy that contain unacceptable abbreviations will not be filled until clarification is obtained.All nursing, pharmacy and medical staff will be educated on the process for clarification for any use of unacceptable abbreviations. The education will be noted in their HR file.20% of all discharged patient’s medical records will be audited on a monthly basis until 6 consecutive months of 100% compliance has been obtained.…
b. The instances of unacceptable abbreviations were reduced to 0.4% by the end of last calendar year, showing substantial decrease in use of most unacceptable abbreviations, with the exception of recording of abbreviation “u” in place of a word “unit”. The instances of using this particular abbreviation have increased from 17% to 63% in the course of a calendar year.…
1. Differentiate between the official coding guidelines for using V codes in an inpatient and outpatient setting.…
Please read the department's policy on medical notes on the COSC home page. Other reasons may…
6. An initial inpatient consultation with a detailed history, detailed exam, and MDM of low complexity would be coded to what E/M code?…
This noticeable feature, however, dates back centuries. Rebuses, or characters used to represent words, were being used in the 1600s, with the creation of IOU (I owe you). As discussed by David Crystal, there is no difference between S.W.A.L.K (sealed with a loving kiss), which was used in the war to shorten letters, and today's modern LOL (laughing out loud). Abbreviations have been created as a natural, intuitive response to what people have encountered in other…
• Abbreviations and symbols in the patient record are permitted only when approved according to hospital and medical staff bylaws, rules, and regulations.…
their medical history. An example being the letters EP. This abbreviation could mean either a…
The American Medical Association (AMA) is responsible for the Current Procedural Terminology (CPT) code. The CPT code is copyright protected by the AMA and describes medical, surgical, and diagnostic services as well as being designed to communicate with uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. Since the AMA is comprised of medical professionals there is a significance to the CPT code under their control. This give the medical professionals better control over the coding that is used within their field and provides a form of self-management. The AMA’s CPT process is updated by the association by…
Protocols and checklist have been shown to reduce patient harm through improved standardization and communication. Standardization is a process used with data analysis in the decreasing or prevention of errors, as well as…
This way nurses from nationally and internationally can share a common terminology to identify the specific problem or intervention implied and the outcome observed. The American Nurses Association has recognized 12 standardized nursing terminologies (Rutherford, 2008). As my chosen specialty is nurse practitioner, I would like to adopt SNOMED CT which provide comprehensive medical terminologies. SNOMED CT supports the development of high quality content in health records. It provides standardized clinical phrases, which can be used by the clinicians easily and permits automatic interpretation. As I am not aware of many of these terms and using this terminology allows me to record my clinical information at appropriate levels of detail using relevant clinical concepts. SNOMED CT provide guideline and decision support system to check the record and provide real time advice through clinical alerts. It allows to record the clinical information accurately during a consultation. SNOMED allows the easy sharing of patient care information among care providers. It removes the language barrier as SNOMED enables multilingual use. SNOMED enables early identification of emerging health issues, monitoring of population health and responses to changing clinical practices. Therefore SNOMED CT has a comprehensive clinical coverage and comprises a depth of detail appropriate to a range of health care disciplines and clinical…
DeYoung, J. L., VanderKooi, M. E., & Barletta, J. F. (2009). Effects of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. American Society of Health-System Pharmacists, 66, 1110-1115.…
What is jargon? Jargon is the specialized or technical language of a trade or profession. Perhaps there are not many people who clearly know when jargon first appeared. However, most people know that since it is used to serve people's needs, jargon has brought many advantages and disadvantages for people who use it in their jobs or their daily lives. In addition, today we can see that jargon is used in many fields in our society. Medical professionals, for example, use a great deal of jargon to explain about the illness to their medical students or their patients. According to Perri Kiass, the author of the essay "She's your basic L.O.L. in N.A.D.", medical jargon can be helpful but also harmful to the medical professional's work. Personally, I completely agree with her views. I believe that there will be gains and losses that results from understanding and using medical jargon.…