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NRP555 Adult And Geriatric Management I

Week 2 Assignment

APRNs: Navigating Third-Party Payor Rules Case Study

On January 1, 2021, significant Evaluation and Management (E/M) Codes went into effect that affect providers working in the outpatient setting. The AMA was instrumental in making these revisions that put “patients over paperwork” with the goal of removing obstacles preventing providers from spending quality time with patients.

Prior to these changes, clinicians spent valuable time away from the patient tabulating elements of the history and physical exam to justify the level of service.

 The process has been simplified allowing clinicians to bill based on either Medical Decision Making (MDM) or Time. Reimbursement also increased for many E/M codes.

 As the FNP in the practice, your office manager has tasked you to present a synopsis of the 2021 billing changes at the next practice meeting. She has requested you create an 8- to 10-slide Microsoft® PowerPoint® presentation, including introduction and references slides (8 to 10 references), as well as detailed speaker notes outlining the key points for billing using MDM and Time in the clinic practice setting. Include the following:

Explain the criteria that differentiates a new patient from an established patient.

Explain the clinician rationale in the decision to choose either MDM or Time as the E/M codes to identify a level of service.

Identify specific activities allowed when using Time as the E/M code.

List the 3 elements considered when using the MDM.

List the 4 types of MDM that are recognized, including the E/M numerical code.

Describe in 1 sentence an example of a patient encounter that reflects each level of MDM.

Extract the element(s) of the MDM criteria that reinforce the example.

Watch the introductory video before you begin.

 Refer to CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes for guidance during this assignment.

Submit your assignment.


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NRP555 Adult And Geriatric Management I

Week 3 Assignment

Evidence-Based Practice Case Study Episodic SOAP Note: Lauren Mesa Pt. 1

This week focused on current treatment strategies for common eyes, ears, nose, and throat disorders, including medications and nonpharmacological management.

Now it’s time to synthesize the subjective and objective information obtained in the visit to formulate differential diagnoses and a final diagnosis.

See the SOAP note template on Lauren Mesa.

Week 3 Case Study Lauren Mesa SOAP Note Template

Review the pertinent subjective and objective findings for Ms. Mesa and synthesize the data to formulate a comprehensive list of 3 differential diagnoses. Include your rationale for ruling each differential in or out and justify your clinical decision-making by citing and referencing evidence-based resources. Conclude the assignment with your final diagnosis and ICD 10 code.

Cite your references according to APA guidelines. Attach the references page to your SOAP Note.


NRP555 Adult And Geriatric Management I

Week 5 Assignment

i-Human Patients®: Wanda Pence Part 2

Access i-Human Patients® through the access link near the top of the main course content page.

This case study asks you to consider how best to collaborate with other professionals and specialists to optimize the treatment plan for the patient.

First, watch the Wk 5 – Video in this week’s Learning Activities folder. Then, read the case study below.

Case Study — Wanda Pence

A patient, Wanda Pence, presented with recurrent chest pain with changing frequency and pattern with dx unstable angina.

Ms. Pence was admitted for cardiac catheterization, which revealed a 95% mid-right coronary lesion, a 45% occlusion of the proximal left anterior descending coronary artery, and a 20% occlusion of the left circumflex. A drug-eluting stent was placed in the right coronary artery to relieve the obstruction, resulting in nearly normal blood flow. Clopidogrel was added to her admission regimen, and her statin dose was increased to further decrease her serum LDL level. She was discharged within 48 hours and has a f/u appointment with her cardiologist in 2 weeks.

Ms. Pence is seeing you, the FNP in the primary care clinic, one week after her hospital discharge. She informs you she just got laid off from her job, lost her health insurance, and is very anxious about her ability to f/u with the cardiologist. She verbalizes that she will buy the baby aspirin 81mg daily over the counter but will stop the other meds (atorvastatin 40mg daily, metoprolol ER 25mg daily, and clopidogrel 75mg daily) until she can get find another job with insurance. As the FNP, you know that Ms. Pence’s intention to stop her medications is not a safe option with her recent stent placement.

Write a 750- to 1,000- word reflection regarding your patient encounter with Wanda Pence in which you:

Formulate a final diagnosis(es) and ICD-10 from the information provided in the scenario taking into consideration her medical and social determinants of health issues. Provide a rationale for the inclusion of each diagnosis.

Discuss best practices for Mrs. Pence to continue her medications after her drug-eluting stent placement based on a current evidence-based practice journal article.

Outline a detailed collaboration plan, including the identification of resources (such as sliding scale clinics and pharmacological discounts), for uninsured patients within your community that will help Ms. Pence continue her medications.


NRP555 Adult And Geriatric Management I

Week 7 Assignment

i-Human Patients: Calvin Rayes

Access i-Human Patients® through the access link near the top of the main course content page.

i-Human Patient: Calvin Rayes

Reflect on your i-Human patient, Calvin Rayes, a 65-year-old male who presented to urgent care with progressive symptoms with polyuria, polydipsia, and polyphagia, leading to a new diagnosis of Type 2 diabetes.

Gather the labs along with the pertinent subjective and objective findings for Mr. Rayes and synthesize the data in the form of a detailed assessment and treatment plan.

Use the SOAP template, which only includes the Assessment and Treatment portions for this assignment. You must include differential diagnoses with your rationale for ruling each in or out your final diagnosis(es) and your comprehensive treatment plan. Ensure your treatment plan includes medications, referrals, patient education, and follow-up plan as appropriate.

Justify your clinical decision-making by citing and referencing evidence-based resources.

Access the most current ADA guidelines to assist with your treatment plan.

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