Doctors Hospital Family Practice
Practice Management Curriculum:
END OF COURSE ASSESSMENT ( Use course material for reference)
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(Case and questions)
67 y/o male with a history of diet controlled HTN and osteoarthritis and has a Medicare
Advantage plan insurance, presents to the office for a Medicare Wellness exam. It has been
350 days since his first on. He (according to the Geriatric Depression Scale) is not depressed,
has normal hearing, can function independently at home (does all the DLs), is not at risk for
falls, and does not have memory impairment. He also had advanced directives in place and
defers, any counseling for nutrition at this time. At the same visit – he reports that he has
some left knee pain after helping his family load into a boat this past weekend. There was
some twisting and a pop in the knee. There is swelling and catching of the knee. He is using
Tylenol for relief. Walking and kneeling are difficult. He has no family history of OA and he has
not had surgery to the knee. Your nurse has collected 4 vital signs. Your exam reveals normal
ENT, neck heart, lung, abdomen, rectal and extremity exams. The knee reveals effusion, no
ligamentous laxity, but positive McMurray’s testing. For the knee pain you suggest RICE
treatment, order a diagnostic test, given counseling and home exercises.
1. Should you do the Medicare Wellness today?
2. What is required for the Medicare Wellness (hint: remember the mnemonic)?
3. What is the ICD-9 code for Medicare Wellness?
4. What counseling should be offered for the Wellness exam?
5. What is the difference between “Welcome to Medicare Wellness Exam”, Initial
Medicare Wellness Exam”, and “Follow-up Medicare Wellness Exam”?
6. What modifier do you use if an EKG is performed at this visit?
7. To screen for colon cancer- what ICD-9 code do you use for the fecal occult blood?
8. To screen for diabetes, what IDC-9 code would you use?
9. Can you bill for the knee pain evaluation and management at the same time as the
Medicare Wellness?
10.What E/M level visit would you code for the knee pain?
11.How many HPI elements are needed for a 99214 office visit?
12.If the patient injured the knee at work, what initial form would need to be submitted
to initiate the claim?
a. Would the Medicare Wellness be the appropriate place to discuss the injury for a
BWC claim?
13.Explain the steps of performing a procedure at DHFP.
14.Explain the 3 “R’s” in writing a consultation note.