Practice Management Flashcards
Need all of the following to bill for consultation
- requested by another physician
- request is documented
- patient’s visit and consultant’s opinions are documented
- opinion is communicated back to requesting physician
If already billed for fx care (whether reduction was done in clinic or OR), then all services related to tx within…
90 days is considered global fee –> cannot bill.
Exception: application of splint or cast during global period is billed separately
Modifier 25
significant, separately identifiable evaluation and management service by same physician on same day of procedure or other service
Modifier 58
appended to 2nd procedure (staged or related procedure) during global period
Physician Payments Sunshine Act
must report payments of > $10
4 legal elements of medical negligence
- duty
- breach of duty
- causation
- damages
Worker’s comp case can be settled once…
patient has reached maximum medical improvement.
Stark Law
prohibits any provider from referring medicare or medicaid patients to a facility in which the provider has a financial relationship with
A formal written complaint from a patient requires…
a formal written response from provider.
What is a physician’s obligations regarding another physician’s error?
ethically but NOT lawfully obligated to inform patient
The federal trade commission prohibits…
false advertising
IMN. with stainless steel is associated with…
increased risk for adverse events (nonunion, revision, fx of implant) because stainless steel causes more autodynamization (screw breakage).
What is the actual lifetime IPV among female patients and perceived IPV prevalence by surgeons?
40% and 10%
Predictor of IPV
repeated ED visits
Timed up and go test predicts…
functional outcome (need for walking aid) after hip hemi.
For occult hip fx, if CT is neg and unable to obtain MRI, then obtain…
bone scan 72 hrs after initial injury.
How to reverse bupivicaine-related cardiac arrest (asystole from injecting bupivicaine into femoral vein)
lipid (20%) fat emulsion
Sheathed tendons receive blood supply from…
vincula.
Tib ant rupture - treat with…
primary tendon repair and possible graft augmentation with EHL.
Also consider gastroc recession if there is contracture bc it can compromise repair.
Scapular injury is most commonly associated with concomitant…
chest injury.
Hip fracture mortality…
in hospital 6%
1 yr 30%
**better if operated on within 48 hours
Outpatient UE surgery should only go home with…
10 narcotic pills.
Compared to freeze-dried allograft, frozen allograft has…
greater torsional and bending strength.
What allograft has the highest immunogenicity?
fresh
What type of nerves are at bone-tendon junction?
free nerve endings –> nociception
What metal has highest rate of bacterial adherence?
titanium
adductor canal block blocks…
saphenous sensory but not femoral motor nerve.
Best predictor of premature physeal closure in pediatric distal tibia fx
physeal gap > 3 mm
Strongest risk factor for patellar tendonitis
hamstring/quad inflexibility
osteoblasts regulate hematopoietic cells and immune response via…
PTH-Jagged1-Notch pathway.
PTH induces Jagged1 on…
osteoblasts which stimulates notch receptors on hematopoietic stem cells leading to cell proliferation.
ECD tendon laceration, after primary repair use…
a yoke splint (relative motion splint) that holds the MCP in slight extension but allows AROM of PIP and DIP.
Tx of chronic SPN pain
neurotomy with transposition into bone
During fx healing, MMP 13 acts to…
degrade cartilaginous ECM.
Tooth avulsion
rinse in water or saline and place in milk, saliva, or sterile saline
Pregnant patient, place in…
left lateral decubitus to minimize positional hypotension due to aortocaval compression.
Malignant hyperthermia genetics
AD
Hypersensitvity to implants is type…
IV (delayed, T-cell mediated)
Osteopoikilosis
AD inheritance
hundreds of bone islands usually around joints
benign
usually asymptomatic –> observe
After flexi nailing of femur or tibia, often need…
supplemental immobilization.
D-zone test
determine whether S aureus infxn that is resistant to erythromycin is also resistant to clindamycin (inducible resistance).
AVN of the talus that requires TTC is best approached via….
lateral transfibular approach which allows removal of the talus, preparation of the tibiotalar and subtalar joints, and bone grafting.
Motor evoked potential
stimulation of the motor cortex to the corticospinal tract –> spinal cord interneurons –> anterior horn cells –> peripheral nerve –> skeletal muscle in an efferent direction.
Sensory evoked potential
afferent direction; signal initiation in UE and LE –> transcranial recording of somatosensory cortex
Groin flap has risk to…
LFCN.
Treatment of osteoporosis resistant to long term bisphosphonates
add teriparatide (anabolic)
Most doctors interrupt patients within…
23 seconds.
Does hypothermia improve otucomes after SCI?
no
Pressure =
force/area
Contact pressure is decreased by…
decreasing joint reactive forces and increasing contact area.
PROMIS
computer adaptive test that minimizes floor and ceiling effects
For tibial shaft fractures, suprapatellar nailing improves…
alignment compared to infrapatellar nailing.
Process improvement
retrospective review of cases for quality improvement (not considered research)
Tx of non-op 5th MC fx
one visit to evaluate and manage w/ taping or splint and optional follow-up
Distal radial physeal injury (gymnast’s wrist) involves the…
zone of provisional calcification.
Bacteria to consider in fishing or water related injuries
Mycobacterium marinum
**incubation of culture at 2 temperatures (35 C and 28-32 C)
A front passenger seat airbag should be turned off for….
children < 80 pounds.
