COMMON PATHOGENS AND NON PATHOGENS

A bacterium is a single-cell microorganism that reproduces rapidly and causes many different infections.

A virus is a tiny micro-organism that causes many infections and diseases. Viruses require living tissue to survive and grow; so unlike bacteria, they are actually parasites

A fungus is a micro-organism that grows on or in animals and plants. The single-cell fungi are yeasts; multi-cell varieties are spore-producing molds. Most fungi do not normally cause diseases

A protozoon is a single-cell parasite that can be microscopic or large enough to see without a microscope. Protozoa thrive in damp environments and in bodies of standing water, such as ponds and lakes. They replicate rapidly inside a living host

Homeostasis is achieved when the body’s systems and biological processes maintain stability. The body has built-in regulatory processes that react to external environmental changes in order to sustain balance. The nervous system and endocrine system are primarily responsible for achieving and maintaining homeostasis, but all body systems play a role

EYE, EAR, AND TOPICAL MEDICATIONS

Prior to administering medications to the ears or eyes, ensure the medication is at room

temperature, the patient is properly positioned, and gloves are worn during administration. The

tip of the containers should not come in direct contact with the patient, as this could lead to

contamination of the solution.

Apply the same principles when administering topical medications. Take precautions not to touch topical medications. In addition to contamination concerns, medications applied topically can absorb into the body and lead to adverse reactions. Use an applicator to apply topical medication

Pre- and post-surgical instructions

Planned surgical procedures commonly performed in a provider’s office include mole removals,

ingrown toenail removals, or wart removals. Unplanned surgical procedures include foreign body

removal or wound suturing.

Planned surgical procedures are often easier to instruct the patient as far as what to expect and

how to prepare. Although the time is limited in an emergency situation, make an effort to allay fears

by informing the patient on what to expect.

Postsurgical instructions include when to return for follow-up, contact information in case of

complications, signs of infection, and how to care for the wound. Patients are often anxious and

have a difficult time remembering instructions following a trauma, so written information should

be reviewed and sent to the patient

Setting up for the procedure

When setting up for the procedure, avoid contamination of the sterilized items or sterile field. When

opening sterile packets or a Mayo stand cover, open the flaps away from you first and then open the

closest flap. At least 1 inch around the sterile field is considered nonsterile, so do not place items in

this area. Basic principles in maintaining a sterile field include the following.

⦁ Open packages so that they can easily drop onto the sterile field or be grasped by the provider

without touching the outer wrapper.

⦁ Lip the bottle of liquids prior to pouring them into sterile containers.

⦁Do not leave a sterile field unattended, reach over a sterile field, or turn your back to a sterile

field.

⦁ Medication vials should be cleaned with alcohol prior to holding with two hands for the provider

to inject the needle into

STAPLE AND SUTURE REMOVAL

Under the direction of the provider, medical assistants can remove sutures or staples. Prior to

removal, a thorough inspection of the wound to approximate the edges and the absence or presence of drainage is necessary. Wounds that have crusting blood or exudate will usually need soaking with saline prior to removal of the sutures or staples.

Equipment for suture removal includes stitch or suture scissors and forceps. A staple removal

device is used to remove staples. Remove every other suture or staple while observing the site. If

at any time there is gaping, stop and notify the provider. Account for the total number of staples

and sutures that were used to close the wound. When cutting sutures, cut close to the knot and pull

the suture out with forceps by grabbing the knot and pulling, observing to ensure the entire suture

was removed.

Butterfly closures can be used to provide reinforcement of the wound after the removal of the sutures or staples depending on the condition and location of the wound

Steps for washing hands using soap and water

Start by wetting hands with clean, running warm water. Apply soap and rub hands together for

at least 20 seconds, making sure to pay attention to all surfaces, including between fingers and

nails. The friction that is created with this step helps to lift debris from the skin. Microbes tend

to concentrate near and under the nails, so pay special attention to these areas. Rinse hands

with running water, and dry with a clean towel or air-dry. If using a standard faucet, once the

hands are clean and dry, use a paper towel to shut the faucet off to avoid exposing the hands to a

contaminated surface.

Sterilization of supplies and equipment

The use of dry heat, gas, chemicals, ultraviolet radiation, ionizing radiation, chemicals, or steam

under pressure in an autoclave are all methods that can be used in the sterilization of medical

equipment. Medical facilities can purchase supplies and equipment from manufacturers already

sterilized and packaged, or they can establish a sterilization space in the facility. Once an item is

sterilized, specific handling must occur so the item is not contaminated

• Pre-cleaning: Done immediately after the endoscope has been removed from the patient, this

consists of wiping the tube with a wet cloth and then soaking the tube in a cleaning solution.

⦁ Leak testing: Use air, pressure, and water to determine if any damage to the endoscope has

occurred.

⦁Manual cleaning: Use the recommended cleaning solution to manually remove debris from the internal and external surfaces of the endoscope.

⦁ Rinse after cleaning: Rinse all parts of the endoscope with clean water to further reduce the

chances of any debris or cleaning solution from remaining.

⦁ High-level disinfection (manual or automated): Use the recommended high-level disinfectant

that the manufacturer suggests for immersion and flushing of endoscope pieces.

⦁ Rinse after high-level disinfection: Rinse all parts to assure no residual chemical disinfectant

remains on the endoscope.

⦁Drying: Rinse all parts with alcohol and then dry with forced air. Store the endoscope vertically in

a clean, dry, and dust-free environment.

Point-of-care testing

Various tests related to chemistry, immunology, microbiology, and hematology are identified as

CLIA-waived and easily performed in physician office laboratories. Common point-of-care tests

include the following.

⦁ Pregnancy testing: Urine is screened for the presence of human chorionic gonadotropin (hCG)

antibodies.

⦁Rapid Streptococcus testing : Throat swabs are obtained to screen for Group B streptococcus.

⦁ Dipstick, tablet, or multi-stick urinalysis: The urinalysis is a screening tool for analytes that are

excreted in the urine.

⦁Hemoglobin: A machine is used to screen for the oxygen-carrying protein in whole blood, performed using capillary blood from a fingerstick (capillary puncture).

⦁ Spun hematocrit: Fingerstick collection of blood in microcapillary tubes is centrifuged and

evaluated for the percentage of red blood cells.

⦁Blood glucose: Whole blood is analyzed in a glucometer for a quantitative glucose level

and is a screening test for diabetes, performed using capillary blood from a finger stick

(capillary puncture).

⦁Hemoglobin A1c : This capillary blood test shows diabetes control over an approximate

3-month period.

⦁Cholesterol testing: Lipids are evaluated using capillary blood.

⦁Helicobacter pylori: A blood sample screens for H. pylori, which is the main cause of

gastriculcers

Mononucleosis screening : This screening tool tests for the presence of the Epstein-Barr virus in

capillary blood.

⦁ Nasal smear for influenza types A and B: This screening is a qualitative test for influenza

antigens using a swab that is inserted into the nostril.

⦁Drug testing: Substances can be detected in urine and blood samples.

⦁Fecal occult blood: This test is performed to screen for hidden blood in the stool

CLIA-waived

is the most common designation for ambulatory care and is the lowest level of

complexity. These tests could be performed in the home environment or easily conducted in the

medical office.

Moderate- and high-complexity

tests are considered nonwaived. Labs performing these tests must

have a CLIA certificate and undergo inspections to ensure standards are being met. These tests are

typically performed in a reference or hospital laboratory.

The Commission on Office Laboratory Accreditation (COLA) is an independent accreditor for laboratories; it focuses on meeting CLIA regulations with the goal of providing the best care to the patient. Additional accreditors approved under CLIA can be found at www.cms.gov

Quality assurance and quality control

The importance of quality cannot be understated in maximizing accuracy and patient safety.

Quality assurance is comprehensive and relates to policies and procedures that must be implemented for the reliability of test results. Quality control is included in quality assurance but is more specific; it is related to testing reliability and accuracy while attempting to uncover errors and eliminate them.

Sending records to patients and other providers

All requests for medical records need to be provided in writing, and the release filed into the

patient’s chart. The patient’s attorney, mediator, or arbitrator must obtain approval from the patient

prior to obtaining access to the patient’s medical records. However, the patient’s attorney may

present a legal power of attorney document that authorizes them to view the medical records on

behalf of the patient if necessary

ICD-10-CMICD-10-CM

coding was implemented on October 1, 2015, after unexpected delays by Congress. ICD-10-CM coding contains approximately 55,000 more codes than ICD-9-CM and allows more specific reporting of diseases and newly recognized conditions.

CD-10-Procedure Coding System (ICD-10-PCS)

is a system comprised of medical classifications for procedural codes typically used within hospitals that record various health treatments and testing

Administrative Assisting CPT codes and modifies current Procedural Terminology (CPT) codes and modifiers are used to document procedures and technical services based on services by providers in outpatient settings

Healthcare Common Procedure Coding System (HCPCS) is a group of codes and descriptions that represent procedures, supplies, products, and services not covered by or included in the CPT coding system. Similar to CPT codes

COMPLIANCE WITH GOVERNMENT AND INSURANCE REQUIREMENTS

Medical assistants should be familiar with the requirements for individual, third-party, and government insurance plans. In addition, it is part of the daily routine to handle tasks associated with an insurance carrier’s handbook, contracts, and forms necessary for plan benefits and any preauthorization or referral requirements. This equips the medical assistant with the knowledge and skills to ensure documentation complies with government and insurance requirements

Billing inquiries

All billing inquiries should be handled in a prompt and courteous manner. If the patient is calling

about an error, place the patient on hold while the account is being pulled up for review, thank the

patient for holding, explain the charges carefully, and make sure all questions and concerns have

been answered. If the medical assistant is unable to resolve the issue, obtain the patient’s contact

information so the appropriate staff can contact them once the issue has been investigated and the

solution has been determined

Steps to appeal a denial

When filing an appeal for a denial received from an insurer, first determine why the claim was denied. Then obtain and complete the insurance company’s appeal document. The appeal document must be filed as quickly as possible so that it doesn’t exceed the time needed for filing. Include a letter from the provider to provide support for medical necessity, progress notes from the treating provider, and relevant results from any testing performed

• Malfeasance

performance of an unlawful, wrongful act; for example, performing a procedure on

the wrong patient.

⦁ Misfeasance

is a performance of a lawful action in an illegal or improper manner; for example,

performing the procedure on the correct patient, but doing so incorrectly.

⦁ Negligence

the failure to do something that a reasonable person of ordinary prudence would do

in a certain situation, or doing something that such a person would not do.

⦁ Nonfeasance

is failure to perform a task, duty, or undertaking that one has agreed to perform or

has a legal duty to perform; for example, waiting to treat a patient until it is too late

⦁Mutual assent:

An agreement by all parties to contract; must prove there was an offer and

acceptance

⦁Consideration:

A benefit of some type for entering into the contract, such as financial

reimbursement

⦁Capacity:

Parties must be legally able to contract (legal age and of sound mind)

⦁Legality:

Subject matter must be legal