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Copyright, ii
List of Procedures, xxvii
Preface, xxxiii
About the Authors, xxxv
Acknowledgments, xxxvii
The Learning Package, xl
Chapter Opener Features, xli
Additional Features, xliii
Unit I. Introduction to the Medical Assisting Profession, 1
Chapter 1. The Medical Assistant Profession and the History of Healthcare, 2
Introduction, 3
The Medical Assistant’s Role in Healthcare, 3
The History of Medicine, 3
Early Healing Practices, 3
Healing Based on the Supernatural, 4
Early Egyptian Medicine, 4
Early Chinese Medicine, 4
Early Native American Medicine, 4
Hippocrates and Early Contributors, 4
The Beginning of Hand Washing in Healthcare, 7
Antisepsis Use in Healthcare, 7
The Medical Value of X-Rays, 7
Important Organizations in Medical History, 7
The History of American Hospitals, 8
The History of the American Medical Association, 8
The Start of the American Red Cross, 9
Important Women in Healthcare, 9
The Work of Marie Curie, 9
The Role of Florence Nightingale, 9
The Contributions of the Blackwell Sisters, 10
The World Health Organization, 10
Ethics and Patient Rights, 10
The American Hospital Association’s Patient Bill of Rights (1973), 10
Professionalism, 10
Communication and Medical Terminology, 12
Physical Requirements, 12
Character, 12
Scope of Practice for Medical Assistants, 12
Job Opportunities, 13
Medical Assistant Educational Programs, 13
Educational Requirements of Medical Assisting, 13
Certification Examination, 15
Multiple Medical-Assisting Statuses, 15
Chapter 2. Medical Assisting Today, 19
Introduction, 20
The Medical Assistant’s Role in Healthcare Today, 20
The History of the Medical Assisting Profession, 20
The Requirements of Other Allied Health Associations, 21
The American Medical Technologists (AMT), 21
The American Academy of Professional Coders (AAPC), 22
The American Health Information Management Association (AHIMA), 22
The Association for Healthcare Documentation Integrity, 22
Choosing Medical Assisting as a Career, 22
Understanding Medical-Assisting Responsibilities, 22
Identifying Positive Medical-Assisting Qualities, 23
Understanding the Medical Assistant’s Role Outside the Office, 25
Managing Time Effectively in the Medical Office, 25
Procedure 2-1. Adapt to Change, 25
Healthcare Team Members, 26
Physician, 26
Physician’s Assistant, 26
Nurse Practitioner, 26
Nurse, 26
Pharmacist, 26
Other Healthcare Team Members, 27
Medical Practice Specializations, 28
Chapter 3. Professionalism in the Workplace, 32
Introduction, 33
The Medical Assistant’s Role in Professionalism, 33
What Is Professionalism?, 33
Characteristics of Professional Behavior, 34
Competence, 34
Honesty, 34
Compassion, 34
Respect for Others, 35
Responsibility, 35
Professional Demeanor, 35
Loyalty, 35
Attitude, 35
Working Together as a Team, 35
Prioritizing Tasks, 36
Barriers to Professionalism, 36
Bringing Personal Problems into the Workplace, 36
Taking Care of Personal Business While at Work, 36
Inappropriate Discussions in Front of Patients, 36
Procrastination of Duties, 36
Chapter 4. Medical Law and Ethics, 39
Introduction, 41
The Medical Assistant’s Role in Medical Law and Ethics, 42
The Sources of Law, 42
Administrative Law, 42
Comparing Public and Private Law, 42
Criminal Law, 42
Felonies, 42
Misdemeanors, 42
Civil Law, 42
Tort Law, 42
Understanding and Classifying Consent, 43
Medical Malpractice, 44
The Doctrine of Respondeat Superior, 45
Types of Malpractice Insurance Policies, 45
Procedure 4-1. Prepare an Informed Consent for Treatment Form, 46
Proving Medical Malpractice, 46
Medical Malpractice Awards, 47
Preventing Medical Malpractice Claims, 47
Defending Against Medical Malpractice Claims, 47
The Statute of Limitations, 48
Using Assumption of Risk as a Defense, 48
Contributory and Comparative Negligence, 48
Immunity from Negligence Suits, 48
Res Judicata and Res Ipsa Locuitur, 48
The Standard of Care, 48
Tort Reform, 48
Capping the Money Awarded to Injured Patients, 48
Repeat Offender Providers, 50
The Physician’s Public Duties and Consequences, 50
Reporting Vaccine Injuries, 51
Reporting Cases of Abuse, 51
Revoking Medical Licenses, 52
The Physician-Patient Relationship, 52
The Role of the Patient, 52
The Role of the Physician, 52
Contracts in Healthcare, 52
Implied Contracts, 52
Expressed Contracts, 52
Terminating Contracts, 53
The Good Samaritan Act, 53
Maintaining Patient Confidentiality Through Proper Records Handling, 53
Releasing Medical Records, 53
Procedure 4-2. Obtain Authorization for the Release of Patient Medical Records, 56
Accommodating Subpoenas of Medical Records, 56
Disclosing Minors’ Medical Information, 56
Guarding Superprotected Medical Information, 56
Procedure 4-3. Respond to a Request for Copies of a Patient’s Medical Record, 57
Faxing Medical Records, 57
Disclosing Medical Records Improperly, 57
The Health Insurance Portability and Accountability Act (HIPAA), 57
Title II of HIPAA, 58
HIPAA and Computer Privacy, 59
The HIPAA Privacy Officer, 59
HIPAA Records Violations, 59
The HIPAA Business Associate Agreement, 59
Penalties for HIPAA Violations, 60
Advance Directives, 60
Employment Law and Healthcare, 60
The Americans with Disabilities Act and Healthcare Employment, 60
The ADA’s Requirements, 60
The Conscience Clause, 62
The Patients’ Bill of Rights, 62
The Clinical Laboratory Improvement Amendments Act (CLIA) and Ambulatory Care, 62
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and Ambulatory Care, 62
Medical Ethics, 62
Ethical Considerations, 62
Ethical Model, 63
Raising Ethical Issues in Healthcare, 64
Bioethics, 64
Chapter 5. Interpersonal Communication Skills, 67
Introduction, 69
The Medical Assistant’s Role in Communication, 69
Verbal Communication, 69
Nonverbal Communication, 70
Personal Space, 70
Writing as a Means of Communication, 71
Symbolic Language, 71
Sign Language, 71
Braille, 71
Reading and Using Body Language, 71
Eye Contact, 73
Facial Expressions, 73
Gestures, 73
Posture, 73
Therapeutic Touch, 74
Demonstrating Active Listening, 74
Interviewing the Patient, 74
Employing Interviewing Techniques, 74
Procedure 5-1. Use Effective Listening Skills in Patient Interviews, 75
Identifying Factors That Hinder Communication, 75
Communicating in Special Circumstances, 75
Communicating with Physically Challenged Patients, 75
Communicating with Hearing-Impaired Patients, 76
Communicating with Sight-Impaired Patients, 76
Communicating with Patients with Speech Impairments, 76
Communicating with Patients via Interpreters, 76
Procedure 5-2. Communicate with a Hearing-Impaired Patient, 77
Communicating with Culturally Diverse Patients, 77
Procedure 5-3. Communicate with a Sight-Impaired Patient, 77
Procedure 5-4. Communicate with a Patient via Interpreter, 78
Communicating with Mentally Ill Patients, 78
Communicating with Angry or Distressed Patients, 78
Communicating with Emotionally Challenged Patients, 79
Communicating with Young Patients, 79
Communicating with Geriatric Patients, 79
Communicating with Grieving Patients, 79
Maintaining Professional Patient Communication, 80
Procedure 5-5. Identify Community Resources, 81
Keeping a Professional Distance, 81
Communicating with Coworkers, 81
Communicating with Other Facilities, 82
Developmental Stages of the Life Cycle and Their Impact on Communication, 82
Procedure 5-6. Prepare a Patient’s Specialist Referral, 82
Maslow’s Hierarchy of Human Needs, 84
Defense Mechanisms, 84
Chapter 6. Patient-Centered Care and Education, 88
Introduction, 90
The Medical Assistant’s Role in Patient Education, 90
Wellness, 90
A Holistic Approach to Health Care, 91
The Mind–Body Connection, 91
Pain, 91
Types of Pain, 91
Physical Pain, 91
Psychological Pain, 91
Phantom Pain, 92
Pain Assessment, 92
Pain Management, 93
Patient Teaching, 94
Educating the Patient, 94
Patient Miscommunication, 95
Determining the Time Needed for Patient Education, 95
Establishing a Proper Learning Environment, 95
Teaching Resources, 95
Patient Skills and Abilities, 95
Culture and Patient Education, 95
The Impact of Finances on Patient Education, 96
Teaching Patients About Preventive Medicine, 96
Preventing Medication Errors, 96
Dieting and Weight-Loss Information, 96
Information on Exercise, 96
Stress Reduction, 97
Smoking and Substance Abuse, 97
Using the Internet for Education, 98
Procedure 6-1. Use the Internet to Find Patient Education Materials, 99
Chapter 7. Considerations of Extended Life, 103
Introduction, 104
The Medical Assistant’s Role in Extended Life Care, 105
Organ and Tissue Donations, 105
Organ and Tissue Harvesting, 105
Donation Issues and Concerns, 105
Transplant Costs, 107
Organ and Tissue Donation Rules and Regulations, 107
Uniform Anatomical Gift Act, 107
Hospitals, 107
Advance Medical Directives, 108
Durable Power of Attorney for Healthcare, 108
Living Wills, 108
Life-Prolonging Declarations, 110
Hospice, 111
Unit II. Administrative Responsibilities of the Medical Assistant, 115
Chapter 8. Written Communication, 116
Introduction, 118
The Medical Assistant’s Role in Written Communications, 118
Writing to Patients and Other Healthcare Professionals, 118
The Role of Spell-Checking, 118
Proper Spelling, Grammar, and Punctuation Use, 118
Sentence Structure, 119
Numbers in Correspondence, 119
Rules for Medical-Term Plurals, 120
Components of the Business Letter, 120
Styles of Business Letters, 123
Using Fonts in Typed Communication, 123
Sending Letters to Patients, 123
Proofreading, 123
Working with Accepted Abbreviations, 124
Creating Memos for the Office, 126
Procedure 8-1. Compose a Business Letter, 128
Mailing Written Communication, 128
Procedure 8-2. Prepare a Document for Photocopying, 128
Window Envelopes, 129
Procedure 8-3. Send a Letter to a Patient About a Missed Appointment, 130
Running and Resetting Postage Meters, 130
Procedure 8-4. Proofread Written Documents, 130
Classifying Mail, Size Requirements, and Postage, 131
Buying Postage Online, 133
Using Multiline Optical Character Readers, 133
Procedure 8-5. Fold Documents for Window Envelopes, 133
“ZIP + 4” Codes, 134
USPS-Approved Abbreviations in Addresses, 134
Restricted Materials, 134
Other Delivery Options, 134
Using E-Mail to Communicate, 135
Managing Mail and Correspondence, 135
Annotation, 135
Procedure 8-6. Open and Sort Mail, 136
Procedure 8-7. Annotate Written Correspondence, 136
Chapter 9. Telephone Procedures, 139
Introduction, 141
The Medical Assistant’s Role in Telephone Communications, 141
Telephone System Features, 141
Making Calls with Hands-Free Devices, 141
Dialing Numbers Automatically, 141
Redialing Last Numbers Called, 141
Making Conference Calls, 141
Conversing via Speaker Telephone, 142
Call Forwarding, 142
Recording Telephone Calls, 142
Direct Telephone Lines, 142
Automatic Routing Units, 142
Placing Callers on Hold, 142
Other Special Features, 143
Using an Answering Service, 143
Using the Voicemail Feature, 143
Patient Telephone Use, 144
Answering the Telephone, 144
Screening Telephone Calls, 144
Directing Patient Calls to Physicians, 144
Procedure 9-1. Answer the Telephone in a Professional Manner, 145
Prioritizing Telephone Calls, 145
Telephone Triage, 146
Taking Emergency Telephone Calls, 146
Being Professional on the Telephone, 147
Communicating with Hard-to-Understand Callers, 148
Handling Difficult Callers, 148
Receiving Calls from Emotional Patients, 149
Documenting Calls from Patients, 149
Taking Telephone Messages, 149
Calling in Prescriptions and Refill Requests, 149
Calling Patients, 149
Procedure 9-2. Take a Telephone Message, 151
Leaving Messages, 151
Calling Other Healthcare Facilities, 151
Using a Telephone Directory, 152
Procedure 9-3. Call a Pharmacy with Prescription Orders, 152
Using an Online Directory, 153
Using a Rolodex System, 153
Long Distance or Toll-Free Calls, 153
Patient Confidentiality, 153
Personal Telephone Calls, 154
Telecommunication Relay Services, 154
Chapter 10. Front Desk Reception, 157
Introduction, 158
The Medical Assistant’s Role in Front Desk Reception, 159
Characteristics of the Front Desk Receptionist, 159
Opening the Office, 159
Preparing Patient Files, 159
HIPAA Compliance, 159
Procedure 10-1. Open the Office, 160
Greeting and Registering Patients, 163
Using Sign-in Sheets, 163
Procedure 10-2. Greet and Register Patients, 164
Administering Patient Paperwork, 164
Notifying Patients of Delays, 165
Collecting Payments at the Front Desk, 165
Escorting Patients, 165
Managing Difficult Patients in the Reception Area, 165
Procedure 10-3. Collect Payments at the Front Desk, 167
Keeping Only Appropriate Patients in the Reception Area, 167
Maintaining the Reception Room, 167
Providing Adequate Seating and Decoration, 167
Choosing Reading Material for the Reception Room, 168
Managing Children in the Reception Room, 168
Accommodating Patients with Disabilities, 169
Serving Patients with Service Animals, 169
Caring for Patients as They Leave the Office, 169
Closing the Office, 169
Procedure 10-4. Close the Office, 170
Chapter 11. Patient Scheduling, 173
Introduction, 175
The Medical Assistant’s Role in Patient Scheduling, 175
Scheduling New Patient Appointments, 175
New and Established Patients, 176
Allowing Appointments Adequate Time, 177
Creating an Appointment Matrix, 177
Balancing Patient and Office Needs in Scheduling, 177
Paper and Electronic Scheduling, 177
Procedure 11-1. Establish an Appointment Matrix, 178
Procedure 11-2. Schedule New Patient, 179
Methods of Appointment Scheduling, 179
Cluster Scheduling, 179
Double Booking, 179
Fixed Appointment Scheduling, 179
Scheduling with Open Hours, 179
Wave Scheduling, 179
Modified Wave Scheduling, 180
Leaving Slack or Buffer Time, 180
Conducting Triage and Appointment Scheduling, 180
Using Appointment Reminder Systems, 180
Procedure 11-3. Schedule an Established Patient Appointment, 180
Correcting the Appointment Schedule, 181
Documenting No-Show Appointments, 181
Following Up on No-Show Appointments, 181
Procedure 11-4. Use Patient Reminder Cards, 181
Managing the Physician’s Professional Schedule, 183
Scheduling Hospital Services and Admissions, 183
Procedure 11-5. Reschedule a Missed Patient Appointment, 183
Procedure 11-6. Manage the Physician’s Professional Schedule and Travel, 184
Procedure 11-7. Schedule a Hospital Procedure, 184
Procedure 11-8. Schedule an Inpatient Admission, 185
Specialty Referral Appointments, 185
Arranging for Language Interpreters, 185
Arranging Transportation for Patients, 186
Achieving Efficiency in Scheduling, 186
Unit III. Managing Health Information in the Medical Office, 189
Chapter 12. Medical Records Management, 190
Introduction, 192
The Medical Assistant’s Role in Medical Records Management, 192
Information Contained in the Medical Record, 192
The Purpose of the Medical Record, 193
Signing Off on Medical Records, 193
Procedure 12-1. Prepare and Maintain the Medical Record, 195
Forms of Charting, 196
The Narrative Style, 196
Charting with SOAP, 196
Problem-Oriented Medical Record Charting, 197
Inserting Flow Charts in Medical Records, 198
Progress Notes, 198
Using Abbreviations in Charting, 199
Charting Patient Communication, 199
Filing Systems, 199
Alphabetic Filing, 199
Procedure 12-2. Chart Patient Telephone Calls, 200
Shingling Items for Medical Records, 200
Numeric Filing, 200
Procedure 12-3. File Documents Using the Alphabetic Filing System, 200
Procedure 12-4. File Manually Using a Subject Filing System, 201
Procedure 12-5. File Documents in Patient Medical Records, 202
File Storage Systems, 202
Procedure 12-6. Use the Numeric System to File Medical Records, 202
Active, Inactive, and Closed Patient Files, 203
Converting Paper Records to Electronic Storage, 203
Retaining Medical Records, 204
Correcting Medical Records, 204
Adding to Medical Records, 205
Charting Conflicting Orders, 205
“Owning” the Medical Record, 205
Documenting Prescription Refill Requests, 205
Procedure 12-7. Correct Errors in the Patient Medical Record, 206
Releasing Medical Records, 206
Releasing Information When a Medical Practice Closes, 207
Conducting Research with Medical Records, 207
Chapter 13. Electronic Medical Records, 210
Introduction, 211
The Medical Assistant’s Role in Using Electronic Medical Records, 212
Electronic Medical Records Are Easily Accessible, 212
How Does Paper Charting Differ from Electronic Charting?, 212
Making the Conversion from Paper to Electronic Medical Records, 213
Training, 213
Electronic Health Records and HIPAA Compliance, 214
Backing Up Computers and Electronic Medical Records, 215
Using Personal Digital Assistants with Electronic Medical Records, 216
Other Benefits of Electronic Medical Records, 216
Electronic Signatures, 216
Avoiding Medical Mistakes, 216
Saving Time, 217
Health Maintenance, 218
Using Electronic Medical Records with Diagnostic Equipment, 218
Marketing Purposes, 218
Communicating Between Staff Members, 218
Putting Medical Records Online, 218
Procedure 13-1. Correct an Electronic Medical Record, 219
Making Corrections in the Electronic Medical Record, 219
Chapter 14. Computers in the Medical Office, 222
Introduction, 223
The Medical Assistant’s Role in Computer Use in the Medical Office, 224
Components of the Computer System, 224
Computer Hardware, 224
The Keyboard, 224
The Monitor, 224
The Computer Hard Drive, 225
Types of Computer Drives, 225
Computer Memory, 225
The Printer, 225
Surge Protection, 226
Backing Up Computer Systems, 226
Computer Peripherals, 226
Scanners, 226
Digital Cameras, 226
Bar-Code Readers, 226
Electronic Sign-in Sheets, 226
Maintaining Computer Equipment, 227
Computer Software, 227
Procedure 14-1. Use Computer Software to Maintain Office Systems, 228
Training Staff on Medical Software, 228
Types of Software Packages, 228
Computer Security, 228
Computer Viruses, 229
Internet Search Engines, 229
Procedure 14-2. Use an Internet Search Engine, 229
Finding Appropriate Web Resources, 230
Buying Medications Online, 230
Procedure 14-3. Verify Preferred Provider Status on an Insurance Company Web Site, 230
Allowing Personal Computer Use in the Office, 231
Personal Digital Assistants, 231
Computer Ergonomics, 231
Unit IV. Managing the Medical Office, 235
Chapter 15. Equipment, Maintenance, and Supply Inventory, 236
Introduction, 237
The Medical Assistant’s Role in Equipment Maintenance and Supply Inventory, 237
Working with Medical Office Equipment, 238
Training Employees to Use Medical Office Equipment, 238
Keeping a Maintenance Log for Medical Office Equipment, 238
Replacing or Buying Medical Office Equipment, 239
Weighing Equipment Leasing Against Buying, 239
Using Fax Machines in the Medical Office, 239
Procedure 15-1. Take Inventory of Administrative and Clinical Equipment for Maintenance and Other Purposes, 239
Using Copy Machines in Healthcare Facilities, 240
Adding Healthcare Data with Machines, 240
Procedure 15-2. Perform Routine Maintenance of a Computer Printer, 240
Medical Transcription, 241
Finding Outside Transcription Services, 241
Procedure 15-3. Fax a Document, 241
Logging Medical Office Supplies, 242
Inventorying Supplies, 242
Checking for the Next Day’s Supplies, 243
Storing Supplies Upon Arrival, 243
Procedure 15-4. Prepare a Purchase Order, 243
Handling Drug Samples, 244
Stocking Clerical Supplies, 244
Tracking Supplies with Computer Software, 244
Procedure 15-5. Receive a Supply Shipment, 244
Chapter 16. Office Policies and Procedures, 248
Introduction, 249
The Medical Assistant’s Role in Office Policies and Procedures, 250
Creating Patient Information Pamphlets, 250
Creating a Personnel Manual, 250
Procedure 16-1. Create an Office Brochure, 251
Creating Policies and Procedures for the Medical Office, 251
Writing a Mission Statement, 251
Preparing an Organisational Chart, 251
Outlining Clinical Procedures, 252
Procedure 16-2. Create a Clinical Procedure for the Procedure Manual, 253
Outlining Administrative Procedures, 253
Documenting Infection Control Procedures, 253
Creating Quality Improvement and Risk Management Procedures, 254
Writing Other Office Policies, 254
Procedure 16-3. Create an Administrative Procedure for the Procedure Manual, 254
Unit V. Understanding Health Insurance: Billing and Coding Procedures, 259
Chapter 17. Insurance Billing and Authorizations, 260
Introduction, 264
The Medical Assistant’s Role in Insurance Claim Processing, 264
The History of Health Insurance, 265
Health Insurance Today, 265
Health Insurance Terminology, 265
Members and Their Families, 266
Premiums, 266
Fee Schedules and Approved Amounts, 266
Deductibles, 266
Copayments and Coinsurance, 267
Stop Loss and Lifetime Maximum, 267
Procedure 17-1. Calculate Deductible, Coinsurance, and Allowable Amounts, 268
Waiting Period, Exclusions, and Pre-Existing Conditions, 268
Private Health Insurance, 269
Sources of Coverage, 269
Group Insurance, 269
Self-Insured Plan, 269
COBRA Coverage, 270
Individual Health Insurance Policies, 270
Types of Plans, 271
Fee-for-Service Plans, 271
Managed Care Plans, 271
Preferred Provider Organization (PPO), 271
Health Maintenance Organizations, 272
Exclusive Provider Organizations, 273
Point-of-Service (POS) Options, 273
Consumer-Directed Healthcare Plans, 273
Blue Cross/Blue Shield Plans, 274
Other Related Benefits, 274
Health Savings Accounts, 274
Medical Savings Accounts, 274
Flexible Spending Accounts, 274
Third-Party Liability, 275
Types of Coverage, 276
Hospital, 276
Medical, 276
Surgical, 276
Outpatient, 276
Major Medical, 276
Home Health Care, 276
Catastrophic Health Insurance, 276
Specialized Policies, 276
Ancillary Coverage, 276
Prescription Drug Coverage, 276
Vision, 277
Dental, 277
Alternative Care, 277
Government Insurance, 278
Medicare Coverage, 278
The National Provider Identifier (NPI), 278
Medicare Part A, 279
Medicare Part B, 279
Medicare Part C: Advantage Plan, 282
Medicare Part D, 282
Medigap Plans, 282
Medicare and Other Health Insurance (OHI), 282
Providers Participating in Medicare, 282
Medicaid, 283
Covered Medicaid Services, 284
State Children’s Health Insurance Program (SCHIP), 284
TRICARE, 284
CHAMPVA, 285
Worker’s Compensation Insurance, 285
Disability Insurance, 286
Types of Disability Insurance, 286
Definition of Disability, 286
SSDI and SSI, 286
The Medical Assistant’s Role with Disability Insurance, 286
Reimbursement Methods, 287
Processing Claims, 287
Patient Registration, 287
Verification of Benefits, 289
Procedure 17-2. Verify a Patient’s Insurance Eligibility, 289
Determining Coordination of Benefits, 290
Preparing Referrals, Authorizations, and Precertifications, 290
Documenting Insurance Company Calls, 291
Health Insurance Claim Forms, 291
The CMS-1500 Claim Form, 291
Optical Character Recognition, 291
Filing Timelines, 300
Billing Insurance Companies Electronically, 300
Procedure 17-3. Obtain a Managed Care Referral, 303
Procedure 17-4. Obtain Authorization from an Insurance Company for a Procedure, 303
Working with Fee Schedules, 304
Charge-Based Fee Structure, 304
Resource-Based Fee Structures, 304
Medicare’s Resource-Based Relative Value Scale, 304
Posting Payments, 305
Information on an EOB, 305
Tracing Claims, 307
Reconciling Payments and Rejections, 307
Procedure 17-5. Abstract Data to Complete a Paper CMS-1500 Claim Form, 308
Procedure 17-6. Complete a computerized Insurance Claim Form, 314
Sending Supporting Documentation, 314
Procedure 17-7. Handle a Denied Insurance Claim, 315
The Office of the Insurance Commissioner, 315
Projecting Health Insurance Costs in the Future, 316
Chapter 18. ICD-9-CM Coding, 321
Introduction, 322
The Medical Assistant’s Role in Diagnostic Coding, 323
The History of Diagnostic Coding, 323
Coding with the ICD-9-CM Book, 324
The Volumes of ICD-9-CM, 324
Volume II, 324
Volume I, 325
Supplementary Code Listings, 325
ICD-9-CM Appendices, 326
Volume III, 326
Determining the Correct Diagnosis Code, 326
Coding for Special Situations, 331
Secondary Diagnoses, 331
Procedure 18-1. Perform Diagnostic Coding, 332
Combination Coding, 332
Multiple Coding, 332
Signs and Symptoms, 332
Hypertension, 332
Neoplasms, 333
V codes, 333
E codes, 335
Poisonings and Adverse Effects, 335
Coding for Fractures, 336
Coding Burns, 336
Using the Rule of Nines in Coding Burns, 336
Late Effects, 337
Obstetrics, 337
Diabetes, 338
Inpatient Services, 338
Pursuing Professional Certification, 338
Chapter 19. Procedural Coding, 341
Introduction, 342
The Medical Assistant’s Role in Procedural Coding, 344
The History of Procedural Coding, 344
Coding with the CPT-4 Manual, 344
Fraud and Abuse, 344
Organization of the CPT Manual, 345
Tabular Index, 345
Appendices, 346
Alphabetical Index, 346
Conventions and Symbols, 346
Determining the Correct Procedure Code, 346
Using CPT Modifiers*, 353
Coding for Evaluation and Management Services, 355
Coding for Special Situations*, 359
Coding for Anesthesia, 359
Procedure 19-1. Code for a Procedure, 360
Coding for Surgery, 360
Coding for Radiology, 362
Coding for Pathology and Laboratory, 363
Coding for Medicine, 363
Unlisted Procedure Codes, 364
The Health Care Common Procedure Coding System (HCPCS), 364
Ensuring Proper Reimbursement, 365
Unit VI. Accounts Payable and Banking Procedures, 369
Chapter 20. Billing, Collections, and Credit, 370
Introduction, 372
The Medical Assistant’s Role in Billing, Collections, and Credit, 372
Identifying Payment Basics, 373
Manual Billing Systems, 373
Computerized Billing Systems, 373
Procedure 20-1. Post an Entry on a Day Sheet, 374
Fee Schedules, 374
Procedure 20-2. Prepare an Accounts Receivable Trial Balance, 374
Participating Provider Agreements, 375
Credit and Collections, 375
Procedure 20-3. Explain Professional Fees to a Patient, 376
Verifying Patient Identification, 377
Managing Accounts Receivables, 377
Collection in Managed Care, 378
Forgiving Deductibles or Copayments, 378
Procedure 20-4. Call a Patient Regarding an Overdue Account, 378
Patients Who File for Bankruptcy, 379
Professional Courtesy, 379
Patient Billing Statements, 379
Dismissing Patients Due to Nonpayment, 380
Charging Interest on Medical Accounts, 381
Addressing Checks That Fail to Clear, 381
Procedure 20-5. Send a Patient Billing Statement, 382
Contacting Nonpaying Patients, 382
Sending Patients Collection Letters, 382
Uncollectible Accounts, 383
Collecting from Estates, 384
Procedure 20-6. Post a Nonsufficient Funds Check, 385
Overpaying on Accounts, 385
Procedure 20-7. Post an Adjustment to a Patient Account, 385
Procedure 20-8. Post a Collection Agency Payment, 386
Procedure 20-9. Process a Patient Refund, 386
Procedure 20-10. Process an Insurance Company Overpayment, 387
Collections Through Small Claims Court, 387
Unit VII. Managing the Medical Office: Banking Procedures and Human Resources Management, 391
Chapter 21. Payroll, Accounts Payable, and Banking Procedures, 392
Introduction, 394
The Medical Assistant’s Role in Payroll, Accounts Payable, and Banking Procedures, 394
Processing Payroll, 394
The History of Payroll, 394
Present-Day Employment Issues, 395
Payroll Processing, 395
Creating New Employee Records, 395
Updating Employee Records, 395
The W-4 Form, 397
Recording Employees’ Work Hours, 399
Calculating Payroll, 399
Procedure 21-1. Create a New Employee Record, 400
Employees Paid on an Hourly Basis, 400
Salaried Employees, 400
Computing Payroll Deductions, 400
The Circular E, 400
Other Deductions, 400
Using Software to Calculate Payroll, 401
Garnishing Wages, 401
Accounts Payable, 401
The Checkbook Register, 402
Ordering and Receiving Supplies, 404
Preparing a Deposit Slip, 404
Procedure 21-2. Calculate an Employee’s Payroll, 405
Endorsement Stamps, 405
Accessing Bank Accounts via the Internet, 405
Procedure 21-3. Write Checks to Pay Bills, 406
Petty Cash, 406
Reconciling Bank Statements, 406
Procedure 21-4. Pay an Office Supply Invoice, 407
Procedure 21-5. Complete a Deposit Slip, 407
Procedure 21-6. Account for Petty Cash, 408
Procedure 21-7. Reconcile a Bank Statement, 408
Chapter 22. Managing the Medical Office, 411
Introduction, 412
The Medical Assistant’s Role in Managing the Medical Office, 413
Characteristics of the Medical Office Manager, 413
Responsibilities of the Office Manager, 413
Leadership Styles, 413
Conducting Effective Staff Meetings, 414
Creating Staff Meeting Agendas, 414
Staff Meeting Minutes, 414
Staffing the Medical Office, 415
Writing Job Descriptions, 415
Creating Job Advertisements, 415
Procedure 22-1. Direct a Staff Meeting, 415
Recruiting and Interviewing Candidates, 416
Avoiding Illegal Interview Questions, 417
Procedure 22-2. Write a Job Description, 417
Calling for Employment References, 418
Hiring New Staff, 418
Procedure 22-3. Conduct an Interview, 419
Training New Staff, 419
Supervising Staff, 419
Overcoming Scheduling Issues, 419
Procedure 22-4. Call Employee References, 420
Performance Evaluations, 420
Disciplining and Terminating Staff, 420
Procedure 22-5. Perform an Employee Evaluation, 421
Sexual Harrassment in the Medical Office, 421
Procedure 22-6. Discipline an Employee, 423
Employment Resources, 423
Providing Employee References, 423
Procedure 22-7. Terminate an Employee, 423
Improving Quality and Managing Risk in the Medical Office, 424
Creating a Quality Improvement Program, 424
Working to Ensure Patient Safety, 424
Reporting Office Incidents, 425
Unit VIII. The Clinical Environment, 429
Chapter 23. The Clinical Environment and Safety in the Medical Office, 430
Introduction, 432
The Medical Assistant’s Role in Office Safety, 432
Personal Safety Measures, 432
Body Mechanics, 432
General Office Safety, 432
Emergency Plans, 434
Fire and Electrical Safety, 434
Disasters, 434
Workplace Violence, 435
Workplace Security, 435
Incident Reports, 435
OSHA Bloodborne Pathogen Standards, 436
Procedure 23-1. File a Medical Incident Report, 436
Patient Safety, 437
Exposure Control Plan, 437
Standard Precautions and Infection Control Practices, 437
Engineering and Work Practice Controls, 437
Personal Protective Equipment, 438
Procedure 23-2. Develop an Exposure Control Plan, 439
Housekeeping and Laundry Decontamination, 439
Hepatitis B Vaccinations, 439
Hazard Communication Program, 439
Training and Record Keeping, 440
Exposure, Postexposure Evaluation, and Followup, 441
Chapter 24. The Clinical Visit: Office Preparation and the Patient Encounter, 444
Introduction, 445
The Medical Assistant’s Role in the Clinical Visit, 446
The Standard Medical Office, 446
Preparing and Maintaining Examination and Treatment Areas, 447
Triage, 447
Critically Ill or Severely Injured Patients, 447
Consent, 448
Charting the Medical History and Clinical Visit, 449
Patient History, 449
Personal History, 449
Past Medical or Health History, 449
Family Medical History, 449
Chief Complaint, 450
Present Illness, 450
Assessment of Body Systems, 450
Completing a Patient History Form, 451
Charting a Clinical Visit, 451
Procedure 24-1. Complete a Patient History Form, 452
Charting Procedures, 453
Documenting a Clinical Visit, 453
Procedure 24-2. Document a Clinical Visit and Procedure, 454
Chapter 25. Medical Asepsis, 458
Introduction, 459
The Medical Assistant’s Role in Infection Control, 460
The Cycle of Infection, 460
Natural Defenses Against Infection, 462
The Integumentary System, 462
The Immune System, 463
General Health, 463
Other Natural Defenses, 463
Asepsis and Infection Control, 464
Occupational Safety and Health Administration (OSHA), 464
Centers for Disease Control and Prevention (CDC), 464
Infection Control Precautions, 464
Personal Protective Equipment (PPE), 465
Hepatitis, 465
Acquired Immunodeficiency Syndrome (AIDS), 467
Caring for the Patient with HIV/AIDS, 469
Procedure 25-1. Perform Correct Handwashing, 470
Latex Allergy, 471
Procedure 25-2. Demonstrate Nonsterile Gloving, 472
Education for the Patient or Health Professional, 473
Chapter 26. Surgical Asepsis, 477
Introduction, 478
The Medical Assistant’s Role in Surgical Asepsis, 479
Surgical Asepsis, 479
Sanitization, Disinfection, and Sterilization, 479
Sanitization, 479
Procedure 26-1. Demonstrate the Performance of Sanitization, 480
Disinfection, 481
Sodium Hypochlorite, 482
Phenolics, 482
Alcohol, 482
Glutaraldehyde, 482
Hydrogen Peroxide, 482
Procedure 26-2. Demonstrate Disinfection Procedures, 483
Sterilization, 483
Autoclave Sterilization, 483
Other Methods of Sterilization, 484
Wrapping Instruments and Preparing Sterile Trays, 485
Preparing the Surgical Field, 485
Procedure 26-3. Demonstrate How to Wrap Surgical Instruments and Prepare Sterile Trays for Autoclave Sterilization, 487
Procedure 26-4. Demonstrate Correct Procedure for Loading and Operating an Autoclave, 488
Procedure 26-5. Demonstrate Correct Procedure for Pouring Sterile Solution onto a Sterile Field, 489
Procedure 26-6. Demonstrate Correct Procedure for Opening a Sterile Surgical Pack to Create a Sterile Field, 490
Procedure 26-7. Demonstrate the Correct Procedure for Using Transfer Forceps, 492
Procedure 26-8. Demonstrate a Sterile Scrub (Surgical Hand Washing), 493
Alcohol-Based Hand Rubs, 494
Procedure 26-9. Demonstrate How to Glove While Wearing Sterile Gown, 496
Procedure 26-10. Demonstrate Sterile Gloving and Removal, 497
Chapter 27. Pharmacology and Medication Administration, 502
Introduction, 504
The Medical Assistant’s Role in Administering and Dispensing Drugs, 504
Basic Pharmacology, 505
The General Effects of Drugs, 506
The Basic Functions of Drugs, 506
Prescription Versus Over-the-Counter Drugs, 506
Drug Nomenclature, 506
Drug Reference Sources, 507
Drug Classifications, 507
Controlled Substances, 509
Medication Measurement and Conversion, 512
Dosage Calculation, 512
Metric and Household Systems of Measurement, 514
Calculating Pediatric Dosages by Body Weight, 515
Safety Guidelines for Administering Medications, 516
The Prescription, 517
Procedure 27-1. Demonstrate Safety Measures to Prepare, Administer, and Document Medication, 519
Safeguarding Prescription Pads, 519
Procedure 27-2. Demonstrate the Preparation of a Prescription for the Physician’s Signature, 520
Forms and Routes of Medication Administration, 520
Parenteral Administration, 522
Ampules and Vials, 524
Procedure 27-3. Demonstrate Withdrawing Medication from an Ampule, 525
Intravenous Therapy, 526
Procedure 27-4. Demonstrate Withdrawing Medication from a Vial, 527
Procedure 27-5. Demonstrate the Reconstitution of a Powdered Drug for Injection Administration, 529
Procedure 27-6. Demonstrate the Administration of Medication during Infusion Therapy, 529
Procedure 27-7. Demonstrate the Preparation and Administration of Oral Medication, 530
Procedure 27-8. Demonstrate the Administration of a Subcutaneous Injection, 532
Procedure 27-9. Demonstrate the Administration of an Intramuscular Injection to Adults and Children, 534
Procedure 27-10. Demonstrate the Administration of a Z-Track Injection, 535
Chapter 28. Vital Signs, 540
Introduction, 541
The Medical Assistant’s Role in the Initial Clinical Visit, 542
Vital Signs Measurement, 542
Temperature, 542
Taking the Temperature, 542
Thermometers, 544
Pulse, 544
Procedure 28-1. Obtain an Oral Temperature with an Electronic Digital Thermometer, 544
Procedure 28-2. Obtain an Axillary Temperature with an Electronic Digital Thermometer, 546
Procedure 28-3. Obtain a Rectal Temperature with an Electronic Digital Thermometer, 547
Procedure 28-4. Obtain an Aural Temperature with a Tympanic Thermometer, 548
Procedure 28-5. Obtain a Dermal Temperature with a Disposable Thermometer, 549
Respirations, 550
Procedure 28-6. Perform a Radial Pulse Count, 551
Procedure 28-7. Perform an Apical Pulse Count, 552
Blood Pressure, 553
Procedure 28-8. Perform a Respiration Count, 554
Korotkoff Sounds, 555
Errors in Blood Pressure Readings, 557
Weight and Height, 557
Weight, 557
Procedure 28-9. Perform a Blood Pressure Measurement, 557
Height, 559
Procedure 28-10. Obtain Weight and Height Measurements, 559
Visual Acuity, 561
Hearing Assessment, 561
Preparing the Patient for a Physical Examination, 561
Gowning, 561
Draping, 561
Positioning the Patient, 561
Procedure 28-11. Demonstrate Patient Positions Used in a Medical Examination, 563
Assessment Methods Used in an Examination, 564
Assisting the Physician During the Examination, 565
Recurrent Clinical Visits, 566
Procedure 28-12. Prepare the Patient for Medical Examination and Assist the Physician, 566
Chapter 29. Minor Surgery, 570
Introduction, 571
The Medical Assistant’s Role in Office Surgery, 572
Surgeries Performed in the Medical Office, 572
Implied and Informed Consent, 573
Preoperative Care and Patient Preparation, 573
Setting Up the Room, 574
Instruments, 574
Clamping and Grasping, 574
Cutting, 575
Dilating, Probing, and Visualizing, 576
Positioning and Draping, 576
Procedure 29-1. Prepare the Skin for Surgical Procedure, 577
Anesthesia, 578
Local Anesthesia, 579
Assisting During Minor Surgery, 579
Procedure 29-2. Set Up a Sterile Tray and Assist the Physician with Minor Surgical Procedures, 580
Sutures and Suture Removal, 582
Suturing, 583
Recovery/Postoperative Care, 584
Procedure 29-3. Assist the Physician with Suturing, 584
Procedure 29-4. Assist the Physician with Suture or Staple Removal, 586
Patient Teaching and Dismissal, 588
Wound Healing, 588
Dressings and Bandages, 589
Procedure 29-5. Change a Sterile Dressing, 589
Unit IX. Diagnostic Testing in the Medical Office, 595
Chapter 30. Diagnostic Procedures, 596
Introduction, 597
The Medical Assistant’s Role in Diagnostic Testing, 597
Clinical Laboratory Improvement Amendments (CLIA), 598
Waived Tests, 598
PPMP Tests, 598
Moderate-Complexity Tests, 599
High-Complexity Tests, 599
Quality Control and Quality Assurance, 599
Procedure 30-1. Check the Accuracy of Glucometer Results Using Quality Control Methods, 600
Regulations and Laboratory Safety, 602
Joint Commission on the Accreditation of Healthcare Organizations, 602
Safe Medical Devices Act, 602
Hospital Laboratory Setting, 602
The Physician Office Laboratory, 603
POL Equipment, 603
Centrifuge, 603
Microscope, 603
Electronic Equipment, 604
Ordering Diagnostic Tests, 604
The Physician’s Order, 604
In-House Ordering, 605
Precertification, 606
Precertification by Telephone, 606
Scheduling with Outside Agencies, 606
Screening and Follow Up of Test Results, 606
Procedure 30-2. Screen and Follow Up Test Results, 608
Chapter 31. Microscopes and Microbiology, 612
Introduction, 614
The Medical Assistant’s Role in Specimen Collection, 614
Microscopes, 614
Types of Microscopes, 614
Structure and Parts of a Microscope, 614
Oculars, 614
Objectives, 615
Oil Immersion Objective, 616
Arm and Focus Control, 616
Light Source, 616
Stage, 616
Substage, 616
Using the Microscope, 616
Procedure 31-1. Demonstrate Correct Use of the Microscope, 616
Microscope Maintenance, 617
Microbiology, 618
Scientific Nomenclature and Morphology, 618
Normal Flora, 618
Pathogens, 619
Bacteria, 619
Fungi, 620
Parasites, 620
Viruses, 621
Preparing Specimens for Microscopic Examination, 621
Preparing a Specimen Smear, 621
Performing a Gram Stain, 621
Preparing Wet Mounts, 621
Saline, 621
Potassium Hydroxide, 621
Procedure 31-2. Prepare a Specimen Smear for Microbiological Examination, 622
Procedure 31-3. Prepare a Gram Stain, 623
India Ink, 624
Specimen Collection, Storage, and Transport, 624
Collection of Stool Specimens, 624
Fecal Culture Testing for Ova, Parasites, and Other Infectious Organisms, 624
Fecal Occult Blood Testing, 625
Culture and Sensitivity Testing, 625
Procedure 31-4. Instruct a Patient in the Collection of a Fecal Specimen for Occult Blood or Culture Testing and Develop the Fecal Occult Blood Test, 626
Procedure 31-5. Perform a Wound or Throat Culture Collection Using Sterile Swabs, 628
Procedure 31-6. Perform Rapid Group A Strep Testing, 630
Performing a Wound or Throat Culture, 630
Urine Cultures, 631
Storage and Transport of Urine Specimens, 631
Chapter 32. Hematology and Chemistry, 635
Introduction, 637
The Medical Assistant’s Role in Hematology and Chemistry, 637
The Anatomy and Physiology of Blood, 638
Plasma, 638
Blood Cells, 638
Red Blood Cells, 638
White Blood Cells, 638
Platelets, 639
Blood Cell Formation, 639
Immunohematology, 640
Blood Collection Equipment and Procedures, 642
Tourniquets, 642
Blood Collection Tubes, 642
Order of Draw, 642
Venipuncture, 643
Evacuated Tube, 643
Needle and Syringe, 644
Winged Infusion (Butterfly), 644
Patient Reactions to Venipuncture, 644
Procedure 32-1. Perform a Butterfly Draw Using a Hand Vein, 645
Venipuncture Sites, 646
Using the Evacuation System, 646
Verifying the Orders, 646
Obtaining Supplies, 647
Identifying the Patient, 647
Verifying Patient Preparation, 648
Proper Patient Care, 648
Procedure 32-2. Perform a Venipuncture, 648
Procedure 32-3. Demonstrate a Venipuncture Using the Syringe Method, 650
Capillary Puncture Collection, 653
Performing a Capillary Puncture, 653
Procedure 32-4. Perform a Capillary Puncture, 654
Transporting Specimens, 656
Performing Basic Laboratory Testing, 656
Basics of Hematology Testing, 657
Manual Tests, 657
Performing a WBC and Platelet Count with a Unopette Vial and Hematocytometer, 657
White Blood Cell Differential, 657
Procedure 32-5. Perform a WBC and Platelet Count with a Unopette Vial and Hemacytometer, 658
Procedure 32-6. Prepare a Blood Smear for a Differentiated Cell Count, 659
Procedure 32-7. Prepare a Smear Stained with Wright’s Stain, 661
Preparing a Blood Smear, 662
Manual Hematocrit, 662
Erythrocyte Sedimentation Rate, 662
Procedure 32-8. Perform a Microhematocrit by Capillary Tube, 662
Procedure 32-9. Perform a Hemoglobin Test Using a Hemoglobulinometer, 664
Procedure 32-10. Perform an ESR Using the Westergren Method, 664
Blood Chemistry Testing, 665
Automated Chemistry Analyzers, 665
Measuring Blood Glucose, 665
Procedure 32-11. Measure Blood Glucose Using Accu-Chek™ Glucometer, 666
Procedure 32-12. Perform a Blood Cholesterol Measurement Using the ProAct Testing Device, 667
Measuring Blood Cholesterol, 668
Blood Typing and Grouping, 669
Immunology Testing, 669
Procedure 32-13. Perform a Test for Infectious Mononucleosis, 669
Unit X. Medical Specialties and Testing, 673
Chapter 33. Urology and Nephrology, 674
Introduction, 676
The Medical Assistant’s Role in Urology and Nephrology, 676
The Anatomy and Physiology of the Urinary System, 677
Kidney Function, 677
Nephrons, 677
Urine Formation, 678
Urinary System Infections, 679
Renal Diseases, 680
Dialysis, 682
Neurogenic Bladder and Urinary Incontinence, 683
Obstructive Conditions, 683
Diagnostic Procedures, 685
Urinalysis, 685
Urinalysis Specimen Collection, 685
Urine Containers, 686
General Specimen Handling, 687
Clean-Catch Urine Specimen Collection, 687
Procedure 33-1. Demonstrate Patient Instruction for a Clean-Catch Urine Specimen, 687
24-Hour Specimen Collection, 688
Procedure 33-2. Demonstrate Patient Instruction for Collection of 24-Hour Urine Specimen, 688
Specimen Collection by Catheterization, 689
Physical Urinalysis, 689
Procedure 33-3. Perform Catheterization of a Female Patient, 690
Procedure 33-4. Perform Catheterization of a Male Patient, 691
Appearance, 693
Odor, 694
Specific Gravity, 694
Procedure 33-5. Measure Urine Specific Gravity with a Refractometer, 694
Urinalysis with Chemical Test Strips, 695
pH, 696
Specific Gravity, 696
Protein, 696
Glucose, 696
Ketones, 697
Bilirubin and Urobilinogen, 697
Blood, 697
Leukocytes, 697
Nitrite, 697
Sediment Examination, 698
Procedure 33-6. Perform Urinalysis Using Chemical Test Strips, 698
Crystals, 699
Procedure 33-7. Perform a Multidrug Screen Urine Test Using the Instant-View Multi-Drug Screen Test, 701
The Male Reproductive System, 701
Anatomy and Physiology, 702
Penis, 702
Scrotum, 702
Internal Structures, 703
Procedure 33-8. Demonstrate Patient Instruction for Testicular Self-Examination, 703
Diseases and Disorders of the Male Reproductive System, 704
Diseases and Disorders of the Prostate, 704
Male Reproductive Disorders, 704
Sexually Transmitted Diseases, 706
Chapter 34. Medical Imaging, 711
Introduction, 712
The Medical Assistant’s Role in Medical Imaging, 712
Radiology, 713
X-rays, 713
Radiographs and Contrast Studies, 713
Procedure 34-1. Perform the General Procedure for an X-ray Examination, 714
Mammography, 715
Angiography, 715
Arthrography, 716
Cholecystography, 716
Fluoroscopy, 717
Computed Tomography, 717
Magnetic Resonance Imaging, 717
Sonography, 718
Nuclear Medicine, 719
Equipment, 719
Portable or Fluoroscopic Equipment, 720
Safety Precautions and Patient Protection, 720
Radiation Shields, 721
Limited-Scope Radiography, 722
Scheduling Radiographs, 722
Assisting with an X-ray, 722
Patient Preparation and Instructions, 722
Preparation of the X-ray Room, 722
Terminology and Landmarks for Positioning, 722
Preparing a Patient for a Mammogram, 722
Preparing the Patient for Abdominal Contrast Studies, 724
Filing and Loaning Radiographic Records, 725
Procedure 34-2. File and Loan Radiographic Records, 726
Chapter 35. Cardiology and Cardiac Testing, 729
Introduction, 732
The Medical Assistant’s Role in Cardiology, 732
Anatomy and Physiology of the Heart, 732
Heart Conduction, 733
Diseases and Disorders of the Heart, 735
Coronary Artery Disease, 735
Angina, 735
Myocardial Infarction, 735
Post-Myocardial Infarction, 735
Sudden Cardiac Arrest, 735
Hypertension/Hypertensive Heart Disease, 736
Congestive Heart Failure, 736
Pulmonary Edema, 736
Cardiomyopathy, 737
Arrhythmias, 737
Arrhythmias Resulting from Impulse Formation or Origin, 737
Arrhythmias Resulting from Conduction Disturbances, 737
Arrhythmias Classified According to Consistency of Point of Origin, 737
Arrhythmias Classified According to Prognosis, 737
Treatment, 738
Infective Heart Disorders, 738
Endocarditis, 738
Myocarditis, 739
Pericarditis, 739
Rheumatic Fever and Rheumatic Heart Disease, 739
Valvular Disorders, 739
Vascular Disorders, 740
Phlebitis, 740
Thrombophlebitis, 742
Embolisms, Deep-Vein Thrombosis, and Thromboembolism, 742
Arteriosclerosis and Atherosclerosis, 742
Aneurysms, 744
Raynaud’s Disease, 744
Buerger’s Disease (Thromboangiitis Obliterans), 744
Diagnostic Tests, 744
Electrocardiogram, 744
Interpreting Waveforms on the ECG Tracing, 746
Artifacts, 747
Holter Monitor, 749
Procedure 35-1. Perform an Electrocardiogram, 750
Procedure 35-2. Demonstrate the Application of a Holter Monitor, 753
Stress Testing, 755
Echocardiogram, 755
Patient Preparation and Instructions, 756
Thallium Scan, 756
MUGA Scan, 756
Blood Studies, 756
Identifying Arrhythmias/Dysrhythmias, 756
Chapter 36. Pulmonology and Pulmonary Testing, 769
Introduction, 771
The Medical Assistant’s Role in Pulmonology, 771
The Anatomy and Physiology of the Pulmonary System, 771
The Upper Airway, 771
The Lower Airways, 771
Pulmonary Physiology, 772
The Mechanics of Gas Exchange, 773
Diseases and Disorders of the Pulmonary System, 773
Lower Respiratory Obstructive Diseases, 773
Infectious and Inflammatory Conditions, 775
Malignancies, 775
Mechanical Insults, 775
Pulmonary Assessment and Diagnosis, 777
Pulmonary Function and Other Common Diagnostic Testing, 777
Procedure 36-1. Demonstrate Performance of Spirometry, 780
ABGs and Pulse Oximetry, 781
Peak Flow Testing, 782
Procedure 36-2. Demonstrate Performance of Measuring Oxygen Saturation Using a Pulse Oximeter, 782
Mantoux Test, 783
Procedure 36-3. Demonstrate Performance of Peak Flow Testing, 784
Procedure 36-4. Demonstrate Performance of the Mantoux Test by Intradermal Injection, 784
Inhalers and Nebulizers, 786
Procedure 36-5. Demonstrate Patient Instruction in the Use of an Inhaler, 787
Procedure 36-6. Demonstrate Patient Instruction in the Use of a Nebulizer, 788
Oxygen Therapy, 789
Common Oxygen Therapy Equipment, 790
Chapter 37. EENT, 793
Introduction, 795
The Medical Assistant’s Role in an EENT Practice, 795
The Anatomy and Physiology of the Eye, 795
Disorders and Diseases of the Eye, 797
Diagnostic Procedures, 798
Visual Acuity, 798
Color Blindness, 801
Eye Treatments, 802
Procedure 37-1. Measure Distance Visual Acuity with a Snellen Chart, 803
Procedure 37-2. Perform the Ishihara Color Vision Test, 804
Procedure 37-3. Perform Eye Irrigation, 804
Procedure 37-4. Perform Instillation of Eye Medication, 806
The Anatomy and Physiology of the Ear, 807
Diseases and Disorders of the Ear, 807
Diagnostic Procedures, 808
Simple Audiometry, 808
Ear Treatments, 808
Procedure 37-5. Perform Simple Audiometry, 811
Procedure 37-6. Perform Ear Irrigation, 812
Procedure 37-7. Perform Instillation of Ear Medication, 813
The Anatomy and Physiology of the Nose, 814
Diseases and Disorders of the Nose and Nasal Passages, 814
Diagnosis and Treatment, 815
The Anatomy and Physiology of the Throat, 815
Procedure 37-8. Assist with the Nasal Examination and Obtain Nasopharyngeal Specimen, 817
Diseases of the Mouth and Throat, 818
Diagnosis and Treatment, 818
Chapter 38. Immunology and Allergies, 823
Introduction, 824
The Medical Assistant’s Role in Immunology and Allergy, 824
The Anatomy and Physiology of the Immune System, 825
Diseases and Disorders of the Immune System, 827
Immunodeficiency Diseases, 827
HIV/AIDS Transmission Prevention Strategies, 828
Autoimmune Diseases, 828
Hypersensitivity and Allergic Reactions, 831
Diagnostic Procedures and Treatments, 832
Chapter 39. Dermatology, 835
Introduction, 836
The Medical Assistant’s Role in Dermatology, 836
The Anatomy and Physiology of the Skin, 837
Diseases and Disorders of the Skin, 839
Dermatitis, 839
Infectious Skin Disorders, 841
Fungal Skin Conditions, 842
Parasitic Skin Conditions, 842
Pigmentation Disorders, 845
Benign Neoplasms, 845
Cancerous Skin Disorders, 846
Miscellaneous Integumentary Conditions, 851
Cosmetic Treatment for Skin Conditions, 852
Chapter 40. Endocrinology, 855
Introduction, 856
The Medical Assistant’s Role in the Endocrinology Office, 856
Anatomy and Physiology of the Endocrine System, 857
The Endocrine Glands, 857
Endocrine Disorders, 860
Pituitary Gland Disorders, 860
Thyroid Gland Disorders, 861
Parathyroid Disorders, 861
Disorders of the Pancreas, 861
Adrenal Gland Disorders, 863
Chapter 41. Emergency Care, 867
Introduction, 869
The Medical Assistant’s Role in Emergencies, 869
Emergency Resources, 870
EMS, 870
Good Samaritan Laws, 870
Medical Office Preparedness, 870
Emergency Equipment and Supplies, 870
Crash Cart and Emergency Medical Box, 870
Emergency Intervention, 871
Emergency Assessment, 871
OSHA Guidelines, 873
CPR, AED, and Obstructed Airway, 874
Airway, 874
Breathing, 876
Circulation, 876
Defibrillation, 876
Heimlich Maneuver, 876
Procedure 41-1. Perform Adult Rescue Breathing and One-Rescuer CPR, 878
Procedure 41-2. Use an Automated External Defibrillator (AED), 879
Chest Pain, 881
Procedure 41-3. Respond to an Adult with an Obstructed Airway, 882
Administering Nitroglycerin, 883
Respiratory Distress, 884
Shortness of Breath (SOB), 884
Hyperventilation, 884
Procedure 41-4. Administer Oxygen, 885
Chronic Obstructive Pulmonary Disease (COPD), 886
Pulmonary Edema, 886
Shock and Anaphylactic Shock, 886
Anaphylactic Shock, 887
Assisting Patients in Shock, 887
Bleeding, 887
Pressure Points, 888
Application of Direct Pressure, 888
Internal Bleeding, 888
Procedure 41-5. Responding to a Patient Who Has Fainted, 888
Epistaxis, 889
Open Wounds, 889
Procedure 41-6. Demonstrate the Application of a Pressure Bandage, 890
Abrasions, 891
Avulsions and Amputations, 891
Lacerations and Incisions, 891
Puncture Wounds, 892
Impaled Objects, 892
Soft-Tissue Injuries, 892
Traumatic Injury Emergencies, 892
Procedure 41-7. Demonstrate the Application of Triangular, Figure 8, and Tubular Bandages, 893
Pressure Bandages, 895
Thermal Injuries: Integumentary and Systemic, 895
Integumentary Insults: Burns, 895
Frostbite, 897
Heat Exhaustion, 898
Hyperthermia, 898
Hypothermia, 898
Musculoskeletal Injuries, 898
Fractures, 899
Procedure 41-8. Demonstrate the Application of a Splint, 900
Splint Application, 901
Sprains, Strains, and Dislocations, 901
Allergic Reactions, 901
Neurological Emergencies, 902
Decreased Level of Consciousness, 902
Seizures, 903
Cerebrovascular Accidents and Transient Ischemic Attacks, 903
Head Injuries, 904
Other Medical Emergencies, 904
Acute Abdominal Pain, 904
Diabetic Coma or Insulin Shock, 905
Poisoning and Overdose, 905
Poison Control Centers, 906
Foreign Bodies in the Eye, Ear, and Nose, 906
Psychosocial Emergencies, 907
Domestic Violence, 907
Sexual Abuse and Rape, 907
Depression, 907
Suicide, 907
Rage, 907
Alcohol Intoxication, 907
Psychotic Behavior, 907
Emergency Preparedness, 908
Earthquakes, 908
Fire, 908
Floods, 909
Hurricanes, 909
Terrorism, 909
Explosions, 909
Biological Threats, 909
Nuclear Blast, 909
Mock-Environmental Exposures, 909
Procedure 41-9. Develop an Environmental Exposure Plan, 910
Chapter 42. Gastroenterology and Nutrition, 914
Introduction, 915
The Medical Assistant’s Role in the Gastroenterology Office, 916
The Anatomy and Physiology of the Gastrointestinal System, 917
The Upper Gastrointestinal Tract (UGI), 917
Mouth, 917
Teeth, 918
Pharynx, 919
Esophagus, 919
Stomach, 920
Duodenum, 920
Lower Gastrointestinal Tract (LGI), 920
The Functions of the Gastrointestinal System, 921
Diseases and Disorders of the GI Tract, 922
Nutrition, 927
The Food Guide Pyramid/MyPyramid Food Guidance System, 931
How to Read a Food Label, 932
Nutrition and Health, 933
Factors That May Affect Caloric Intake, 933
Obesity, 934
The Effects of Alcohol on Nutrition, 934
The Effects of Aging on Nutritional Status, 935
Diseases and Disorders Involving Nutrition, 935
Food Allergies and Food Intolerances, 935
Diagnosis and Treatment of GI Disorders, 936
Diagnostic Procedures, 937
Colonoscopy, 938
Procedure 42-1. Assist with a Colon Endoscopic/Colonoscopy Exam, 939
Sigmoidoscopy, 940
Rectal Suppositories, 940
Patient Instruction in Nutrition, 940
Procedure 42-2. Assist with a Sigmoidoscopy, 942
Procedure 42-3. Insert a Rectal Suppository, 944
Therapeutic Diets, 944
Chapter 43. Orthopedics and Physical Therapy, 949
Introduction, 951
The Medical Assistant’s Role in the Orthopedic Office, 951
The Anatomy and Physiology of the Musculoskeletal System, 952
Bones, 952
Joints, 954
Muscles, 956
The Contraction of Muscle Cells, 957
Common Musculoskeletal Diseases and Disorders, 958
Neoplasia, 961
Traumatic Musculoskeletal Conditions, 961
Fractures, 961
Other Traumatic Conditions, 961
Amputation, 962
Diagnostic Procedures, 963
Treatment of Musculoskeletal Conditions in the Orthopedic Office, 963
Splints and Braces, 963
Casts, 964
Cast Application, 964
Procedure 43-1. Assist with Fiberglass Cast Application, 965
Cast Removal, 966
Physical Therapy Modalities, 966
Procedure 43-2. Assist with Cast Removal, 967
Thermodynamics, 968
Ultrasonography, 969
Assistive Aids for Ambulation, 969
Crutches, 969
Procedure 43-3. Assist the Patient with Cold Application/Cold Compress, 970
Procedure 43-4. Assist the Patient with Hot Moist Application/Hot Compress, 970
Procedure 43-5. Assist with Therapeutic Ultrasonography, 971
Procedure 43-6. Demonstrate Measuring for Axillary Crutches, 972
Canes, 975
Walkers, 975
Procedure 43-7. Assist a Patient with Crutch Walking, 976
Procedure 43-8. Assist a Patient in Using a Cane, 977
Prostheses, 977
Procedure 43-9. Assist a Patient in Using a Walker, 978
Body Mechanics, 978
Procedure 43-10. Assist a Patient in a Wheelchair to and from an Exam Table, 979
Chapter 44. Obstetrics and Gynecology, 983
Introduction, 985
The Medical Assistant’s Role in the OB/GYN Office, 985
The Anatomy and Physiology of the Female Reproductive System, 985
Anatomy and Physiology of the Female Breast, 987
The Menstrual Cycle, 987
Menstrual Disorders, 988
Contraception, 988
Infertility, 991
Pregnancy and the Birth Process, 991
Delivery, 992
Obstetrical History, 992
Complications of Pregnancy, 994
Procedure 44-1. Assist with a Prenatal Exam, 994
Breastfeeding, 996
Gynecological Diseases and Disorders, 996
Assessing Vaginal Bleeding, 996
Sexually Transmitted Diseases, 998
Breast Disorders and Conditions, 998
Procedure 44-2. Instruct the Patient in Breast Self-Examination, 1000
Routine Assessment, 1001
Diagnostic Procedures, 1001
Procedure 44-3. Assist the Physician in the Performance of a Pelvic Examination and Pap Test, 1001
Procedure 44-4. Perform a Urine Pregnancy Test, 1004
Treatment Modalities, 1004
Cryosurgery, 1005
Procedure 44-5. Assist with Cryosurgery, 1005
Psychological Considerations, 1006
Chapter 45. Pediatrics, 1010
Introduction, 1011
The Medical Assistant’s Role in Pediatrics, 1012
Physical, Developmental, and Emotional Growth of a Child, 1012
Monitoring Growth Development, 1012
Routine Visits (Well-Baby Checks), 1018
Measuring Growth, 1018
Procedure 45-1. Perform and Record Measurements of Height or Length, Weight, and Head and Chest Circumference, 1018
Procedure 45-2. Perform and Record Pediatric Vital Signs and Vision Screening, 1020
Immunizations, 1021
Procedure 45-3. Perform Documentation of Immunizations, Both Stored and Administered, 1024
Storing Vaccines, 1025
Common Pediatric Diseases and Conditions, 1025
Common Contagious Diseases of Childhood, 1025
Congenital Neurological Disorders/Neural Tube Defects, 1025
Congenital Heart Conditions, 1028
Blood Disorders, 1028
Other Conditions, 1029
Diagnostic Procedures, 1029
Positioning and Securing the Child for Examination and Treatment, 1030
Pediatric Urine Collection, 1031
Procedure 45-4. Perform Urine Collection with a Pediatric Urine Collection Bag, 1032
Chapter 46. Neurology, 1036
Introduction, 1038
The Medical Assistant’s Role in Neurology and Neurosurgery, 1038
The Anatomy and Physiology of the Nervous System, 1038
The Central Nervous System, 1039
The Peripheral Nervous System, 1039
The Neuron, 1040
Functions of the Nervous System, 1041
Assessing the Neurological System, 1041
Procedure 46-1. Assist in a Neurological Exam, 1042
The Glasgow Coma Scale, 1043
Lumbar Punctures, 1043
Electroencephalography, 1043
Procedure 46-2. Assist with a Lumbar Puncture, 1044
Procedure 46-3. Prepare a Patient for an Electroencephalogram, 1045
Disorders and Diseases of the Central Nervous System, 1045
Cerebrovascular Accidents, 1045
Transient Ischemic Attack, 1046
Epilepsy, 1046
Amyotrophic Lateral Sclerosis, 1047
Parkinson’s Disease, 1047
Multiple Sclerosis, 1047
Headache, 1047
Infectious Conditions of the Central Nervous System, 1048
Encephalitis, 1048
Meningitis, 1048
Brain Abscess, 1048
Brain Tumors, 1049
Head Trauma, 1049
Concussions and Contusions, 1049
Spinal Cord Injuries, 1050
Disk Disorders, 1050
Diseases of the Peripheral Nervous System, 1050
Bell’s Palsy, 1050
Trigeminal Neuralgia, 1050
Shingles (Herpes Zoster), 1051
Chapter 47. Mental Health, 1054
Introduction, 1055
The Medical Assistant’s Role in the Mental Health Field, 1056
The Anatomy and Physiology of Cognitive Functioning, 1057
Mental Wellness, 1058
General Mental Disorders, 1058
Schizophrenia, 1058
Mood Disorders, 1059
Major Depressive Disorder, 1059
Postpartum Depression, 1062
Seasonal Affective Disorder, 1062
Bipolar Disorder, 1063
Personality Disorders, 1063
Anxiety Disorders, 1063
Generalized Anxiety Disorder and Panic Disorder, 1064
Phobic Disorder, 1064
Obsessive-Compulsive Disorder, 1064
Posttraumatic Stress Disorder, 1064
Somatoform Disorders, 1064
Somatization Disorder, 1064
Conversion Disorder, 1064
Hypochondriasis, 1065
Factitious Disorders, 1065
Gender Identity Disorder, 1065
Mental Retardation, 1066
Dementia, 1066
Alzheimer’s Disease, 1066
Vascular Dementia, 1066
Dementia due to Head Trauma, 1067
Mental Disorders Occurring During Childhood, 1067
Substance-Related Disorders, 1068
Assessment and Diagnosis, 1070
Standard Treatments for Mental Disorders, 1070
Chapter 48. Oncology, 1074
Introduction, 1075
The Medical Assistant’s Role in the Oncology Practice, 1076
The Classification and Physiology of Cancers, 1076
Diagnostic Procedures, 1077
Routine Diagnostic Screening, 1078
Tumor Markers, 1078
Staging and Grading Malignant Tumors, 1078
Cancer Treatment, 1079
Chemotherapy, 1079
Radiation, 1080
Surgery, 1080
Hormone Therapy and Immunotherapy, 1081
Side Effects of Cancer Treatment, 1082
Recent Developments in Cancer Treatment, 1082
Hospice and Emotional Support, 1082
The Cancer Prevention Lifestyle, 1083
Chapter 49. Geriatrics, 1086
Introduction, 1087
The Medical Assistant’s Role in the Geriatric Office, 1088
The Aging Process, 1088
Physical Aspects of Aging, 1088
Social and Psychological Aspects of Aging, 1089
Nutritional Aspects of Aging, 1090
Economic Aspects of Aging, 1090
Procedure 49-1. Role-Play Sensorimotor Changes of the Elderly, 1091
Cultural Views of Aging, 1092
Promoting Health Among the Elderly, 1093
Unit XI. Nontraditional Medicine, 1097
Chapter 50. Alternative Medicine, 1098
Introduction, 1099
The Medical Assistant’s Role in Alternative Medicine, 1100
Complementary and Alternative Medical Systems, 1100
Alternative Medicine, 1100
Ayurveda, 1100
Homeopathy, 1100
Naturopathy, 1101
Acupuncture, 1101
Mind–Body Interventions, 1101
Biofeedback, 1101
Integrative Medicine, 1101
Biologically Based Therapies, 1101
Aromatherapy, 1102
Herbal Medicine, 1102
Manipulative and Body-Based Methods, 1102
Hydrotherapy, 1102
Acupressure, 1102
Chiropractic, 1103
Craniosacral Therapy, 1103
Exercise, 1103
Reflexology, 1103
Massage, 1104
Lymphatic Massage, 1104
Sports Massage, 1104
Swedish Massage, 1104
Energy Therapies, 1105
Unit XII. Career Strategies, 1111
Chapter 51. Competing in the Job Market, 1112
Introduction, 1113
The Medical Assistant’s Role in Competing in the Job Market, 1113
The Externship Experience, 1114
Understanding the Externship Site’s Responsibilities, 1114
Outlining the Student’s Responsibilities, 1114
The Responsibilities of the Medical Assisting Program, 1114
Writing an Effective Resume, 1114
Preparing a Cover Letter, 1116
Identifying Places to Look for Employment, 1116
Procedure 51-1. Write an Effective Resume, 1116
Completing Employment Applications, 1117
Procedure 51-2. Compose a Cover Letter, 1117
The Successful Interview, 1120
Preparing for the Interview, 1120
Dressing for the Interview, 1120
Presenting the Right Image, 1121
Following Up After the Interview, 1121
Changing Jobs, 1121
Procedure 51-3. Follow Up with an Employer After an Interview, 1122
Appendix A. Correlation of Text to the General, Clinical, and Administrative Skills of the CMA (AAMA), 1125
Appendix B. Registered Medical Assistant (RMA) Medical Assisting Task List, 1129
Appendix C. How to Become a Successful Student, 1131
Appendix D. Preparing for the CMA (AAMA) and RMA (AMT) Certification Exams, 1133
Appendix E. Translation of English–Spanish Phrases, 1137
Appendix F. Normal Blood Values/Disease Conditions Evaluated for Abnormal Values, 1139
Appendix G. Common Medical Abbreviations, 1145
Appendix H. Medical Terminology Word Parts, 1147
Appendix I. Answers to Chapter Case Study Critical Thinking Questions and In-Practice Scenarios, 1159
Appendix J. Introduction to Medisoft Advanced (version 12) and Medisoft Simulation, 1177
Glossary, 1213
References, 1239
Index, 1241
Pearson Education, Inc., EP-1

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