Module 12 - Essentials of Coding

The business of health care sometimes seems like a big bowl of alphabet soup.
You will hear the terms CPT code, ICD-9 code, and HCPCS (hic-picks) used by
the business office staff, physicians, and support staff. They may be
complaining that a claim was not paid because it had the wrong code. Since
getting paid for the services rendered in your office is critical, it is important that
everyone has a basic understanding of the various codes used to bill third-party
payers for the services rendered.
The Purpose of Coding
Why do we use codes? First, the government mandates that all providers use
the same codes. Second, coding is a way to collect data about the state of the
countrys health care. If we read a report or hear in a news program that there
were 234,000 hip replacement surgeries done in the United Kingdom in 2004,
how does the author of that report know that number? You can check for that
kind of information. Additionally, accurate coding provides researchers with
information for epidemiological studies and quality of care issues.
There are really two types of coding that are commonly used to describe what
was done for the patient and why. Understanding the types of coding is
important for all staff members of the medical office.
International Classification of Diseases, Ninth Revision
International Classification of Diseases, Ninth Revision (ICD-9) codes are the
codes that identify the reason for the visit. These codes provide the diagnoses
associated with the services provided. They are based on the official version of
the World Health Organizations ninth revision of the International Classification
of Diseases. The ICD-9-CM (International Classification of Diseases, Ninth
Revision, Clinical Modification) classifies morbidity (illness) and mortality (death)
information for statistical purposes.
The ICD-9-CM is updated every year in October.
As discussed previously, coding the diagnosis for each patient is very important.
To do proper coding, you must have training in medical terminology. Some
understanding of anatomy and physiology is also important.
In the outpatient setting, diagnoses must be coded based on the primary (first)
diagnosis. The primary diagnosis is the main reason the patient came to see a
physician or other health care provider. This could be a symptom such as
vomiting, coughing, or diarrhoea; an acute problem such as a laceration; or a
chronic illness such as diabetes. Patients may often have more than one
diagnosis, but it is critical to identify the primary diagnosis.
1

ICD-9 codes are usually five digits (numbers). However, ICD-9 codes may be
three or four digits or may start with the letter E or V. M codes or morphology
codes are used to further identify the behaviour of a neoplasm and are used by
cancer registries. M codes are not used when submitting claims to a third-party
payer.
The ICD-9 code book consists of three volumes: Volume 1 is a tabular
numerical listing of diagnosis codes; Volume 2 is the alphabetic listing of
diagnoses; and Volume 3 is a combined tabular and alphabetic listing of
procedures and is used primarily in the hospital setting. There are also five
appendixes.
Volumes 1 and 2 are used by physicians and other care providers who are able
to bill for their services. Like Annual code changes are implemented on October
1.
Volume 2, the Index to Diseases, actually appears first in all ICD-9 books. That
is because it is necessary to start with the index first to find the correct
diagnostic code. There are three sections in Volume 2. Section One is the
alphabetical listing of symptoms, signs, diagnoses, and conditions. Section Two
is an alphabetic index to poisoning and external causes of adverse effects of
drugs and other chemical substances. Section Three is an alphabetic index to
external causes of injury.
Volume 1 lists all the diseases and injuries numerically. There are 17 chapters.
Each chapter groups problems by cause (aetiology) or anatomical site.
Additionally, the V and E codes are listed, and there are several appendixes
and tables at the end of Volume 1. Each chapter is divided into sections of
similar diseases.
Within each disease category, a fourth and sometimes a fifth digit are necessary
to identify the diagnosis correctly. These digits provide more specific information
than just a three-digit code can and are placed after the first three digits. Here
are two examples:
401.1 is benign essential hypertension.
404.11 is benign hypertensive heart and renal disease, without mention of
heart failure or renal failure.
Care must be taken to include fourth and fifth digits where indicated in the ICD9 code book. Failure to do so will mean nonpayment of the claim. Again, the
example of essential hypertension illustrates the need for a fourth digit. Look at
the code 401 in the ICD-9 code book. It will show a check 4th digit in front of
the code. That means that unless a fourth digit is added, the coding is not
correct. Professional coders will tell you that the first cardinal rule in coding is to
code to the highest level of specificity when coding diagnoses.
These codes are used to identify patient encounters when the circumstances
are other than an actual disease or injury. For example, there may be a
2

personal or family history of disease, but the patient does not actually have that
disease at the time of the visit. Or, the patient may have been exposed to an
infectious disease, but has no symptoms. V codes are also used for
immunizations and to code supervision of pregnancy. Table 9.6 contains a list of
the major V code headings. V codes may be used as a primary diagnosis when
appropriate.
V codes are separated into three main categories: problems, services, and
factual findings. A problem is something that affects the patients health status,
such as a history of disease or a problem. For example, V12.52 is history of
thrombophlebitis. This is not the primary diagnosis code, but would be important
to record if the patient was being assessed for surgery. A service is when a
patient is seen for something other than illness or injury. An example would be
V09.1 which is the code for vaccination for diphtheria-tetanus-pertussis (DTP)
with typhoid-parathyroid. Finally, factual findings are used to describe facts for
statistical purposes. The most commonly used are codes related to
reproduction and development. V33.01 is the code for twins delivered in the
hospital by caesarean section.
Like the other diagnostic codes, V codes may have five digits. Using the V33.01
mentioned, the last two digits help specify the conditions. If the V code was
V33.10, that would indicate that the twins (V33) were born before admission to
the hospital (1) and without mention of caesarean section (0). As you can see,
specificity is important.
The last area of diagnostic coding is E codes. These codes identify external
causes of injury and poisoning and are used to code the events or
circumstances surrounding the cause of injury, poisoning, or other adverse
effect. For example, the patient may have been in a minor auto accident and
comes to the office because his or her neck is strained. The diagnostic code for
the neck strain is 847.0. However, it will be important to code for the
circumstances (auto accident) also. E codes are never used alone. They are
always at least secondary to the primary diagnosis.
Why is it important to do E coding? There may be many different payers
involved in a patients care, particularly if the care is needed because of an
accident. In the previous example, auto insurance (either the patients or the
persons who caused the accident) is responsible for payment of the costs
associated with care. The patients primary health insurance is not liable for any
costs until the limits on the auto insurance liability have been exhausted. Even
then, there may be problems with coverage. E coding assists the payers in
sorting out who is responsible.
Diagnostic coding is complicated. To appropriately code an office visit or other
outpatient procedure, there are steps that should be followed routinely. Keep in
mind that if an incorrect or inappropriate code is submitted for billing, not only
may the practice not be paid, but you may be inadvertently labelling a patient
with an illness he or she does not have. The second cardinal rule in ICD-9 in the
outpatient setting is that you code signs and symptoms if you do not have a
confirmed diagnosis. Fever, headache, muscle and joint ache, sore throat, and
3

diarrhoea are all symptoms of HIV, but they are also symptoms of the flu. In a
case like this, the medical professional who may suspect HIV will be sure to get
a detailed patient history looking for known risk behaviours that could lead to
HIV. For purposes of coding the first visit, the signs and symptom already
mentioned would be coded, not HIV.
You will need to go through this same process for each sign, symptom,
diagnosis, or condition. Be sure that the first code listed is the primary
diagnosis. Do not code conditions when the provider has said suspected, rule
out, questionable, or probable. As mentioned, the symptoms are coded.
Until you have a confirmed diagnosis, you cannot code a disease.
Coding is an important aspect of the health care business. Coding is the
translation of procedures, services, supplies, and diagnoses into numeric and
sometimes alphanumeric codes for research and statistical purposes.

Module 12 - Office Safety and

Wellness
The health and safety of the physicians, staff, patients, and other visitors should
always be a top priority in the medical office. Providing a physically safe
environment not only makes common sense, but it also makes good business
sense. All practices should have appropriate measures in place to protect the
patients and staff.
There are six standards that apply to all medical offices and a seventh standard
that applies if you offer X-ray services in your office.
The first standard is the blood borne pathogens standard. The intent of this
standard is to reduce exposure to blood borne diseases. The rule specifically
targets the human immunodeficiency virus (HIV) and the hepatitis B and C
viruses. The basic rules require the following:
A written exposure control plan, updated annually. The update should
reflect any changes in technology (the use of newer, safer devices in
order to reduce risk of needle sticks, for example). The plan doesnt
require the use of every new device on the market, only documentation
as to why you chose the specific devices. The plan should also document
input from employees when selecting various devices.
Use of safer needles and sharps.
Use of the right personal protective equipment (PPE). This includes
gloves, face and eye protection, and gowns.
Use of universal precautions.
Hepatitis B vaccinations for staff who may have exposure.
Medical follow-up after an exposure incident.
Proper containment of all regulated waste.
Identification (via labels or colour-coding) of regulated waste containers,
sharps disposal boxes, and containers for disposal of hazardous waste.
Employee training.
The second standard is the hazard communication standard. Under this
standard, if your office contains any hazardous chemicals of any kind, the
employees have a right to know about them. Every medical office contains
5

some hazardous chemicals. Alcohol, disinfectants, anaesthetic agents, and

sterilizing agents are examples. The safety officer should have collected the
manufacturer-supplied Material Safety Data Sheets (MSDS) that outline the
proper procedures for working with a specific substance, as well as how to
contain the material in the event of a spill or other emergency. If an MSDS has
been misplaced, a simple Internet search will provide the safety officer with a
variety of resources to get a new MSDS. Just enter MSDS into any search
engine. It is a good idea to keep the sheets in separate sheet protectors, and to
clearly label the notebook.
Having clearly marked exit routes is the third standard. All offices must provide
safe and accessible building exits in case of fire or other emergencies.
Accessible means they cannot be blocked or locked from the inside. At a very
minimum, you must establish exit routes to accommodate all employees and
patients in a defined workspace. The easiest way to remember what to do in the
case of fire or other emergency that requires everyone to evacuate is to
remember the acronym RACE. Figure 11.1 outlines RACE. Every office should
have a fire drill at least once a year, preferably twice a year.
The fourth standard deals with the safe use and location of electrical outlets and
wiring in hazardous locations. If you use flammable gases, you may need
special wiring and equipment installation. In these cases, it is important to check
with your local fire department or to ask for a consult.
The fifth standard: This standard requires the reporting of occupational injuries
and illnesses. However, your state law may be different.

Figure 11.1 Fire Procedures

The final guideline for all offices is the requirement to display the notice of
employee rights in a conspicuous place in the office. Usually these posters are
found in the employee break room.
The seventh standard applies to X-ray machines or other imaging services. This
standard requires:
A survey of the types of radiation used in the facility, including X-rays.
Restricted areas to limit employee exposures.
Employees working in restricted areas to wear personal radiation
monitors such as film badges or pocket dosimeters
6

 Rooms and equipment to be labelled and equipped with caution signs.

The law requires that one employee be designated as a safety officer. This
person is responsible for developing and maintaining the safety programs. The
safety officer creates and updates the safety manual and trains all new
employees in the safety standards. Employees must annually review safety
programs, and the safety officer must also annually review the rules to ensure
that they are up-to-date. In addition, the safety officer is responsible for all
recordkeeping requirements imposed by the law or the state health and safety
office, as well as representing the facility in the event of an inspection by law or
the state.
The law has a general duty clause in its regulations. This means that either the
safety officer, practice administrator, or physician administrator must review the
facilitys physical space for adequate lighting, appropriate signage for exiting,
safe stairs and stairways, and air quality. Additionally, an evaluation of the fire
safety system in place as well as evacuation procedures is important. If
automated external defibrillators are in place, the safety officer is responsible for
their proper installation and the training of appropriate personnel.
Preventing the Transfer of Disease in the Office
As mentioned, the law requires that all offices have an infection control plan in
place. Infection control is the effort made, often regulated by the federal or state
government, to control the presence of harmful microorganisms. Everyone in
the office is responsible for maintaining a safe working environment. Much of
the work to ensure this safe working environment is the responsibility of the
clinical staff; however, all staff should have an understanding of how disease is
spread.
We have all used the words bugs or germs to describe an illness we have had
that we believe we caught from someone or something else. These bugs and
germs are microbes that cause disease. The microbes are called pathogens,
and most pathogens belong to one of four groupsviruses, fungi, bacteria, and
protozoa.
Viruses are tiny bits of protein-coated nucleic acid that take over cells in another
living organism. Viruses need living cells to reproduce. The flu and the common
cold are viruses.
Fungi are plant like organisms. They live in the air, the soil, on other plants, and
in water. Mushrooms and mould are the most commonly known fungi. Only
some fungi cause disease. There is evidence that our bodies may react
adversely to mould. Ringworm is another example of a disease caused by a
fungus.
Bacteria are one-celled creatures found in water and soil, and also on other
organisms. There are thousands of different types of bacteria in the world and
many are harmless. Some are even helpful to humans. However, some bacteria
cause disease. The most commonly known problem caused by bacteria is strep
7

throat. This problem is caused by a bacteria called streptococcus A. Bacteria

may also form spores. A spore is a protective protein shield that bacteria form
around themselves. The bacteria rest until the right conditions exist for growing.
Protozoa are tiny parasites that live in or on another organism. Found mostly in
tropical or moist environments, they can cause diseases like malaria.
Most pathogens live in our environment, but they dont always cause disease.
The chain of infection has five links, as illustrated in Figure 11.3.
The process of infection is like a chain with five links. The first link is the
reservoir host, the animal, human, or insect where the microorganism lives and
grows. Sometimes the reservoir host shows signs of infection, but sometimes it
does not. The reservoir host is the carrier of the microorganism.
The second link is the exit from the reservoir. Some of the exit routes include
the nose or mouth, the urinary tract, the intestinal tract, or a wound.

Figure 11.3 Process of Infection

The third link in the process is called the vehicle of transmission. This is the way
the organisms are carried about. Hands, equipment, instruments, silverware
and linens, and air droplets are examples of vehicles of transmission.
A portal of entry is the fourth link in the cycle. The pathogen must have nutrients
to survive, so the portal of entry is where the microorganism can enter the next
hosts body. The microbes may be in air droplets that we breathe. Some
microbes may be found in food or drink. An open cut can be a portal of entry.
The final link is a susceptible host. This is a person who cannot fight the
pathogen once it has entered the body. He or she becomes ill. The new host
also becomes a carrier, or reservoir host, and the infection chain may start
again.
Some pathogens make you sick for a short time, some for a long time. There
are three types of infectionacute, chronic, or latent.
An acute infection develops quickly and lasts for a short time. The flu is an
example. The immune system works to destroy the virus and the symptoms
disappear in one to two weeks.
A chronic infection lasts for a long timesometimes for a lifetime. Symptoms
may not always be present. Hepatitis B is an example of a chronic infection
caused by a virus. The virus may be detectable only in the patients
bloodstream, and the patient may have no symptoms.
When a pathogen has not been active (dormant), it is called a latent infection.
Viruses can cause these kinds of infections. Genital herpes is an example of a
dormant infection. When the pathogen becomes active, the virus may be
transmitted to other people. Table 11.1 illustrates some common infectious
diseases and how they are spread.
There are two types of transmission of infectious diseases. Direct transmission
is when there is direct contact between the reservoir host and the susceptible
host. Direct transmission includes:
Touching blood or other infected body fluids of the reservoir host
Inhaling infected air droplets of the reservoir host
Intimate contact such as kissing or sexual intercourse
Shaking hands

Table 11.1 Common Infectious Diseases

Indirect transmission is when the pathogens are spread through a vector.
Vectors are objects that contain pathogens. Some examples of vectors are:
Using a medical instrument that has not been properly disinfected
Getting bitten by an insect that carries the disease
Eating food that is contaminated
Drinking from an infected persons glass
Touching a contaminated surface, such as doorknob or a childs toy
In the office, it is necessary to break this chain so that the microorganism is no
longer able to live. The methods and practices designed to prevent the spread
of disease are referred to as medical asepsis.
The most important medical aseptic practice is washing your hands. Learning
the correct way to wash your hands is important.
When should you wash your hands? Before and after patient contact or contact
with blood or other bodily fluids; after coughing, sneezing, or blowing your nose;
before and after lunch; after using the restroom; and after any contact with
contaminated material. Clinical personnel routinely wear latex gloves when
handling anything that could pose a risk of contamination.

10

Table 11.2 Levels of Infection Control

There are three levels of infection control, as shown in Table 11.2. The lowest
level is sanitization, cleaning the surface using soap or detergent. This process
will reduce the number of microbes. Warm, soapy water should be used to
thoroughly clean surfaces.
Disinfection is the second level of infection control. Common disinfectants like
bleach, when used properly, can destroy many pathogens and other microbes.
Disinfectants are more effective if the items have been sanitized first.
The process that destroys all forms of microorganisms and bacterial spores is
sterilization. As the highest level of infection control, sterilization is used on
medical instruments. Any medical instrument that breaks the skin, contacts
surgical incisions, or becomes contaminated during a procedure should be
sterilized. There are five different methods of sterilization, as shown in Figure
11.6. Additionally, many medical offices use disposable sterile supplies that
come in ready-to-use packages. These supplies are to be used once and
discarded appropriately after use.
Not everyone in the medical office has the same exposure to infection under
normal circumstances. Front desk staff members are less likely to be exposed
to the same types of infections as clinical staff members. However, it is
important for everyone to be aware of how germs and bugs are spread and to
take the right precautions to avoid the spread of disease.

Figure 11.6 Types of Sterilization

11

Module 12 - Pandemics
In the past several years, we have heard much about the bird or avian flu, and
the term pandemic has been used a lot. A pandemic is an epidemic that is
spread over wide areas of the world and affects large numbers of people. The
World Health Organization says that a flu pandemic occurs when a new
influenza virus emerges for which people have little or no immunity, and for
which there is no vaccine. The disease spreads easily person-to-person,
causes serious illness, and can sweep across the country and around the world
in a very short time.
Despite all the publicity about the HFNI (bird) flu virus, it has not yet become a
pandemic. Does that mean we will never see a pandemic again? Most experts
believe that flu pandemics occur in cycles of 10 to 30 years. As you can see, the
medical community was able to reduce the number of deaths from flu
pandemics partly because it has a much better understanding of how a
pandemic spreads. Therefore, we need to have both personal and office plans
in place because it could happen again. Authorities worldwide are making plans,
but because it has been so long since this country and the world have seen a
true pandemic, we tend to dismiss the potential problems. Medical facilities
should be particularly concerned, as the patients with the flu will be seeking
care. According to the World Health Organization, it is difficult to predict when
the next influenza pandemic will occur or how severe it will be. Wherever and
whenever a pandemic starts, everyone around the world is at risk. Countries
might, through measures such as border closures and travel restrictions, delay
arrival of the virus, but they cannot stop it.

Table 11.3 Flu Pandemic Deaths

The characteristics of a pandemic include the following:
The disease will spread rapidly from person to person due to little or no
immunity.
Substantial numbers of people will require some form of medical care.
Normal flu viruses have a major effect on older and younger individuals;
a pandemic flu will impact all ages.

12

 Death rates are high.

The health care systems are unable to manage the spread of the
disease as there will not be enough staff, hospital beds, and equipment
to manage a large influx of patients.
The need for vaccine will outstrip the supply; the antiviral drugs needed
in the early stages of the pandemic will be depleted quickly.
Difficult decisions will have to be made about who gets the vaccines
and antiviral medications.
Past flu pandemics have come in two or three waves, each lasting six to
eight weeks.
Travel bans, school closures, and other restrictions will create
problems.
Caring for a sick family member and fear of exposure will create
significant employee absenteeism.
Communication and information are critical components of pandemic response.
The World Health Organization has indicated that education and outreach are
critical to preparing for a pandemic. Understanding what a pandemic is, what
needs to be done at all levels to prepare for pandemic influenza, and what could
happen during a pandemic helps us make informed decisions both as
individuals at our practices and as a nation. Your practice needs a plan in place.
This plan will help you deal with a pandemic or local flu epidemic that becomes
crippling.
Experts agree that all medical offices should have a response plan in place for
an epidemic and/or pandemic. The first step in establishing that plan is based
on the practice type and location. Rural practices will have to prepare to be a
major focal point for their community. Many times, options for inpatient care are
limited in rural settings, and the medical communities will need to look at ways
to create space for higher than normal levels of hospitalized patients. Urban and
metropolitan practices have more resources at hand, but it will require
significant coordination among the various area agencies.
Although every practices plan will differ, there are key components that all
practices should identify for their internal plan.
The first step is to develop a structure for planning and decision making. This
includes identifying members of a planning committee (if appropriate due to the
size of the practice) as well as identifying point-of-contact people within the
practice.
The second and third steps are to develop a written plan. The plan should
include:

13

 Surveillance and detection of pandemic influenza in the population

served.
A communication plan within the practice and with key public health
contacts, as well as health care entities.
Education and training for all medical office staff.
Informational materials for patients that are in language and reading
level appropriate for the population being served.
A plan for triage and management of patients during the pandemic.
An infection control plan.
A vaccine and antiviral use plan.
An occupational health plan that includes handling of staff who become
ill, when personnel may return to work, when personnel who are
symptomatic but well enough to work will be permitted to continue
working, and personnel who need to care for their ill family members.
Issues related to surge capacitythe influx of patients and staff and
supply shortages.
Safety is everyones responsibility. In the medical practice, not only do we have
to be aware of the commonsense things like washing our hands and covering
our mouths when we cough, but also those procedures that reduce the chances
of anyone becoming infected. Constant attention to infection control should be a
day-to-day activity.
The threat of pandemic or other major emergency affecting the community must
be treated seriously. As a country, we are still learning much about how to react
to these types of threats. In an emergency, common sense sometimes
disappears, so well-prepared health and medical personnel is a must.

14

Module 12 - Physiotherapy
department
The physiotherapy department treats people of all ages with physical problems
caused by illness, accident or ageing. Physiotherapists identify and maximise
movement potential through health promotion, preventive healthcare, treatment
and rehabilitation.
The core skills used by physiotherapists include manual therapy, therapeutic
exercise and the application of electro-physical modalities. Physiotherapists
also have an appreciation of psychological, cultural and social factors which
influence their clients.
There is usually only a part-time secretary in this department.
The following are just a few of the areas physiotherapists work:
outpatients

intensive care

womens health

care of the elderly

stroke patients

orthopaedics

mental illness

learning difficulties

occupational health

terminally ill

paediatrics
Physiotherapists working within hospitals are needed in virtually every
department, from general out-patients to intensive care, where round-the-clock
chest physiotherapy can be vital to keep unconscious patients breathing.
Hospitals often have physiotherapy gyms, hydrotherapy and high-tech
equipment so that specialist therapy can be carried out.
Nowadays, more and more physiotherapists work outside the hospital setting, in
the community where a growing number are employed by GP fund holders.
Treatment and advice for patients and carers take place in their own homes, in
nursing homes or day centres, in schools and in health centres.

15

Module 12 - Plastic surgery and

burns
Plastic surgery is a medical specialty concerned with the correction or
restoration of form and function. While famous for aesthetic surgery, plastic
surgery also includes many types of reconstructive surgery, hand surgery,
microsurgery, and the treatment of burns.
In World War I, a New Zealand otolaryngologist working in London, Harold
Gillies, developed many of the techniques of modern plastic surgery in caring
for soldiers suffering from disfiguring facial injuries. His work was expanded
upon during World War II by his cousin and former student Archibald McIndoe,
who pioneered Procedures for RAF aircrew suffering from severe burns. In one
of my medical secretarial positions I worked for the curator of the Gillies
Archives based at a hospital in Sidcup.
Subspecialties
Plastic surgery is a broad field, and may be subdivided further.
Burn
Cosmetic
Craniofacial
Hand
Micro
Paediatric
Techniques and procedures
In plastic surgery, the transfer of skin tissue (skin grafting is a very common
procedure. Skin grafts can be taken from the recipient or donors:
Autografts are taken from the recipient. If absent or deficient of natural tissue,
alternatives can be cultured sheets of epithelial cells in vitro or synthetic
compounds, such as integra, which consists of silicone and bovine tendon
collagen with glycosaminoglycans.
16

Allografts are taken from a donor of the same species.

Xenografts are taken from a donor of a different species.
Usually, good results are expected from plastic surgery that emphasizes careful
planning of incisions so that they fall in the line of natural skin folds or lines,
appropriate choice of wound closure, use of best available suture materials, and
early removal of exposed sutures so that the wound is held closed by buried
sutures.
Reconstructive surgery
Plastic surgery is performed to correct functional impairments caused by burns;
traumatic injuries, such as facial bone fractures and breaks; congenital
abnormalities, such as cleft palates or cleft lips; developmental abnormalities;
infection and disease; and cancer or tumours. Reconstructive plastic surgery is
usually performed to improve function, but it may be done to approximate a
normal appearance.
The most common reconstructive procedures are tumour removal, laceration
repair, scar repair, hand surgery, and breast reduction.
Some other common reconstructive surgical procedures include breast
reconstruction after a mastectomy, cleft lip and palate surgery, contracture
surgery for burn survivors, and creating a new outer ear when one is
congenitally absent.
Plastic surgeons use microsurgery to transfer tissue for coverage of a defect
when no local tissue is available. Free flaps of skin, muscle, bone, fat, or a
combination may be removed from the body, moved to another site on the body,
and reconnected to a blood supply by suturing arteries and veins as small as 1
to 2 millimeters in diameter.
Cosmetic surgery
Abdominoplasty ("tummy tuck"): reshaping and firming of the
abdomen
Blepharoplasty ("eyelid surgery"): reshaping of the eyelids or the
application of permanent eyeliner,
Phalloplasty
Mammoplasty
Buttock augmentation
Chemical peel: minimizing the appearance of acne, chicken pox, and
other scars as well as wrinkles (

17

Labiaplasty: surgical reduction and reshaping of the labia

Lip enhancement: surgical improvement of lips' fullness through
enlargement
Rhinoplasty: reshaping of the nose
Otoplasty: reshaping of the ear, most often done by pinning the
protruding ear closer to the head.
Rhytidectomy ("face lift"): removal of wrinkles and signs of aging from
the face
Browplasty ("brow lift" or "forehead lift"): elevates eyebrows,
smoothes forehead skin
Midface lift ("cheek lift"): tightening of the cheeks
Suction-assisted lipectomy ("liposuction"): removal of fat from the
body
Chin augmentation: augmentation of the chin with an implant, usually
silicone, by sliding genioplasty of the jawbone or by suture of the soft
tissue
Cheek augmentation ("cheek implant"): implants to the cheek
Orthognathic Surgery: manipulation of the facial bones through
controlled fracturing
Fillers injections: collagen, fat, and other tissue filler injections, such as
hyaluronic acid
Laser skin resurfacing

Module 12 - Psychiatry
A psychiatrist is a physician who specialises in psychiatry and is certified in
treating mental disorders. All psychiatrists are trained in diagnostic evaluation
and in psychotherapy. As part of their evaluation of the patient, psychiatrists are
one of the few mental health professionals who may prescribe psychiatric
medication, conduct physical examinations, order and interpret laboratory tests
and electroencephalograms, and may order brain imaging studies such as
computed tomography or computed axial tomography, magnetic resonance
imaging, and positron emission tomography scanning.
Sub Specialities
18

The field of psychiatry itself can be divided into various subspecialties. These
include:

Addiction psychiatry

Adult psychiatry

Child and adolescent psychiatry

Consultation-liaison psychiatry

Cross-cultural psychiatry

Emergency psychiatry

Forensic psychiatry

Learning disability

Neurodevelopmental disabilities

Neuropsychiatry

Psychosomatic medicine
Conditions
Depression = severe, typically prolonged, feelings of despondency and
dejection or a long and severe recession in an economy or market.
Eating disorders = are psychological illnesses defined by abnormal eating
habits that may involve either insufficient or excessive food intake to the
detriment of an individual's physical and mental health. Bulimia nervosa and
anorexia nervosa are the most common specific forms of eating disorders.
Sexual disorders
Psychosis intervention = The word "psychosis" is used to describe conditions
that affect the mind, in which there has been some loss of contact with reality.
When someone experiences symptoms of psychosis, their condition is referred
to as a psychotic episode. "First episode" psychosis simply means that an
individual is experiencing psychosis for the first time.
Psychosis affects an individual's thoughts, feelings, and behaviours. The
manner in which it is manifested varies widely, such that two individuals
experiencing psychosis may have very different symptoms. It is a component of
normal human experience and of several distinct mental and physical disorders.
Who Gets Psychosis?
Approximately 3% of all individuals experience an episode of psychosis in their
lifetime
Approximately 1% experience schizophrenia
Psychosis affects males and females equally
First episodes of psychosis generally develop in young people in their late teens
to mid-twenties
Psychosis occurs across cultures and levels of socioeconomic status
19

A PSYCHOTIC EPISODE OCCURS IN FOUR PHASES:

Premorbid Phase - The period in time prior to the onset of symptoms.
Prodrome - Early signs of psychosis may occur but are frequently vague and
hardly noticeable. There may be changes in the way individuals describe their
feelings, thoughts, and perceptions.
Features of the prodrome may include:
Reduced concentration, attention
Reduced drive and motivation, lack of energy
Depressed mood
Sleep disturbance
Anxiety
Social withdrawal
Suspiciousness
Deterioration in role functioning
Irritability
Acute - Psychotic symptoms, including delusions and hallucinations, are
experienced.
Residual or Recovery - Psychosis is treatable and most people recover, either
partially or fully.
Mood disorders = a psychological disorder characterized by the elevation or
lowering of a person's mood, such as depression or bipolar disorder.
Anxiety disorders = are a group of mental illnesses that cause people to feel
excessively frightened, distressed, or uneasy during situations in which most
other people would not experience these same feelings.
Obsessive-compulsive disorder = is an anxiety disorder that affects about 12% of the population. People with OCD experience both obsessions and
compulsions. Obsessions are unwanted and disturbing thoughts, images, or
impulses that suddenly pop into the mind and cause a great deal of anxiety or
distress.
Post-traumatic stress disorder = a condition of persistent mental and
emotional stress occurring as a result of injury or severe psychological shock,
typically involving disturbance of sleep and constant vivid recall of the
experience, with dulled responses to others and to the outside world.
Commonly prescribed drugs in psychiatry
Abilify (aripiprazole)
Adderall XR
Aplenzin

20

ARICEPT
Celexa
Chantix (varenicline)
Clomipramine hydrochloride
Concerta
Cymbalta (duloxetine)
Depakote (divalproex sodium)
Effexor (venlafaxin),
Fanapt (iloperidone)
Intuniv
Invega (paliperidone)
Lexapro (escitalopram oxalate)
Lithobid (Lithium Carbonate)
LUVOX (fluvoxamine maleate)
Marplan Tablets
Metadate C
Naltrexone Hydrochloride
NicoDerm CQ
Nicotrol nasal spray
Oleptro (trazodone hydrochloride)
Paxil (paroxetine hydrochloride)
paroxetine hydrochloride, Paxil CR
Prochlorperazine
Prozac (fluoxetine HCl)
Redux
21

Remeron (Mirtazapine)
Remeron SolTab (mirtazapine)
Risperdal Oral Formulation
Ritalin LA
Saphris (asenapine)
Seroquel (R)
Sonata
Stavzor
Subutex
Vyvanse (Lisdexamfetamine Dimesylate)
Ziprasidone (ziprasidone hydrochloride)
Zoloft (sertraline HCl)
Zyban Sustained-Release Tablets
Zyprexa

22

Module 12 - Glossary of terms used

in psychiatry
abreaction An emotional release or discharge after recalling a painful
experience that has been repressed because it was not consciously tolerable.
abulia A lack of will or motivation which is often expressed as inability to make
decisions or set goals.
acalculia The loss of a previously possessed ability to engage in arithmetic
calculation.
adiadochokinesia The inability to perform rapid alternating movements of one
or more of the extremities.
Affective disorders Refers to disorders of mood.
agnosia Failure to recognize or identify objects despite intact sensory function;
This may be seen in dementia of various types.
agoraphobia Anxiety about being in places or situations in which escape might
be difficult or embarrassing or in which help may not be available should a panic
attack occur.
agraphia The loss of a pre-existing ability to express one's self through the act
of writing.
akathisia Complaints of restlessness accompanied by movements such as
fidgeting of the legs, rocking from foot to foot, pacing, or inability to sit or stand.
akinesia A state of motor inhibition or reduced voluntary movement.
Alexia Loss of a previously intact ability to grasp the meaning of written or
printed words and sentences.

23

algophobia Fear of pain.

alienation The estrangement felt in a setting one views as foreign,
unpredictable, or unacceptable.
amnesia Loss of memory.
Anhedonia Inability to experience pleasure from activities that usually produce
pleasurable feelings. Contrast with hedonism.
Apathy Lack of feeling, emotion, interest, or concern.
Aphasia An impairment in the understanding or transmission of ideas by
language in any of its forms--reading, writing, or speaking--that is due to injury
or disease of the brain centers involved in language.
anomic or amnesic aphasia Loss of the ability to name objects.
Apraxia Inability to carry out previously learned skilled motor activities despite
intact comprehension and motor function; this may be seen in dementia.
ataxia Partial or complete loss of coordination of voluntary muscular movement.
aura A premonitory, subjective brief sensation.
capgras' syndrome The delusion that others, or the self, have been replaced
by imposters.
cathexis Attachment, conscious or unconscious, of emotional feeling and
significance to an idea, an object, or, most commonly, a person.
concrete thinking Thinking characterized by immediate experience, rather
than abstractions.
confabulation Fabrication of stories in response to questions about situations
or events that are not recalled.
coprophagia Eating of filth or faeces.
depersonalisation An alteration in the perception or experience of the self so
that one feels detached from, and as if one is an outside observer of, one's
mental processes or body (e.g., feeling like one is in a dream).
detachment A behaviour pattern characterized by general aloofness in
interpersonal contact.
dysphoric mood An unpleasant mood, such as sadness, anxiety, or irritability.

24

displacement A defence mechanism, operating unconsciously, in which

emotions, ideas, or wishes are transferred from their original object to a more
acceptable substitute; often used to allay anxiety.
dyskinesia Distortion of voluntary movements with involuntary muscular
activity.
dyslexia Inability or difficulty in reading, including word-blindness and a
tendency to reverse letters and words in reading and writing.
dyssomnia Primary disorders of sleep or wakefulness characterized by
insomnia or hypersomnia as the major presenting symptom.
Dystonia Disordered tonicity of muscles.
Echolalia The pathological, parrot like, and apparently senseless repetition
(echoing) of a word or phrase just spoken by another person.
echopraxia Repetition by imitation of the movements of another. The action is
not a willed or voluntary one and has a semiautomatic and uncontrollable
quality.
ego In psychoanalytic theory, one of the three major divisions in the model of
the psychic apparatus, the others being the id and the superego.
ego-dystonic Referring to aspects of a person's behavior, thoughts, and
attitudes that are viewed by the self as repugnant or inconsistent with the total
personality.
eidetic image Unusually vivid and apparently exact mental image; may be a
memory, fantasy, or dream.
elaboration An unconscious process consisting of expansion and
embellishment of detail, especially with reference to a symbol or representation
in a dream.
elevated mood An exaggerated feeling of well-being, or euphoria or elation. A
person with elevated mood may describe feeling "high," "ecstatic," "on top of the
world," or "up in the clouds."
Engram A memory trace; a neurophysiological process that accounts for
persistence of memory.
Euthymic Mood in the "normal" range, which implies the absence of depressed
or elevated mood.
expansive mood Lack of restraint in expressing one's feelings, frequently with
an overvaluation of one's significance or importance. irritable Easily annoyed
and provoked to anger.

25

extinction The weakening of a reinforced operant response as a result of

ceasing reinforcement. See also operant conditioning. extraversion A state in
which attention and energies are largely directed outward from the self as
opposed to inward toward the self, as in introversion.
fantasy An imagined sequence of events or mental images (e.g., daydreams)
that serves to express unconscious conflicts, to gratify unconscious wishes, or
to prepare for anticipated future events.
flat affect An affect type that indicates the absence of signs of affective
expression.
flight of ideas A nearly continuous flow of accelerated speech with abrupt
changes from topic to topic .
glossolalia Gibberish-like speech or "speaking in tongues."
gender dysphoria A persistent aversion toward some or all of those physical
characteristics or social roles that connote one's own biological sex.
grandiose delusion A delusion of inflated worth, power, knowledge, identity, or
special relationship to a deity or famous person.
gustatory hallucination A hallucination involving the perception of taste
(usually unpleasant).
incoherence Speech or thinking that is essentially incomprehensible to others
because words or phrases are joined together without a logical or meaningful
connection.
incorporation A primitive defense mechanism, operating unconsciously, in
which the psychic representation of a person, or parts of the person, is
figuratively ingested.
individuation A process of differentiation, the end result of which is
development of the individual personality that is separate and distinct from all
others.
labile affect An affect type that indicates abnormal sudden rapid shifts in affect.
learned helplessness A condition in which a person attempts to establish and
maintain contact with another by adopting a helpless, powerless stance.
macropsia The visual perception that objects are larger than they actually are.
masochism Pleasure derived from physical or psychological pain inflicted on
oneself either by oneself or by others.
micropsia The visual perception that objects are smaller than they actually are.

26

nihilistic delusion The delusion of nonexistence of the self or part of the self,
or of some object in external reality.
oedipus complex Attachment of the child to the parent of the opposite sex,
accompanied by envious and aggressive feelings toward the parent of the same
sex.
olfactory hallucination A hallucination involving the perception of odor, such
as of burning rubber or decaying fish.
panic attacks Discrete periods of sudden onset of intense apprehension,
fearfulness, or terror, often associated with feelings of impending doom.
paranoid ideation Ideation, of less than delusional proportions, involving
suspiciousness or the belief that one is being harassed, persecuted, or unfairly
treated.
prodrome An early or premonitory sign or symptom of a disorder
projection A defense mechanism, operating unconsciously, in which what is
emotionally unacceptable in the self is unconsciously rejected and attributed
(projected) to others.
prosopagnosia Inability to recognize familiar faces that is not explained by
defective visual acuity or reduced consciousness or alertness.
pseudodementia A syndrome in which dementia is mimicked or caricatured by
a functional psychiatric illness.
psychotic This term has historically received a number of different definitions,
none of which has achieved universal acceptance. The narrowest definition of
psychotic is restricted to delusions or prominent hallucinations, with the
hallucinations occurring in the absence of insight into their pathological nature.
psychotropic medication Medication that affects thought processes or feeling
states.
regression Partial or symbolic return to earlier patterns of reacting or thinking.
Manifested in a wide variety of circumstances such as normal sleep, play,
physical illness, and in many mental disorders.
repression A defence mechanism, operating unconsciously, that banishes
unacceptable ideas, fantasies, affects, or impulses from consciousness or that
keeps out of consciousness what has never been conscious.
superego In psychoanalytic theory, that part of the personality structure
associated with ethics, standards, and self-criticism. It is formed by identification
with important and esteemed persons in early life, particularly parents.

27

suppression The conscious effort to control and conceal unacceptable

impulses, thoughts, feelings, or acts.
symbiosis A mutually reinforcing relationship between two persons who are
dependent on each other; a normal characteristic of the relationship between
the mother and infant child. See separation-individuation.
synaesthesia A condition in which a sensory experience associated with one
modality occurs when another modality is stimulated, for example, a sound
produces the sensation of a particular colour.
tic An involuntary, sudden, rapid, recurrent, nonrhythmic, stereotyped motor
movement or vocalization.
unconscious That part of the mind or mental functioning of which the content is
only rarely subject to awareness.
undoing A mental mechanism consisting of behaviour that symbolically atones
for, makes amends for, or reverses previous thoughts, feelings, or actions.
urophilia One of the paraphilias, characterized by marked distress over, or
acting on, sexual urges that involve urine.
verbigeration Stereotyped and seemingly meaningless repetition of words or
sentences.
visual hallucination A hallucination involving sight, which may consist of
formed images, such as of people, or of unformed images, such as flashes of
light.
Wernicke's aphasia Loss of the ability to comprehend language coupled with
production of inappropriate language.
word salad A mixture of words and phrases that lack comprehensive meaning
or logical coherence; commonly seen in schizophrenic states.

28

Module 12 - Assignment
Welcome to your Module 12 Assignment.
Please note that all your work for this assignment should be saved in one document and it
should follow the following title requirements:
Medical Secretary_ Module 12_Your Name
Part 1:
Write a 500 words essay on the role of the medical secretary in maintaining office wellness and safety.
Part 2:

Research ALL the drugs and side effects of the drugs listed in this module.

Please read below before submitting your assignment:

1. You must ensure that you have COMPLETED the assignment and all the requirements before
submitting your work.
2. In order to successfully complete your module you are required to achieve a minimum pass
mark of 75%.
3. By submitting your assignment you indicate that you have understood the following statements:
This assignment is my own original work, except where I have appropriately cited the original
source ( References for text or images used )
This assignment has not previously been submitted for assessment in this or any other subject.

29

 If it is deemed that my assignment includes unoriginal work that is not referenced, my assignment
will be failed with no option to resubmit.

30