MEDICAL INSURANCE CODING AND BILLING PROJECT

LASE STllDY 2-11

GO0DMEDICINE CLINIC 1 Provider Street . Anywhere, NY 12345 . (101) 111-2222

Npl: 3345678901

PROVIDER(S): HENRY C. CARDIAC, M.D. EIN: 22-1234567

PATIENT INFORMATION: Name`

Acldres§,

Crty:

State:

ZIP Code.

-elephone.

Sender;

=ate of Birth:

=ccupat,On.

-ITPIoyer:

Scouse's Employer:

Germane Fontaine

132 Canal St

Injury

NY

12347-1234

(101) 111-9685

Female

05-07-1965

Unemployed

]atient status I Married I Divorced

Diagnosis

SPECIAL NOTES:

Case Study

Npl.. 3456789012

INSURANCE INFORMATION: Patient Number; 2 -11

Place of service: office

Primary Insurance plan: Medicaid

PrlmarylnsuranceplanlD#. 11347765

Group #:

Primary policyholder: sel f

Policyholder Date of Birth.

RelatLonship to Patient.

Secondary Insurance Plan:

Secondary Insurance Plan ID #:

Secondary Policyholder:

E single E student E other

DIAGNOSIS INFORMATloN Diagnosis Code

Date Code Charge 06-20-¥Y¥¥ 26. 00

o6-2o-¥¥¥¥ 12. 00

GOODMEDICINE CLINIC 1 Provider Street . Anywhere, NY 1234.5 . (101) 111-2222

PROVIDER: HENRY C. CARDIAC, M.D.

Patient Record

FONTAINE, GERMANE

OFFICE VISIT 06/20/YYYY S: This patient returns today complaining of a sore throat for the past

three days, temperature to 101 degrees Fahrenheit with pleuritlc cough. She has had abundant postnasal drip.

0: NAD. Sinuses are tender about the maxillary and frontal areas. TMs, gray bilaterally. Pharynx is injec.ted, and there ls obvious purulent material in the left posterior pharymt. Neck: Supple, no nodes. Chest: Clear. COR: RRR without murmur. Lab: Sinus films normal.

A: Clinical chronic sinusitis; her sore throat is probably from this, but will obtain a strep test to rule out that possibility, at her request.

P: Beconase nasal spray, 1 whiff to each nostril q.i.d. for 1 week, then 1 whiff b.i.d. to each nostril. If she has not improved in 3 weeks, refer to ENT specialist.

Jleape.eaAha,M.3i. Henry C. Cardiac, M.D.