Medical Billing Math and EKG Electrode Placement Simplified

First question, let's get into it and it's a tricky one: a little bit of math. What amount would a patient owe if they have a coinsurance of 20 and the cost of their medical visit is $400? So first off, what does coinsurance mean? That's the amount that the insured, that's the patient, is responsible for paying compared to the amount that the insurance company will cover. So, coinsurance of 20 means that the patient is responsible for 20% of the total, which in this case is $400. In order to calculate the patient's portion of the payment, we're going to multiply the total cost of the visit by the percentage that they're responsible for, which is 20. So, we can find 20% of $400 by taking $400 and multiplying by 0.2, because 0.2 is the decimal form version of 20%. Similarly, if we had 50%, the decimal form would be 0.5. In this case, we have 20%, so we're going to multiply it by 0.2. So, how do we do $400 times 0.2? Well, there are a couple of ways. The first is to say, what is $400 times 0.1? Well, we would just move the decimal place over one, so $400 times 0.1 would be equal to $40. Now, we weren't actually trying to multiply it by 0.1, we were trying to multiply it by 0.2. Therefore, we have to take our total from 0.1 and multiply it by 2. So, it would be equal to $80. That, in my mind, is the simplest way of doing this calculation. Therefore, this patient would owe $80, which is the 20% coinsurance of $400. Next question, and these are tough ones. There's a lot of memorization in an EKG: which electrode is placed at the fourth intercostal space on the left side of the sternum? So first, what does intercostal mean? Well, intercostal is the space in between two different ribs. So, if this is a rib and this is a rib, the intercostal space exists in between them. The sternum represents the central part of the rib cage right in here. So, going back to our question, in an EKG, which is going to place a bunch of electrodes on the chest, which one is going to be placed at the fourth intercostal space on the left side of the sternum? A medical assistant is placing a V5 lead on a patient for an EKG. Where should the assistant place the electrode? And this is a slightly different question than what we're looking at, but we're going to use this for the explanation. So, we try to break things down really simply, and we have this list of where each electrode goes. V1 is at the fourth intercostal space, the right sternal edge, V2, etc. And we also have this schematic that kind of outlines what is that we're referring to. Here's V1 electrode, V2 electrode, V3, V4, V5, and V6. And I'm not going to go into each of these right now. You need to take time. It will take some time to study this and memorize it. But just to get an idea, here's what this would look like when it's actually being placed on the chest. And this is just referring to the chest electrodes. We also have the limb electrodes, which aren't shown here. So, here's where all of these different chest electrodes are being placed. Now, if we head back to our original question, which electrode is placed at the fourth intercostal space on the left side of the sternum? And we can see that V2 is placed at that fourth intercostal space at the left sternal edge right there. And therefore, V2 is the answer to our question. Here's the next question: a medical assistant has an order to administer an intramuscular pain medication to a patient. Which of the following actions should the assistant take prior to giving the injection? A. Retrieve a lancet. B. Anchor the vein. C. Cleanse the site in a circular motion from the center outward. D. Don gloves and a face shield. And the answer is C. Cleanse the site in a circular motion from the center outward. So what does that mean? It means that, say, the deltoid (the shoulder) is our injection site. You're going to start from the center of the injection site and move your hand with the alcohol pad in a circular motion, starting from the center and gradually moving outward. Why are we going to do that? This is going to widen the area of cleansing, making sure that we get far enough around the site of the injection. And by moving from the center outward, it prevents moving bacteria from outside the skin. In this way, we're always cleansing and pushing the bacteria outwards and making sure that we're cleansing that area, which is going to help to reduce the risk of infection. Isopropyl alcohol is the main cleansing agent used for this, and it's important to note that the alcohol swab needs to have at least 70% alcohol. That's a high-yield point that comes up. And then, finally, this also has a high-yield point that comes up on tests: after cleansing the site, you need to let the alcohol dry completely before you do your injection to ensure that everything has been disinfected properly. Now let's look at the incorrect answer choices: A. Retrieve a lancet. Now, this is incorrect. A lancet is used to puncture the skin, often the fingertip, to get a little bit of blood. It's often used for blood glucose testing. It's not used for intramuscular injections. This is an example of a finger prick with a lancet, where a little bit of blood is going to be drawn up and then used for blood glucose testing. B. Anchor the vein. No, anchoring a vein is done during, for example, a blood draw or an intravenous injection. And you can see anchoring being done here, where the thumb is pressed below the site of the injection. This helps to make the vein more prominent and prevents the vein from rolling out of position when we're trying to slide that intravenous needle into it. C. Cleanse the site in a circular motion from the center outward. We know that's the correct answer. D. Don gloves and a face shield. No, gloves and a face shield aren't necessary for administering an intramuscular injection. PPE, personal protective equipment, is what we reasonably think is required to keep us and the patient safe. A procedure like a cyst removal, where there could be potential blood splatter, would be a good example of when a gown and a face shield would be necessary. But for delivering an intramuscular injection, just a basic mask and sometimes gloves are all that are required. At least, by law. Though, medical assistants can request additional PPE if they'd like. Next question, which of the following actions should a medical assistant take when disposing of a used needle and disposable syringe? A. Recap the needle before disposal. B. Remove the needle from the syringe. C. Drop the syringe needle first into the sharps container. D. Place the needle and syringe in a biohazard bag. And the answer is C. Drop the syringe needle first into a sharps container. So, this demonstrates what that looks like. The reason why we do needle first is because you don't want the needle pointing up at you. So, we're going to hold the needle pointing downwards over top of the sharps container and then drop it and let it go. And this way, we're going to ensure safe disposal of the needle that keeps us safe as well as other people that might be in the vicinity. Why are the incorrect answers wrong? A. We never recap needles before disposal. This is a sign that maybe used to be done and it's no longer done. When a needle is used, it is not recap. This is an example of capping a needle and actually showing it in the worst way possible, which is with two hands. Even this method down here, though capping it off of the table, is no longer recommended. What the recommendations are is to directly dispose of the needle by dropping, as we said, needle first into a sharps container. We don't need to recap it after use. It should be disposed of right away. This helps to prevent accidental needle stick injuries. B. Remove the needle from the syringe. So, in theory, that would be unscrewing the needle tip from the syringe itself. We're not going to do that. Again, we're just going to dispose of it. D. Place the needle in syringe in a biohazard bag. No, a biohazard bag is a plastic bag that could be punctured by the needle. We always need to use a proper plastic sharps container, which is designed specifically for sharps and will be disposed of in a way that is designed for sharps waste. Other things that might go in a sharps receptacle include scalpel blades. Okay, next question. Which of the following represents the dorsal recumbent position? A. The patient is lying on their stomach with their head turned to the side. B. The patient is lying on their back with their legs bent and feet flat on the exam table. C. The patient is lying on their back with their legs elevated and held in stirrups. D. The patient is lying on their left side with their right leg bent upward and their left arm behind their back. The answer is B. The patient is lying on their back with their legs bent and their feet flat on the exam table. Patient positioning is a common question and a high-yield question on these medical assistant certification tests. So, you should know all of these positions. When I hear "dorsal," I'm thinking of the back, and "recumbent" is lying down. So, dorsal recumbent position is to me the patient lying on their back with their feet flat. This is a good example of dorsal recumbent, which is also known as supine, and the patient lying flat on their back. Now let's go through the other answer choices: A. The patient is lying on their stomach with their head turned to the side. This represents the prone position, which we can see here, the patient lying flat on their stomach, called prone, with their head turned to the side. B. The patient is lying on their back with their legs elevated and held in stirrups. This is actually that very common position for medical assistant certification tests called lithotomy. In lithotomy, it's similar to dorsal recumbent, the patient is on their back, but this time their feet are in stirrups and it is elevated. This is often used for pelvic exams, so examinations of the genital area, particularly in women, for vaginal exams. C. The patient is lying on their back with their legs elevated and held in stirrups. This is the lithotomy position. D. The patient is lying on their left side with their right leg bent upward and their left arm behind their back. There's a lot of words going on here, and you might see the patient lying on their left side and start to think that this sounds like the lateral recumbent. Lateral meaning side. However, we can see that this patient doesn't have their leg bent and their left arm behind their back. So, what's described here is actually the Sims position. Sims is a common position used for rectal exams, where the patient is on their side, with one arm behind their back, and their leg bent. This positions the patient for the most comfort. Therefore, D refers to the Sims position. Let's answer one more bonus question just for fun: A medical assistant is documenting an interaction in a patient chart. Which of the following documentation types is structured based on the entity that provided the data? A. Problem-oriented. B. Source-oriented. C. Cheddar formatting. D. SOAP formatting. The answer is B. Source-oriented. So, what are the differences between a problem-oriented medical record and a source-oriented medical record? At a high level, problem-oriented medical records organize charts based on the problems around the patient's medical issues and concerns, while source-oriented records organize information based on the source of that information. Here's an example of problem-oriented, where it's kind of going through the patient's chief complaint, the patient's history, the examination findings, test results, and treatment plans. Versus in source-oriented, it goes through who provided, who was the source of the information. And in this detailed explanation, we also go through cheddar formatting and SOAP formatting (Subjective, Objective, Assessment, and Plan).