Pre-certification assignment - Essay Example

Insurance Precertification analysis Patient one 200 chronic tonsillitis The diagnosis of the patient is in line with chronic tonsillitis criteria 200. For a patient to qualify in this, he needs to have the following; a throat pain of more than 6 months, either with, tender cervical lymph node, tonsillar erythema fever or evidence of enlarged tonsil size, besides the person, should have been on two courses of antibiotic treatment for 10 days. The patient qualifies against the criteria he meets all the level 200 criteria.

In level 211, he has had twelve months with six recurrent episodes of strep infection, in strep infections throat pain is an identifying symptom, therefore, this person meets the criteria for pain for more than six months. In level 212 the patients reach 211 (1, 3 and 4,) the history of the patient also demonstrates the patient to have had episodes of sore throat with is a sign of tenderness of the tonsils. The patient also has difficulty in swallowing which is a typical sign of tonsillar enlargement.

In addition, the patient presents with fever in the history. Finally, in level three, the patient seems to have taken two courses of antibiotics even though it is nonspecific; most strep antibiotics are 7 to 12 daysPatient two; criteria 400 obstructive adenotonsillar hypertrophyThe patient should have a history of snoring, bleeding, suspected sleep apnea hyponasal speech persistent drooling or more than six months accompanied by grade three or four tonsillar enlargements with the patient having normal palate This patient qualifies for the criteria 400 for the diagnosis of adenotonsillar hypertrophy.

In 412, the patient snores a sign of sleep apnea she also has signs of bleeding. In 411, the speech is hyponasal with the sore strep throat; the patient, however, does not meet the level 413. 420 The patient also meets the criteria 413 as he has a 4+ tonsillar enlargement on the right that touches the uvula and 3+ in the left tonsil that is pink in appearance. The patient seems to meet the 430 criteria, as there is no physical pathology with the palate for it is not reported. In this, the assumption is that only the pathological findings are recorded.

The patient, therefore, meets all the requirements for these criteria for the insurance coverPatient three; criteria 400 adenotonsillar hypertrophyThe patient needs to present with symptoms of tonsillar history enlargement of grade 3 or for by physical exam. Besides, on the physical exam the patient should have a normal palate. Also, the patient needs to have history any of the following symptoms, bleeding, suspected sleep apnea hyponasal speech persistent drooling or more than six months. The patient meets the criteria for this diagnosis and, therefore, eligible for the insurance cover.

In 410, the patient meets criteria 412 for he snores and grasping for breath, which are suspected signs for sleep apnea. 420, the patient also has a 3-4 plus tonsillar enlargement on the physical examination. 430, the patient has a normal palate, this is absent in the physical exam records since there was no abnormality detected on the examination (430). Tis patient, therefore, qualifies for the insurance policy for the procedure ordered following the set criteria.