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Dr Leona Koenig Removed the Appendix of a Plan Member

question 49

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Dr. Leona Koenig removed the appendix of a plan member of the Helium health plan. In order to increase the level of reimbursement that she would receive from Helium, Dr. Koenig submitted to the health plan separate charges for the preoperative physical examination, the surgical procedure, and postoperative care. All of these charges should have been included in the code for the surgical procedure itself. Dr. Koenig's submission is a misuse of the coding system used by health plans and is an example of:


Definitions:

Enteric Nervous System

A part of the nervous system that directly controls the gastrointestinal system, functioning independently of the central nervous system.

CNS

CNS, or Central Nervous System, refers to the complex part of the nervous system consisting of the brain and spinal cord, responsible for processing and sending out signals.

Serotonin

A neurotransmitter involved in regulating mood, appetite, and sleep.

Motility

The ability of an organism or fluid to move spontaneously and actively, consuming energy in the process.

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