Hi Everyone,
I started new outpatient work and am slowly building a practice. In the meantime, I picked up an opportunity doing nursing home rounds 2 days a week. I was reluctant to take on the gig, because I have little geriatric experience. The medical director just said start low go slow, but thats not very reassuring. I brainstormed some questions if anyone wants to pipe in.
What codes do you use most frequently? 99308?
what diagnosis do I use? mostly dementia behavioral disturbance?
Can I add modifiers for medicare patients? like therapy add on 90833?
Now that MMSE is off the table are you using MOCA? are you doing this on every new eval for a baseline?
What do you do use for your go to prns?
When you round and the patient is in an activity do you pull them out?
An established patient all the sudden acts up? you think maybe something medical maybe UTI
do you order CBC, urine culture? Or have the nurse call medical tell them your recommendations so they manage?
I was thinking I would stick to:
mirtazapine: helps with depressive symptoms, sleep, appetite, blood pressure etc
celexa: maybe for less acute first line less interactions less qtc
ripserdone: second line maybe .25 at night to start add an afternoon dose if necessary
seroquel: maybe 25 at night for sleep and behavioral disturbances
Insomnia: are you guys using trazadone if mirtazapine isn't enough?
Anyone ever use topical ativan? which patients? maybe for a prn?
Do you still use onlazapine, abilify, geodon?
Thanks for the help! I will be seeing around 25-30 starting Monday...
I started new outpatient work and am slowly building a practice. In the meantime, I picked up an opportunity doing nursing home rounds 2 days a week. I was reluctant to take on the gig, because I have little geriatric experience. The medical director just said start low go slow, but thats not very reassuring. I brainstormed some questions if anyone wants to pipe in.
What codes do you use most frequently? 99308?
what diagnosis do I use? mostly dementia behavioral disturbance?
Can I add modifiers for medicare patients? like therapy add on 90833?
Now that MMSE is off the table are you using MOCA? are you doing this on every new eval for a baseline?
What do you do use for your go to prns?
When you round and the patient is in an activity do you pull them out?
An established patient all the sudden acts up? you think maybe something medical maybe UTI
do you order CBC, urine culture? Or have the nurse call medical tell them your recommendations so they manage?
I was thinking I would stick to:
mirtazapine: helps with depressive symptoms, sleep, appetite, blood pressure etc
celexa: maybe for less acute first line less interactions less qtc
ripserdone: second line maybe .25 at night to start add an afternoon dose if necessary
seroquel: maybe 25 at night for sleep and behavioral disturbances
Insomnia: are you guys using trazadone if mirtazapine isn't enough?
Anyone ever use topical ativan? which patients? maybe for a prn?
Do you still use onlazapine, abilify, geodon?
Thanks for the help! I will be seeing around 25-30 starting Monday...