EVALUATION AND MANAGEMENT (E/M)
Insurance coding and billing is complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to the service that you provided. The payer then reimburses the service at a certain rate. As a provider, you will have to understand what codes to use and what documentation is necessary to support coding.(Evaluation and Management Comprehensive Nursing Essay)
For this Assignment, you will review evaluation and management (E/M) documentation for a patient and perform a crosswalk of codes fromDSM-5-TR to ICD-10. (Evaluation and Management Comprehensive Nursing Essay)
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
TO PREPARE
- Review this week’s Learning Resources on coding, billing, reimbursement.
- Review the E/M patient case scenario provided.
THE ASSIGNMENT
- Assign DSM-5-TR and ICD-10 codes to services based upon the patient case scenario.
Then, in 1–2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit altogether as one document.(Evaluation and Management Comprehensive Nursing Essay)
- Explain what pertinent information, generally, is required in documentation to support DSM-5-TR and ICD-10 coding.
- Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.(Evaluation and Management Comprehensive Nursing Essay)
- Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
BY DAY 7 OF WEEK 2
Submit your Assignment.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK2Assgn1_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.(Evaluation and Management Comprehensive Nursing Essay)
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NRNP_6675_Week2_Assignment1_Rubric
NRNP_6675_Week2_Assignment1_Rubric
CriteriaRatingsPts
This criterion is linked to a Learning OutcomeIn the E/M patient case scenario provided:• Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.(Evaluation and Management Comprehensive Nursing Essay)
20 to >17.0 pts
Excellent 90%–100%
DSM-5 and ICD-10 codes assigned to the scenario are correct, with no more than a minor error.
17 to >15.0 pts
Good 80%–89%
DSM-5 and ICD-10 codes assigned to the scenario are mostly correct, with a few minor errors.
15 to >13.0 pts
Fair 70%–79%
DSM-5 and ICD-10 codes assigned to the scenario contain several errors.
13 to >0 pts
Poor 0%–69%
DSM-5 and ICD-10 codes assigned to the scenario contain significant errors, or response is missing.
20 pts
This criterion is linked to a Learning OutcomeIn 1–2 pages, address the following: • Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.(Evaluation and Management Comprehensive Nursing Essay)
25 to >22.0 pts
Excellent 90%–100%
The response accurately and concisely explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.(Evaluation and Management Comprehensive Nursing Essay)
22 to >19.0 pts
Good 80%–89%
The response accurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.
19 to >17.0 pts
Fair 70%–79%
The response somewhat vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.(Evaluation and Management Comprehensive Nursing Essay)
17 to >0 pts
Poor 0%–69%
The response vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding, or the explanation is incomplete or missing.
25 pts
This criterion is linked to a Learning Outcome• Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
25 to >22.0 pts
Excellent 90%–100%
The response accurately and concisely identifies the pertinent misssing information from the case scenario and clearly identifies what additional information would narrow coding and billing options.(Evaluation and Management Comprehensive Nursing Essay)
22 to >19.0 pts
Good 80%–89%
The response accurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.
19 to >17.0 pts
Fair 70%–79%
The response somewhat vaguely or inaccurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.(Evaluation and Management Comprehensive Nursing Essay)
17 to >0 pts
Poor 0%–69%
The response vaguely or inaccurately identifies the pertinent misssing information from the case scenario or partially identifies what additional information would narrow coding and billing options, or this information is incomplete or missing.
25 pts
This criterion is linked to a Learning Outcome• Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.(Evaluation and Management Comprehensive Nursing Essay)
15 to >13.0 pts
Excellent 90%–100%
The response accurately and concisely explains how to improve documentation to support coding and billing for maximum reimbursement.
13 to >11.0 pts
Good 80%–89%
The response accurately explains how to improve documentation to support coding and billing for maximum reimbursement.
11 to >10.0 pts
Fair 70%–79%
The response somewhat vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement.(Evaluation and Management Comprehensive Nursing Essay)
10 to >0 pts
Poor 0%–69%
The response vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement, or response may be incomplete or missing.(Evaluation and Management Comprehensive Nursing Essay)
15 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.(Evaluation and Management Comprehensive Nursing Essay)
5 to >4.0 pts
Excellent 90%–100%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.(Evaluation and Management Comprehensive Nursing Essay)
4 to >3.5 pts
Good 80%–89%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.(Evaluation and Management Comprehensive Nursing Essay)
3.5 to >3.0 pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.(Evaluation and Management Comprehensive Nursing Essay)
3 to >0 pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time…. Purpose statement, introduction, and conclusion were not provided.(Evaluation and Management Comprehensive Nursing Essay)
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation(Evaluation and Management Comprehensive Nursing Essay)
5 to >4.0 pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4 to >3.5 pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors
3.5 to >3.0 pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors
3 to >0 pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.(Evaluation and Management Comprehensive Nursing Essay)
5 to >4.0 pts
Excellent 90%–100%
Uses correct APA format with no errors
4 to >3.5 pts
Good 80%–89%
Contains 1-2 APA format errors
3.5 to >3.0 pts
Fair 70%–79%
Contains 3-4 APA format errors
3 to >0 pts
Poor 0%–69%
Contains five or more APA format errors
5 pts
Total Points: 100
Evaluation and Management Comprehensive Nursing Essay
In the given case scenario, the DSM-5-TR diagnoses include Post-Traumatic Stress Disorder (PTSD), Attention Deficit Hyperactive Disorder (ADHD), and Stimulant Use Disorder (STU). The DSM-5-TR and ICD-10 codes for PTSD are 309.81 and F43.12, respectively. The DSM-5-TR and ICD-10 codes for ADHD, predominantly inattentive presentation, are 314.01 and F90.0, respectively. The DSM-5-TR and ICD-10 codes for SUD are F1x.10 and F15.20, respectively.(Evaluation and Management Comprehensive Nursing Essay)
Pertinent Information Required In Documentation to Support DSM-5-TR and ICD-10 Coding.
Documentation is an essential component of healthcare services, including diagnosing, treating, and managing medical conditions. To support the accurate coding of medical diagnoses and procedures using the DSM-5-TR and ICD-10 (the documentation must include pertinent information. These include chief complaint, history of the present illness, past medical history, review of systems, physical examinations, diagnostic test results, and assessment and treatment plan (Silverman et al., 2015). Documentation with the pertinent information supports accurate DSM-5-TR and ICD-10 coding. Consequently, accurate and complete documentation ensures appropriate treatment and reimbursement for services rendered.(Evaluation and Management Comprehensive Nursing Essay)
Pertinent Information Missing from the Case Scenario
The given case scenario misses crucial pertinent information. For instance, there is no indication of ownership and transfer of patient records, which is essential in providing additional information on the patient’s past treatment and medical history (American Medical Association [AMA], 2021). Such information would be vital in preventing billing errors and fraudulent claims. In this case, a comprehensive timeline of the patient’s mental health diagnoses would be crucial in narrowing billing and coding. Additionally, there is missing information related to the retiring provider is the patient’s insurance coverage, which is not documented and influences coding and billing.(Evaluation and Management Comprehensive Nursing Essay)
Moreover, there is no documentation of the client’s mental health assessment, which is a critical element of psychiatric evaluation and a crucial source of clinical information for definitive diagnosis (Boland & Verduin, 2021). Lastly, details on the patient’s somatic symptoms, vital in making a definitive diagnosis, are superficially given. Information on current symptoms and related information, such as frequency and severity, would also be crucial in narrowing billing and coding. Information on other non-mental health illnesses, assessments, and social support systems would also be essential in narrowing billing and coding.(Evaluation and Management Comprehensive Nursing Essay)
How to Improve Documentation to Support Coding and Billing for Maximum Reimbursement
Various mechanisms can be adopted to enhance documentation for improved coding and billing. One way documentation can be enhanced is through appropriate education and training of healthcare personnel (Faux et al., 2021). Training and education would facilitate complete, accurate and detailed documentation, i.e., including the services provided to the patient and any other relevant diagnoses or conditions documented using specific and descriptive language appropriate for coding and billing purposes. This can ensure that correct codes are assigned to the services provided. Moreover, documentation can be improved by using templates and standardized forms, such as SOAP notes, to capture all relevant information and streamline the process. Providers should also adhere to the available coding guidelines to ensure consistent accuracy and comprehensive documentation. Lastly, electronic health records (EHR) would help streamline documentation (Aguirre et al., 2019). EHR captures accurate clinical data by reducing errors that could be transferred into billing and coding and contains crucial information necessary for coding and billing, such as demographic and personal information.(Evaluation and Management Comprehensive Nursing Essay)
References
Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: a review of resources and tools. Cureus, 11(9). https://doi.org/10.7759%2Fcureus.5649
American Medical Association. (2021). Obtaining Medical Records from Closed Practices. Available at: https://www.ama-assn.org/system/files/2021-02/Patient-access-obtaining-medical-records-from-closed-practices.pdf (Accessed 6 March 2023)
Boland, R., & Verduin, M. (2021). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins.
Faux, M., Adams, J., & Wardle, J. (2021). Educational needs of medical practitioners about medical billing: a scoping review of the literature. Human Resources for Health, 19(1), 1-9. https://doi.org/10.1186%2Fs12960-021-00631-x
Silverman, J. J., Galanter, M., Jackson-Triche, M., Jacobs, D. G., Lomax, J. W., Riba, M. B., … & Yager, J. (2015). The American Psychiatric Association practice guidelines for the psychiatric evaluation of adults. American Journal of Psychiatry, 172(8), 798-802. https://doi.org/10.1176/appi.ajp.2015.1720501
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