Assignment 1: Evaluation and Management (E/M)

Week 2  Assignment 1: 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.

 

For this Assignment, you will review evaluation and management (E/M) documentation for a patient and perform a crosswalk of codes from DSM-5 to ICD-10

 

Case Scenario:

Now who wants to be paid for the care they give, I do. This is very important if you are on production model and even if you are on hourly pay for when you ask for pay raises. I work in a private clinic and I am paid on percentage of recovery of billing. Prior in my time at the clinic, the billing department missed billing 10 visits for me and multiple for others as well and was beyond the date of when the insurance company would accept the bills. Many providers were not happy, so many providers now watch each visit billing and recovery. I really don’t have the time for that and hope they are doing their jobs now. But, if it was my primary employment, I would care more too. Knowing the codes and criteria for each billing code also will keep you out of trouble when insurance or government do audits of records. You do not want to be the provider to pay back money for errors in billing codes.

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 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.

Explain what pertinent information, generally, is required in documentation to support DSM-5 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.

Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.