NU673 U7D

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Feb 20, 2024

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NU673 U7D 1. CPT E&M Code and ICD-10 Diagnosis: This visit would be coded 99204, new patient visit with moderate complexity medical decision-making. His ICD-10 diagnosis is F40.11, Social anxiety disorder which involves anxiety about social situations that stems from a person being afraid of being scrutinized by others and judged negatively. The anxiety causes a person to avoid the social situations or to experience them with intense emotional stress. The anxiety is out of proportion, persistent, and impairs functioning (APA, 2022). 2. The level of medical complexity encompassed by including the number of points for the diagnoses/management options and the amount/complexity of data reviewed; then identify the level of risk for complications, morbidity, mortality. This was an initial visit which included a comprehensive physical exam and comprehensive patient history, and it includes 1 undiagnosed new problem with uncertain prognosis. His symptoms of anxiety and depression along with sweating and heart palpitations indicate a concerning level of severity. Potential outcomes if left untreated include the patient dropping out of school or suicidal ideation. A new problem to the provider with no planned additional work-up is 3 points. According to the description, this would qualify as minimal or no data complexity reviewed, 0 points. The risk for complications can be inferred by the treatment/management of the patient (APA, 2020). This patient could be managed with prescription medications which makes him a moderate risk. Combining these three components yields an E/M od moderate medical decision-making. Although this code is based on complexity, a new patient visit with a comprehensive physical exam and history would likely coincide with a 45-59 minute visit as listed in the American Medical Association E/M Summary Guide (AMA, 2020). 3. In the discussion explore how the ICD-10 Codes that you assigned impact third-party payor reimbursement for this visit. Third-party reimbursement is based on assigning an accurate ICD 10 code to the encounter which supports the use of the specific CPT code involved (CMS, 2023). As an example, an ICD-10 code of F51.02,

transient short-term insomnia, would not support the use of an E/M code for moderate or high-complexity medical decision making. References AAPC Thought Leadership Team (2023). 99202-99215: Office/Outpatient E/M Coding in 2021. AAPC . https://www.aapc.com/resources/evaluation-management- coding-changes-2021 American Psychiatric Association (Ed.). (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787 Coding for evaluation and management Services: AAFP . (n.d.). https://www.aafp.org/family-physician/practice-and-career/getting-paid/ coding/evaluation-management.html CPT E/M Office Revisions Level of Medical Decision Making (MDM) (2019). American Medical Association (AMA). https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf Evaluation and Management Services Guide. (August, 2023). Centers for Medicare and Medicaid Services (CMS). https://www.cms.gov/outreach-and-education/medicare-learning- network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf Update on 2021 Office/Outpatient E/M billing and Documentation . (November, 2020). American Psychiatric Association (APA). https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-and- reimbursement/update-on-2021-office-outpatient-e-m-billing-and-d Responses: Thank you for your post, . It looks like we came up with different procedure codes for this patient. I Think this is a good example of the difficulties we will face as psychiatric mental health nurse practitioners. Unlike many medical conditions, psychiatric conditions are often encumbered with subjective interpretations and gray area criteria. I think the most difficult component to assess when determining the correct level of medical decision making for evaluation and management would be the risk of complications and or morbidity or mortality of the patient. A patient could be experiencing what appears to be mild depressive symptoms but if the patient is attempting to mask the true severity of what they are experiencing they could very well be at high risk of suicide. In a 2014 meta-analysis, Chesney et al found an increase in all- cause mortality across twenty different mental disorders. This complicates determining risk because while we don’t want to call every person with one of these disorders at high risk of suicide, we do need to be cognizant of the inherent risks of the patient population we will be treating. References

Chesney, E., Goodwin, G.M. and Fazel, S. (2014), Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13: 153- 160. https://doi.org/10.1002/wps.20128 Thank you for your post, Nicole. It looks like we came up with different CPT codes. I think this assignment hands out the complexity and difficult nuances we will have to navigate as new PMHNP’s. With suicide being a very real risk for the patients we will be seeing, I can’t really say I disagree with you the code you came up with. You are correct that the hopelessness exhibited by the patient is highly concerning for SI. As future PMHNPs it is important that we code correctly as it not only impacts our reimbursement, but also can attach a diagnosis to a patient’s record. This is a lot or responsibility and I think providers need to be aware of the gravity of this. I think it is interesting that at some level, correct coding of diagnosis and procedure also impacts the flow of the supply chain (Curvo, n.d.). When viewed as a systems level data point, there are likely many ways this information can be used to improve efficiency as well as patient care. References Curvo (n.d.). Current uses of ICD-10: Medical reimbursements & more. https://www.curvolabs.com/full-blog/current-uses-of-icd-10-medical-reimbursements-and- more Links to an external site.

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