kkringle HIM1257 Module 06 Assignment Worksheet_revised 020624

docx

School

Rasmussen College *

*We aren’t endorsed by this school

Course

1257

Subject

Mechanical Engineering

Date

Feb 20, 2024

Type

docx

Pages

Uploaded by SuperElectron11132

HIM1257 Ambulatory Coding Module 06 Written Assignment: H ow Correct Coding affects Billing and Reimbursement Instructions: Each scenario is worth a potential 10 points. Points in parentheses are for each scenario. This assignment is worth a total of 30 points.  Read each scenario and review the assigned codes. (The 3m encoder’s APC finder is useful to identify any billing edits.)  Identify the error in the claim and explain why it might be improperly paid or denied (3 points)  Describe how this error could be remedied (3 points)  Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points) 1. A 90-year-old white female with a known history of hypertensive kidney disease is referred by her regular internal medicine physician for a cystoscopy. She was treated for urinary tract infection but microscopic hematuria is persistent. A cystourethroscopy was performed under general anesthesia. The urologist removed a small 0.6 cm tumor from the lateral wall of the bladder. The specimen was sent to pathology. A squamous cell carcinoma was diagnosed. The reported diagnosis codes were: R31.21, C67.2, I12.9, N18.9 The reported procedure codes were: 52000, 52234  Identify the error in the claim and explain why it might be improperly paid or denied (3 points) 5200 Is meant to be listed as a separate procedure but in this case it was not.   Describe how this error could be remedied (3 points) Remove the 5200.  Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points)

Incorrect reporting of procedure codes can result in issues with reimbursement, compliance, and coder performance. It can also affect the accuracy of clinical documentation and reporting, potentially leading to challenges in clinical decision- making and quality of care. 2. A 55-year-old female with a known history of varicose veins in the left leg presents to the clinic complaining of left ankle pain. No know injury is recalled. A short leg splint is placed for the patient’s comfort and to provide stability. She is advised to follow up in one week if there is no improvement. The reported diagnosis codes were: S93.402A, I83.92 The reported procedure codes were: 29515, 73090  Identify the error in the claim and explain why it might be improperly paid or denied (3 points) The error in the claim is the reported procedure code 73090. This code is for radiological examination for the forearms with two views. This is unrelated to the services provided for the patient's ankle pain and the placement of a short leg splint.  Describe how this error could be remedied (3 points) Removal of 73090.  Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points) Similar to the impact described previously, inaccurate reporting of procedure codes can lead to issues with reimbursement, compliance, coder performance, and reporting accuracy. It can also affect data quality and analysis, potentially impacting patient care and resource allocation decisions. 3. A 67-year-old male established patient presents to the clinic complaining of chronic low back pain. The patient also noted urinary hesitation and cloudy appearing urine. A urine culture is ordered. The patient is advised to take acetaminophen for the pain and follow up in 3 days unless symptoms worsen. The physician spent approximately 15 minutes with the patient with low level medical decision making. The reported diagnosis codes were: M54.5 The reported procedure codes were: 99213, 87086  Identify the error in the claim and explain why it might be improperly paid or denied (3 points) The error is code 99213. It is for an office visit with low level but the visit must reach 20 minutes. The visit was only 15 minutes.  Describe how this error could be remedied (3 points) Removal of 92213 and replacement with code 99212.

 Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points) Reporting inaccurate procedure codes can result in issues with reimbursement, compliance, and coder performance. It may also affect the accuracy of clinical documentation and reporting, potentially leading to challenges in clinical decision- making and resource allocation. Additionally, wrong procedure codes may result in overbilling, leading to fraud.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version