cloynes_module06assignmentworksheet_121423

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Mechanical Engineering

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Feb 20, 2024

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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) 52000 should be removed due to it being covered in the other code. Describe how this error could be remedied (3 points) This could be remedied by deleting code or doing an audit. 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) It could delay the reimbursement process. 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) 73090 because it is for upper examination of upper body. It would be denied due to it being for forearm and the patient injured left ankle. Describe how this error could be remedied (3 points) This could be remedied by deleting the code and adding LT modifier to the 29515. 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) It can cause issues with reimbursement and slow down the process for the claims to be paid. 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) 87086 is incorrect code. It should be 87088. It would be denied due it is submitting the wrong code. Describe how this error could be remedied (3 points) This could be remedied by submitting the correct codes. 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) Submitting incorrect claims can delay the process of approval and procedure not being paid in full.
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