Uniqua Allen - answers to chapter 6 medical bok

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Feb 20, 2024

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Uniqua Allen Chapters 6 and 13 *ANSWERS ONLY * Case 1.6 Auditing Linkage A CPT ICD-10-CM Linked 1 77057 Z12.31 correct 2 99214 H61.21 not 3 57284 N41.10, B95.6 not 4 96365 Z51.11, D05.90 correct 5 99203, 72040, 73590 S82.51XA, S13.8XXA,W18.01X, Y82.838 not Explanation 1. CPT 77057 represents screening bilateral mammography and ICD-10-CM Z12.31 represents an encounter with a physician and screening for malignant neoplasm. 2. CPT represents an encounter with the patient who meets at least two out of three criteria detailed history, detailed examination, the medical decision of moderate complexity, and ICD-10-CM H61.21 represents impacted cerumen. This is not meeting the criteria and is not properly linked, 3. CPT 57284 represents paravaginal defect repair and ICD-10-CM N41.10, B95.6 represents an inflammatory disease of the prostate. This is not possible coding because one patient can't have both vaginal defect and prostate inflammation. The codes are not linked correctly. 4. CPT 96365 an administration of infusion represents and ICD-10-CM Z51.11, D05.90 represents encounter for chemotherapy and In situ carcinoma of the breast. This is properly linked together the codes are compatible. 5. CPT 99203, 72040, 73590 represents visit evaluation and management of a new patient who needs three services detailed history, detailed examination, the medical decision of low complexity, and ICD-10-CM S82.51XA, S13.8XXA, W18.01X, Y82.838 represents fractures of the medial malleolus, sprain of joints and ligaments of the neck. These are not low complexity decisions and because of that, the link is not proper.

B. Modifier 25 is always appended to an E/M service coded noted with the procedure code. This indicates that E/M service was a separate event on the same day conduct by the same physician as a procedure. In this case modifier, 25 is appended with Z00.00. Modifier 25 is indicating significant separate, examination and evaluation of a patient done by the same physician on the same day. This is necessary so that edits don't recognize this as an improper coding Case 6.2 Calculating Expected Charges A. CPT 99204 in Galveston, TX - $1,292.42 B. CPT 33502 in Manhattan, NY - 67.00 C. CPT 99203 in Columbus, OH - $ 68.81 Case 6.3 calculating Insurance math CPT 99212 is usually charged 44$. Payer reimbursement is 19$ ( 44 - 25). The patient charge is 25$. The provider is not participating in a Ringdale medical plan. There is no allowed charge so there is no write-off. There is a copayment of 25$ for non-participating providers. Payer reimbursement is 19 Patient charge 25 A Payer Reimbursement: $140.80 Patient Charge:$35.20 B Payer Reimbursement: $0.00 Patient Charge: $224.00 C D Payer Reimbursement: $107.20 Patient Charge: $26.80 E Payer Reimbursement: $62.40 Patient Charge: $15.60

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