HIM1257 Module 06 Assignment Worksheet_revised

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Rasmussen College *

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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) R31.21 is the cystoscopy procedure's reported diagnosis code for the diagnosis of a bladder tumor. Squamous cell carcinoma is a malignancy of the squamous cells, and the diagnosis code is C67.2. For the excision of a tumor from the bladder, the procedure code for cystoscopy operation is 52234. Cystoscopy cannot be coded using the cancer diagnosis code. An error in the claim has been made since the CPT code for a cystoscopy was invoiced instead of the code for a tumor removal (52234) (52200).  Describe how this error could be remedied (3 points). Billing the right CPT code for the procedure that was actually done can fix this mistake. Here, 52234 is the proper code (cystoscopy).  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) Incorrectly reporting the code(s) could have major consequences. It's possible that incorrect coding will result in underpayments, problems with regulatory compliance, and inaccurate reporting. It's possible that incorrect coding will result in underpayments, problems with regulatory compliance, and inaccurate reporting. 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) Codes S93, 402A AND 73090 are not needed .  Describe how this error could be remedied (3 points) This error of coding my dear student can be remedied by thoroughly checking the patient's information and data, and declare the error done once verified and correct it. Coders should read the provider's or clinician's notes before coding to avoid discrepancies like this.  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) One of the known consequences of incorrect coding my dear student is the possibility of a delayed or denied reimbursements which can build up a cache and may cause stress because of too much paperwork. In addition with this, coders who tend to have too much coding errors can face serious federal penalties and fines. Coding errors also affects the patients in a way that incorrect or inappropriate codes reported can result to improper patient care and medical assistance and services. There is also a risk for the patients my dear students to pay bills of the wrong coded procedures and may cause them monetary lost. Frequent reported errors like this in your institution will make patients lose their trust in you and may lead to decrease in patient numbers attending in your institution and thus may cause loss of revenue.

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 in the claim is that only one diagnosis code (M54.5 - Low back pain) is reported, while the patient also presented with urinary hesitation and cloudy appearing urine. This may lead to the claim being improperly paid or denied because the services provided are not fully supported by the reported diagnosis code.  Describe how this error could be remedied (3 points) To remedy this error, additional diagnosis codes should be added to the claim to accurately represent the patient's conditions. The appropriate codes for urinary hesitation and cloudy appearing urine are R39.14 (Urinary hesitancy) and R82.99 (Other abnormal findings in urine). The updated claim should include the following diagnosis codes: M54.5, R39.14, and R82.99.  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 the codes incorrectly can have several negative impacts. First, it may lead to reduced reimbursement, as the payer may not cover all the services provided due to insufficient documentation. Second, it can result in non-compliance with coding guidelines and payer policies, potentially leading to audits, penalties, or other consequences. Third, it can negatively affect coder performance, as inaccurate coding can be a sign of insufficient knowledge or training. Finally, incorrect coding can impact reporting and data analysis, as it may lead to an inaccurate representation of the patient population and the services provided. Overall, accurate coding is essential for proper billing, reimbursement, and compliance with regulations. The final answer in bold LaTeX format: To remedy the error in the claim, the additional diagnosis codes R39.14 (Urinary hesitancy) and R82.99 (Other abnormal findings in urine) should be added. The updated claim should include the following diagnosis codes: M54.5, R39.14, and R82.99

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