HIM1257 Module 06 Assignment Worksheet_revised_09.15.23

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Rasmussen College, Florida *

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HIM1257

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Mechanical Engineering

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Dec 6, 2023

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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) – The error code is 52000 because it is already covered within the other code. This may be improperly paid or denied due to duplicate coding.  Describe how this error could be remedied (3 points) - This error could be remedied by deleting the code entirely.  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) - duplicate coding can cause a delay in reimbursement and possibly make pay outs harder as now they may question it all together and request clinical documentation that shows medical necessity for the entire procedure. It may be possible for company to be overpaid. 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) - They error in this claim in the 73090 code as it is for diagnostic imaging of the upper extremities. The 29515 code is correct but needs a modifier added which is LT due to pts left leg being worked on. The error may cause a denial in the claim as the code being billed is for an upper extremities when clinical notes will show the treatment was needed for the lower extremity.  Describe how this error could be remedied (3 points) - This could be remedied by deleting the improper code and adding the correct modifier to the correctly listed code. Double checking notes and services performed as well prior to coding so the procedures are billed correctly.  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) – This kind of error could potentially cause conflict to the other works in the chain as it may slow them down. Not coding correctly or double checking may show an inefficiency on the coders end. 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 the error in this claim as this is not the correct code for the urine culture. Due to the urinary hesitation the correct code would be 87088  Describe how this error could be remedied (3 points) – This could be remedied by reading the code description entirely.  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 these codes incorrectly will lead to claims not being paid out in full as the supporting documents will show necessity for a different test as the pt is unable to urinate

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