hpapen_mod6_121523

doc

School

Rasmussen College *

*We aren’t endorsed by this school

Course

1257

Subject

Mechanical Engineering

Date

Apr 3, 2024

Type

doc

Pages

3

Uploaded by BrigadierKookabura3490

Report
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 code 52000 is the cystourethroscopy as a separate procedure but the 52234 code is the cystourethroscopy with the resection of a small bladder tumor, which would be correct. N18.9 is chronic kidney disease, unspecified where I12.9 is hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease or unspecified chronic kidney disease. The scenario specifically mentions hypertensive kidney disease so the I12.9 would be the correct code. Describe how this error could be remedied (3 points) Paying closer attention to the specific wording between the scenario and the codes. Making sure you know the differences in diseases. 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 codes incorrectly can have a massive effect. Coder performance is supposed to be 99-100% and incorrect codes can cause job loss. Reimbursement can also be effected where the claim gets rejected and no payment is made due to incorrect codes being used or stacked.
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 is a radiologic examination of the forearm. The patient is presenting with varicose veins and left ankle pain. Describe how this error could be remedied (3 points) Resubmitting the claim with the correct codes. The procedure code of 73090 is an entirely incorrect code that is on the wrong body part. 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 coder could absolutely lose their job, coding for an incorrect body part and even coding an arm instead of a leg is a huge deal. As for reimbursement, this claim would definitely be denied for that same reason. 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 encoder says that M54.5 is not a valid code. Describe how this error could be remedied (3 points) Make sure the diagnosis code is correct!
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 code is not an accurate code at all, the coder would lose their job as well as the office not being in compliance. Reimbursement would be denied.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
  • Access to all documents
  • Unlimited textbook solutions
  • 24/7 expert homework help