HIM1257 Module 06 Assignment Worksheet_revised (1) (1)

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Apr 3, 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) The error in this scenario is code 52000  Describe how this error could be remedied (3 points) Remove the code 52000 its needed  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 error can impact the coder’s performance, the insurance and reimbursement because the payment will be incorrect, charging the patient/insurance more money and an over payment for the physician. It may also impact the compliance of the provider. 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 known 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) The error in this scenario is the code 73090 and missing modifier  Describe how this error could be remedied (3 points) Remove the code 73090 and add modifier LT for the left leg to code 29515 (29515-LT)  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) 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 this scenario is that a diagnosis code is missing for the urine culture  Describe how this error could be remedied (3 points) Add the diagnosis code for the urine culture so that the procedure code does not seem unnecessary  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)

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