HIM1257 Module 06 Assignment Worksheet_revised

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Mechanical Engineering

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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) 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) code 52234 should not be reported Describe how this error could be remedied (3 points) remove code 52234 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) adding this code would result in overpayment/reimbursement of procedure 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) missing modifier LT code 73090 should be ommitted Describe how this error could be remedied (3 points) LT modifier should be added remove code 73090 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) The reimbursement would be impacted, it may result in compliance investigation, it affects the coders performance as well 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) M54.5 diagnostic code incorrect Describe how this error could be remedied (3 points) remove code m54.5 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) the coder performance would need review the reimbursment for the provide would be inaccurate
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