Assignment task: Evaluation and Management (E/M)
Insurance coding and billing is complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to the service that you provided. The payer then reimburses the service at a certain rate. As a provider, you will have to understand what codes to use and what documentation is necessary to support coding.
For this Assignment, you will review evaluation and management (E/M) documentation for a case study patient. You will analyze the documentation to formulate DSM-5-TR diagnoses and ICD-10 coding. You will formulate a billing code for reimbursement of the case study. You will consider legal and ethical considerations for coding and billing. You will analyze and consider the documentation necessary to support accurate billing and coding procedures.
To Prepare:
- Review this week's Learning Resources on coding, billing, reimbursement.
- Review the E/M patient case scenario provided.
The Assignment:
- Assign DSM-5-TR diagnoses, ICD-10, and reimbursement codes to services based on the patient case scenario.
Then, in 2-3 pages, address the following. You will add your narrative answers to these questions to the bottom of the case scenario document and submit them altogether as one document.
- What reimbursement billing code would you use for this session? Provide your justification for using this billing code.
- Explain what pertinent information is required in documentation to support your chosen DSM-5-TR diagnoses, ICD-10 coding, and billing code.
- Explain what pertinent documentation is missing from the case scenario and what other information would be helpful to narrow your coding and billing options. (There are at least 12 missing pertinent components of documentation).
- Discuss legal and ethical dilemmas related to overbilling, upcoding, and fraudulent practices. Propose 2 strategies for promoting legal and ethical coding and billing practices within your future clinical roles.
- Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.