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Assignment 1: 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 patient and perform a crosswalk of codes from DSM-5-TR to ICD-10.
***** TO PREPARE:
-Review this week’s Learning Resources on coding, billing, reimbursement.
-Review the E/M patient case scenario provided. (FILE ATTACHED)
Assign DSM-5-TR and ICD-10 codes to services based upon the patient case scenario (CASE SCENARIO FILE ATTACHED).
******Then, in 2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit them altogether as one document.
—Explain what pertinent information, generally, is required in documentation to support DSM-5-TR and ICD-10 coding.
—Explain what pertinent documentation is missing from the case scenario (case scenario file attached), and what other information would be helpful to narrow your coding and billing options.
—Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
Learning Resources for NRNP 6675: PMHNP Care Across the Lifespan II Class
Required Readings (click to expand/reduce)
American Psychiatric Association. (2022). ICD-10-CM Codes Update. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/updates-to-dsm-5-tr-criteria-text
American Psychiatric Association. (2022). Changes to ICD-10-CM Codes for DSM-5 Diagnoses. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/coding-updates
American Psychiatric Association. (2020). Updates to DSM–5 criteria, text and ICD-10 codes. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
American Psychiatric Association. (2013). Insurance implications of DSM-5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Insurance-Implications-of-DSM-5.pdf
Clicking on this link will initiate the download of the PDF.
American Psychiatric Association. (2020). Coding and reimbursement.
American Psychiatric Association. (2022). Numerical listing of DSM-5 diagnoses and codes (ICD-10-CM). In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Chapter 9, “Reimbursement for Nurse Practitioner Services”
Centers for Medicare & Medicaid Services. (2020). Your billing responsibilities. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
Chapter 15, “Reimbursement for Nurse Practitioner Services”
Walden University Academic Skills Center. (2017). Developing SMART goals. https://academicguides.waldenu.edu/ld.php?content_id=51901492
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
Chapter 4 “Neuroanatomy, Physiology, and Mental Illness”