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 fromDSM-5-TR to ICD-10.
Review this weekâ€s Learning Resources on coding, billing, reimbursement.
Review the E/M patient case scenario provided.
Assign DSM-5-TR and ICD-10 codes to services based upon the patient case scenario.
Then, in 1â€“2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit 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, 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.
American Psychiatric Association. (2022). ICD-10-CM Codes UpdateLinks to an external site.. 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 DiagnosesLinks to an external site.. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/coding-updates
American Psychiatric Association. (2020). Updates to DSMâ€“5 criteria, text and ICD-10 codesLinks to an external site.. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
American Psychiatric Association. (2013). Insurance implications of DSM-5Links to an external site.. 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 reimbursementLinks to an external site..https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/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 disordersLinks to an external site. (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, â€œReimbursement for Nurse Practitioner Servicesâ€
Centers for Medicare & Medicaid Services. (2020). Your billing responsibilitiesLinks to an external site.. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities
DeNisco, S. M. (2023). Role development for the nurse practitioner (3rd ed.). Jones & Bartlett Learning.
Chapter 17, â€œReimbursement for Nurse Practitioner Servicesâ€ (pp. 403-427)
Chapter 14, â€œConcepts and Challenges of the Professional Nurse Practitionerâ€ (pp. 351-362)
Chapter 15, â€œHealth Policy and the Nurse Practitionerâ€ (pp. 367-384)
Chapter 16, â€œMentoring and Lifelong Learningâ€ (pp. 389-399)
Walden University Academic Skills Center. (2017). Developing SMART goalsLinks to an external site.. 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 â€œNeuroanatomy, Physiology, and Mental Illnessâ€
Document: E/M Patient Case Study
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