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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.
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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 and ICD-10 codes to services based upon the patient case scenario.
Then, in 1–2 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.
Week 2
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK2Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button.
NRNP_6675_Week2_Assignment1_Rubric
| Excellent 90%–100% | Good 80%–89% | Fair 70%–79% | Poor 0%–69% | ||
| In the E/M patient case scenario provided: • Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario. | 18 (18%) – 20 (20%) DSM-5 and ICD-10 codes assigned to the scenario are correct, with no more than a minor error. | 16 (16%) – 17 (17%) DSM-5 and ICD-10 codes assigned to the scenario are mostly correct, with a few minor errors. | 14 (14%) – 15 (15%) DSM-5 and ICD-10 codes assigned to the scenario contain several errors. | 0 (0%) – 13 (13%) DSM-5 and ICD-10 codes assigned to the scenario contain significant errors, or response is missing. | |
| In 1–2 pages, address the following: • Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding. | 23 (23%) – 25 (25%) The response accurately and concisely explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding. | 20 (20%) – 22 (22%) The response accurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding. | 18 (18%) – 19 (19%) The response somewhat vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding. | 0 (0%) – 17 (17%) The response vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding, or the explanation is incomplete or missing. | |
| • Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options. | 23 (23%) – 25 (25%) The response accurately and concisely identifies the pertinent misssing information from the case scenario and clearly identifies what additional information would narrow coding and billing options. | 20 (20%) – 22 (22%) The response accurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options. | 18 (18%) – 19 (19%) The response somewhat vaguely or inaccurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options. | 0 (0%) – 17 (17%) The response vaguely or inaccurately identifies the pertinent misssing information from the case scenario or partially identifies what additional information would narrow coding and billing options, or this information is incomplete or missing. | |
| • Finally, explain how to improve documentation to support coding and billing for maximum reimbursement. | 14 (14%) – 15 (15%) The response accurately and concisely explains how to improve documentation to support coding and billing for maximum reimbursement. | 12 (12%) – 13 (13%) The response accurately explains how to improve documentation to support coding and billing for maximum reimbursement. | 11 (11%) – 11 (11%) The response somewhat vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement. | 0 (0%) – 10 (10%) The response vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement, or response may be incomplete or missing. | |
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. | 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. | 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. | 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. | 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. Purpose statement, introduction, and conclusion were not provided. | |
| Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation | 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors | 4 (4%) – 4 (4%) Contains 1-2 grammar, spelling, and punctuation errors | 3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 grammar, spelling, and punctuation errors | 0 (0%) – 3 (3%) Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding | |
| Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list. | 5 (5%) – 5 (5%) Uses correct APA format with no errors | 4 (4%) – 4 (4%) Contains 1-2 APA format errors | 3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 APA format errors | 0 (0%) – 3 (3%) Contains five or more APA format errors | |
| Total Points: 100 | |||||
