Reimbursement and the appropriate coding to support it are of paramount importance to the business side of the medical field. When a service is provided, a code is used to extract billable information from the medical documentation, which results in insurance reimbursements to the provider. Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses, and you will need to understand how to accurately code services for documentation, billing, and reimbursement.
This week, you analyze the relationships among documentation, coding, and billing in advanced practice nursing as you practice applying diagnostic criteria and service codes to a case study.
Apply DSM-5-TR diagnosis criteria and ICD-10 codes to patient service documentation
Analyze the relationships among documentation, coding, and billing in advanced practice nursing
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.
· Review this week’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 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.
· American Psychiatric Association. (2022). . https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/updates-to-dsm-5-tr-criteria-text
· American Psychiatric Association. (2022). . https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/coding-updates
· American Psychiatric Association. (2020). . https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
· American Psychiatric Association. (2013). . 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). .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). (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). . 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). . 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”