HIM1257 Module 06 Assignment Worksheet How to corrct coding affects billing and reimbursement

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Apr 3, 2024

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HIM1257 Ambulatory Coding Module 06 Written Assignment: H ow Correct Coding affects Billing and Reimbursement Instructions: Each scenario is worth a potential 10 points. Points in parentheses are for each scenario. This assignment is worth a total of 30 points. • Read each scenario and review the assigned codes. (The 3m encoder’s APC finder is useful to identify any billing edits.) • Identify the error in the claim and explain why it might be improperly paid or denied (3 points) • Describe how this error could be remedied (3 points) • Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points) • A 90-year-old white female with a known history of hypertensive kidney disease is referred by her regular internal medicine physician for a cystoscopy. She was treated for urinary tract infection but microscopic hematuria is persistent. A cystourethroscopy was performed under general anesthesia. The urologist removed a small 0.6 cm tumor from the lateral wall of the bladder. The specimen was sent to pathology. A squamous cell carcinoma was diagnosed. The reported diagnosis codes were: R31.21, C67.2, I12.9, N18.9 The reported procedure codes were: 52000, 52234 • Identify the error in the claim and explain why it might be improperly paid or denied (3 points) • Ans: The error code 52000, It's already covered with the other code. this may be improperly paid or denied becouse of duplicate code. • Describe how this error could be remedied (3 points) • Ans: This could be remedied by deleting the code entirely. • Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points) • Ans: Duplicate coding can cause late reimbursement and possibly make pay outs harder as they may ask all together and requist clinial decumentation, shows medical for the precedure, It coud be possible over paid.

• A 55-year-old female with a known history of varicose veins in the left leg presents to the clinic complaining of left ankle pain. No know injury is recalled. A short leg splint is placed for the patient’s comfort and to provide stability. She is advised to follow up in one week if there is no improvement. The reported diagnosis codes were: S93.402A, I83.92 The reported procedure codes were: 29515, 73090 • Identify the error in the claim and explain why it might be improperly paid or denied (3 points) • Ans: The mistake is the upper extremity diagnostic imaging code 73090. Correct code 29515 requires modifier LT patient's left leg worked on. The mistake might deny the claim since it was billed for upper extremities while it was for lower extremities. • Describe how this error could be remedied (3 points) • Ans: This might be fixed by removing the impropre code and replacing it with the right modifier from the correctly listed code. Prior to coding, double-check notes and services delivered to ensure that procedures are invoiced accurately. • Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points) • Ans:This kind of mistake has the potential to create conflicts in the workflow, since it might impede the progress of subsequent tasks in the chain. Failing to code accurately or neglecting to verify the code might reveal an inadequacy on the part of the developer. • A 67-year-old male established patient presents to the clinic complaining of chronic low back pain. The patient also noted urinary hesitation and cloudy appearing urine. A urine culture is ordered. The patient is advised to take acetaminophen for the pain and follow up in 3 days unless symptoms worsen. The physician spent approximately 15 minutes with the patient with low level medical decision making. The reported diagnosis codes were: M54.5 The reported procedure codes were: 99213, 87086 • Identify the error in the claim and explain why it might be improperly paid or denied (3 points) • Ans:The mistake in this assertion is that the code 87086 is incorrect for the urine culture. The appropriate code for urinary hesitation is 87088.

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