EVALUATION AND MANAGEMENT

EVALUATION AND MANAGEMENT

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Insurance coding and billing are complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to your service. The payer then reimburses the service at a certain rate. As a provider, you must understand what codes to use and what documentation is necessary to support coding.

For this Assignment, you will review a patient’s evaluation and management (E/M) documentation and perform a crosswalk of codes from  DSM-5-TR to ICD-10. 

TO PREPARE

· Review this week’s Learning Resources on coding, billing, and 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.  

LEARNING RESOURCES

· American Psychiatric Association. (2022).  Changes to ICD-10-CM Codes for DSM-5 Diagnoses Links to an external site. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/coding-updates

· American Psychiatric Association. (2020).  Coding and reimbursement Links to an external site. . https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement

· Centers for Medicare & Medicaid Services. (2020).  Your billing responsibilities Links to an external site. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities

· I have also attached two other resources.

HINTS TO CONSIDER:

Please be sure to research and answer all questions following the Rubric above.

Hi,

Thoughts on this case: Stimulant use d/o needs more details. Was ADHD under treated leading to D/O? Consider drug to drug interactions between fluoxetine and Strattera. Increasing fluoxetine raises risk of serotonin syndrome even more. Symptoms patient C/O already suggest adverse effects and lack of efficacy with Strattera (Atomoxetine). Choose a stimulant that has no abuse potential (Vyvanse). Suggest a taper schedule for Strattera and D/C before increasing fluoxetine. Use adult ADHD self-report scale to measure current criteria met for ADHD and again for response to changes in medication. 

Trauma history and treatment, coping skills need more details. Does patient need help with managing triggers? What does     “good support” consist of? 

30-day interval between appointments is not appropriate. Patient needs a sooner appointment for medication safety reasons.

I hope this helps for starters.

More HINTS:

1. we need to know what prevoious tREATMENTS the pt RECEIVED?

1. did shE receive intensive CARE TREATMENT, OR DIALECTICAL BEHAVIORAL THERAPY?

1. when did the failed medication trial happen?

1. when was the flueoxitine prescribed?

1. we need moore information on pt’s adhereance to medication PLAN, what Is her believe about medication, did she choose to follow a medication plan or not? was she refered to a trauma TREATMENT?

1. met with HER FROM 9am -9:57am medication mgmt & psychoeducation – spend 30mins on med mgmt & filling out paperwork and reviewed with pt

1. look up cpt code for billing med mgmt & filling out paperwork documentation

1. fluoxetine((Atomoxetine) is cyp2d6 INHIBITOR, atomoxitine is a cy2d6 SUBSTRATE. flUOXETINE and Atomoxitine are not the best combination drugs – do some research to back it the claim.

1. vyvanse is a better combination with fluoxetine does not depend on cyp2d6

Week 2 Announcement

Week 2

Now who wants to be paid for the care they give, I do. This is very important if you are on production model and even if you are on hourly pay for when you ask for pay raises. I work in a private clinic and I am paid on percentage of recovery of billing. Prior in my time at the clinic, the billing department missed billing 10 visits for me and multiple for others as well and was beyond the date of when the insurance company would accept the bills. Many providers were not happy, so many providers now watch each visit billing and recovery. I really don’t have the time for that and hope they are doing their jobs now. But, if it was my primary employment, I would care more too. Knowing the codes and criteria for each billing code also will keep you out of trouble when insurance or government do audits of records. You do not want to be the provider to pay back money for errors in billing codes.

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