Coding/Billing and Study Plan
Week 2: Coding/Billing and Study Plan
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. You will also evaluate the progress you made on the study plan that you created in NRNP 6665 and develop additional goals to help you prepare for your nurse practitioner national certification exam.
Learning Objectives
Students will:
Apply DSM-5 diagnosis criteria and ICD-10 codes to patient service documentation
Analyze the relationships among documentation, coding, and billing in advanced practice nursing
Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination
Create a study plan for the nurse practitioner national certification examination
Learning Resources
Required Readings (click to expand/reduce)
Reminder: Keep Your Library of Advanced Practice Nursing Texts at Your Fingertips
Several textbooks are assigned in multiple courses in your program. That is, you will see reading assignments from the books assigned in the Learning Resources of more than one course. You should, however, keep all prior textbooks, not just the ones explicitly assigned, readily accessible. The expectation is that you will independently consult these prior textbooks to synthesize information needed to complete your final courses. This is your time to “put it all together” to more fully embrace the advanced practice nursing role. Part of the responsibility of advanced practice is developing information literacy skills to know where to locate needed information for your clinical practice.
Photo Credit: [Peter Polak]/[iStock / Getty Images Plus]/Getty Images
Assignment 1: 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 to ICD-10.
Photo Credit: Getty Images/Tetra images RF
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 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 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.
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