: 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.
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To Prepare
Review this week’s Learning Resources on coding, billing, reimbursement.
https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement
https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities
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
Rubric Detail
In the E/M patient case scenario provided:
• Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.
—
Excellent
90%–100% 18 (18%) – 20 (20%)
Good
80%–89% 16 (16%) – 17 (17%)
Fair
70%–79% 14 (14%) – 15 (15%)
Poor
0%–69% 0 (0%) – 13 (13%)
In 1–2 pages, address the following:
• Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.
—
Excellent
90%–100% 23 (23%) – 25 (25%)
Good
80%–89% 20 (20%) – 22 (22%)
Fair
70%–79% 18 (18%) – 19 (19%)
Poor
0%–69% 0 (0%) – 17 (17%)
• Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.–
Excellent
90%–100% 23 (23%) – 25 (25%)
Good
80%–89% 20 (20%) – 22 (22%)
Fair
70%–79% 18 (18%) – 19 (19%)
Poor
0%–69% 0 (0%) – 17 (17%)
• Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.–
Excellent
90%–100% 14 (14%) – 15 (15%)
Good
80%–89% 12 (12%) – 13 (13%)
Fair
70%–79% 11 (11%) – 11 (11%)
Poor
0%–69% 0 (0%) – 10 (10%)
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.
—
Excellent
90%–100% 5 (5%) – 5 (5%)
Good
80%–89% 4 (4%) – 4 (4%)
Fair
70%–79% 3.5 (3.5%) – 3.5 (3.5%)
Poor
0%–69% 0 (0%) – 3 (3%)
Written Expression and Formatting – English Writing Standards:
Correct grammar, mechanics, and proper punctuation
—
Excellent
90%–100% 5 (5%) – 5 (5%)
Good
80%–89% 4 (4%) – 4 (4%)
Fair
70%–79% 3.5 (3.5%) – 3.5 (3.5%)
Poor
0%–69% 0 (0%) – 3 (3%)
Written Expression and Formatting –
The paper follows correct APA format for parenthetical/in-text citations and reference list.
—
Excellent
90%–100% 5 (5%) – 5 (5%)
Good
80%–89% 4 (4%) – 4 (4%)
Fair
70%–79% 3.5 (3.5%) – 3.5 (3.5%)
Poor
0%–69% 0 (0%) – 3 (3%)
Total Points: 100
