Order ID:89JHGSJE83839 | Style:APA/MLA/Harvard/Chicago | Pages:5-10 |
Instructions:
Accessing Your Coding Skills Discussion Responses
read and contribute/comment to peer discussion in 75 words or more with at least 2 or more credible references in APA st
Peer 1:
Coding
The Main Reason for The Visit
Chronic Pain treatment (code G89.4) which is causing depression (code F33)
Keyword
Treatment and psychiatrist
Other Problems Include
Headaches (R51) and high blood pressure (code R03.0)
Indexes For Determining Code Selection
Alphabetical index. The alphabetical index was used to locate the Chronic Pain Syndrome diagnosis, which was further delimited with “chronic” to get the final code for G89.4. F33 for recurrent Major Depressive Disorder is suitable since it is a chronic disorder associated with Chronic Pain Syndrome. I selected R03.0 since the patient is not diagnosed, and this is the code for an undiagnosed discovery of increased blood pressure. R51 is utilized for headaches because it is a generic code that may be used for all sorts of recurrent headaches. There is insufficient information to elaborate on the code based on the information supplied.
The Reimbursement Cycle
The reimbursement cycle for healthcare is divided into three phases: the front-end, the middle, and the back-end. The front-end consists of patient access functions like appointment scheduling, registration, prior authorization, insurance verification, and money management.
The middle section includes case management, documenting costs for an insurance review, and the coding methods detailed in this activity (Oachs & Watters, 2020).
The back-end portion of the revenue cycle is responsible for processing claims by analyzing the coding documentation and may also include follow-up, customer support, and collection of delinquent invoices or rejection management.
Medical coding for services and patient visits includes examining medical records and applying precise codes to all billable activities and diagnoses. These codes are used by the patient’s insurance company or payor to compensate the provider/clinic/hospital for healthcare services rendered to the patient as documented in the billing documents (Martins et al., 2017. A skilled medical biller checks and analyzes the data to ensure that the right payment is coordinated depending on the patient’s health plan.
References
Martins, L., Nicholson, R., & Kohn, R. (2017). Issues in Medicare billing, documentation, and coding. Oxford Medicine Online. https://doi.org/10.1093/med/9780199374656.003.0036
Oachs, P., & Watters. (2020). Health information management: Concepts, principles, and practice (6th ed.).
Peer 2:
A patient visits the clinic where he is treated by his psychiatrist for chronic pain syndrome that is causing his depression. During the work- up his blood pressure is elevated and he has complaints of frequent headaches.
Chronic Pain and Depression were the primary reasons for the visit.
Chronic Pain is the keyword used to look up the primary reason for the visit. The code is G89.4 for Chronic pain syndrome.
Depression was coded: F33 for Major Depressive disorder, recurrent. Elevated Blood Pressure: R03.0 and Headache: R51.
The alphabetical index was used to find the Chronic Pain Syndrome diagnosis with Pain in the R52 index and further coincided with chronic to have the final code for G89.4. F33 for Major Depressive Disorder was used for recurrent diagnosis is appropriate because it is a chronic condition of Chronic Pain Syndrome. R03.0 was used because the patient did not have a diagnosis of hypertension and this code was used to find the code for elevated blood pressure without a diagnosis.
The healthcare reimbursement cycle follows three phases: front-end, middle, and the back-end. Revenue cycle management (RCM) is the implementation of clinical functions to capture, monitor and collecting patient service revenue. Health Information and Management Systems Systems (HIMSS) define RCM as” a healthcare organization’s financial circulatory system and basic process of the organization securing reimbursement for products or services rendered to patients” (Oachs &Watters, 2020).
Revenue Management Cycle According to (Oachs &Watters, 2020):
The front-end includes patient access such as scheduling visits or services, patient registration, prior authorization processes, insurance verifications, point-of-service, and financial counseling.
The middle involves case management, documentation of charges to be reviewed by the patient’s insurance, and the coding procedures.
The back-end phase is the revenue cycle process that involves claims processing by reviewing the coding documentation and may involve follow-up, customer service, and collections of unpaid bills, payments, or denial management.
Medical coding for services and patient visits involves the review of medical documentation and the use of specific codes for all billable activities and diagnoses. These codes are used by the patient’s insurance/the payment reimbursement to the provider/clinic/hospital for healthcare services provided to the patient based on the billing documentation. As professional medical billers/coders, we are to review the documentation and analyze the codes used in the documentation to coordinate the appropriate reimbursement based on the patient’s health plan (Oachs & Watters, 2020).
References
Oachs, P.K. & Watters, A.L. (2020), Health Information Management: Concepts, principles, and practice (6th Ed.). pp. 244-266. Chicago, IL: AHIMA.
The Web’s Free 2021 ICD-10-CM/PCS Medical Coding Reference. (n.d.). http://www.icd10data.com/.
Accessing Your Coding Skills Discussion Responses
RUBRIC |
||||||
Excellent Quality 95-100%
|
Introduction
45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Literature Support 91-84 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met. |
|||
Average Score 50-85% |
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided. |
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration. |
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met. |
|||
Poor Quality 0-45% |
37-1 points The background and/or significance are missing. No search history information is provided. |
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration. |
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met |
|||
You Can Also Place the Order at www.collegepaper.us/orders/ordernow or www.crucialessay.com/orders/ordernow
Accessing Your Coding Skills Discussion Responses |
Accessing Your Coding Skills Discussion Responses