WK2ASSIGNMENT1DRAFT.docx

WK 2 ASSIGNMENT 1 DRAFT

Assignments: Each assignment must contain an INTRODUCTION and CONCLUSION page. Make sure you follow the Grading Rubrics to write the homework.  Please review the rubrics for the assignment to make sure all the elements are present prior to submission. 
(Selected Journal article MUST not be more that 5 years old)

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

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.   

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2020). Updates to DSM–5 criteria, text and ICD-10 codes. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5

American Psychiatric Association. (2013). Insurance implications of DSM-5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Insurance-Implications-of-DSM-5.pdf
· Clicking on this link will initiate the download of the PDF.

American Psychiatric Association. (2020). Coding and reimbursement.
https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement

American Psychiatric Association. (2013). Numerical listing of DSM-5 diagnoses and codes (ICD-10-CM). In Diagnostic and statistical manual of mental disorders (5th ed.).https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.1176/appi.books.9780890425596.ICD10Num_list

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
· Chapter 9, “Reimbursement for Nurse Practitioner Services”

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

Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
· Chapter 15, “Reimbursement for Nurse Practitioner Services”

Walden University Academic Skills Center. (2017). Developing SMART goals. https://academicguides.waldenu.edu/ld.php?content_id=51901492

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.  
· Chapter 4 “Neuroanatomy, Physiology, and Mental Illness”

Document: E/M Patient Case Study

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NRNP_6675_Week2_Assignment1_Rubric

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Grid View

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List View

Excellent

90%–100%

Good

80%–89%

Fair

70%–79%

Poor

0%–69%

In the E/M patient case scenario provided:

• Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.

18 (18%) – 20 (20%)
DSM-5 and ICD-10 codes assigned to the scenario are correct, with no more than a minor error.

16 (16%) – 17 (17%)
DSM-5 and ICD-10 codes assigned to the scenario are mostly correct, with a few minor errors.

14 (14%) – 15 (15%)
DSM-5 and ICD-10 codes assigned to the scenario contain several errors.

0 (0%) – 13 (13%)
DSM-5 and ICD-10 codes assigned to the scenario contain significant errors, or response is missing.

In 1–2 pages, address the following:

• Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

23 (23%) – 25 (25%)
The response accurately and concisely explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

20 (20%) – 22 (22%)
The response accurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

18 (18%) – 19 (19%)
The response somewhat vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

0 (0%) – 17 (17%)
The response vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding, or the explanation is incomplete or missing.

• Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

23 (23%) – 25 (25%)
The response accurately and concisely identifies the pertinent misssing information from the case scenario and clearly identifies what additional information would narrow coding and billing options.

20 (20%) – 22 (22%)
The response accurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.

18 (18%) – 19 (19%)
The response somewhat vaguely or inaccurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.

0 (0%) – 17 (17%)
The response vaguely or inaccurately identifies the pertinent misssing information from the case scenario or partially identifies what additional information would narrow coding and billing options, or this information is incomplete or missing.

• Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.

14 (14%) – 15 (15%)
The response accurately and concisely explains how to improve documentation to support coding and billing for maximum reimbursement.

12 (12%) – 13 (13%)
The response accurately explains how to improve documentation to support coding and billing for maximum reimbursement.

11 (11%) – 11 (11%)
The response somewhat vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement.

0 (0%) – 10 (10%)
The response vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement, or response may be incomplete or missing.

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.

5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. Purpose statement, introduction, and conclusion were not provided. Written Expression and Formatting - English Writing Standards: Correct grammar, mechanics, and proper punctuation 5 (5%) - 5 (5%) Uses correct grammar, spelling, and punctuation with no errors 4 (4%) - 4 (4%) Contains 1-2 grammar, spelling, and punctuation errors 3.5 (3.5%) - 3.5 (3.5%) Contains 3-4 grammar, spelling, and punctuation errors 0 (0%) - 3 (3%) Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding Written Expression and Formatting - The paper follows correct APA format for parenthetical/in-text citations and reference list. 5 (5%) - 5 (5%) Uses correct APA format with no errors 4 (4%) - 4 (4%) Contains 1-2 APA format errors 3.5 (3.5%) - 3.5 (3.5%) Contains 3-4 APA format errors 0 (0%) - 3 (3%) Contains five or more APA format errors Total Points: 100 Name: NRNP_6675_Week2_Assignment1_Rubric 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: · we need to know what prevoious tREATMENTS the pt RECEIVED? · did shE receive intensive CARE TREATMENT, OR DIALECTICAL BEHAVIORAL THERAPY? · when did the failed medication trial happen? · when was the flueoxitine prescribed? · 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? · met with HER FROM 9am -9:57am medication mgmt & psychoeducation – spend 30mins on med mgmt & filling out paperwork and reviewed with pt · look up cpt code for billing med mgmt & filling out paperwork documentation · 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. · vyvanse is a better combination with fluoxetine does not depend on cyp2d6 Week 2 Announcement Posted on: Sunday, June 6, 2021 11:04:37 PM EDT 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. Assignment #1 due by day 7 of week 2: 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.