MN663 Discussion Response Essays Please respond to both separately positively. r

MN663 Discussion Response Essays
Please respond to both separately positively. references less than 5 years. 2 references each 4 total.
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unit 5 discussion-coding
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Crissy Patierno posted Feb 3, 2023 10:18 PM
This patient’s diagnosis of social anxiety disorder falls under the ICD diagnosis code F40.1, social phobia (American Psychiatric Association, 2021). The diagnosis criteria in this patient includes excessive anxiety at school in which Liam has increased difficulty meeting new people due to feelings of being subpar. He feels he will appear unappealing in the presence of others and has avoided authority figures. He reports feeling anxious when leaving his dorm room. He describes this feeling as an increased sensation of heart palpitations and sweating. The anxiety causes significant social disruptions in which the patient constantly feels judged and unlikeable. The patient avoids interactions, skipping class and avoiding hanging out, in fear of embarrassment.
Evaluation and management codes, E/M, is a 5-digit numerical value utilized to present services that were provided to a patient to allow for reimbursement of professional services provided to manage a condition. These codes also provide a method of monitoring and analyzing services. The current procedural terminology (CPT) code describes the service level in multiple categories. The setting, type of service, medical decision-making level, and time spent. There are criteria that must be met to bill for each level. To qualify as a “new” patient encounter, the patient must not have received services from the provider completing the face-to-face visit, over the 3 years preceding the current visit. This code also does not apply if there was a service provided by a provider from the same physician group specialty in the same 3-year-period.
I would choose 99204 due to the complexity of medical decision making. First, this element includes the number and severity of the problem addressed. In Liam’s case, social phobia is a new diagnosis with uncertain progression, thus resulting in moderate level criteria. The next component of interpretation includes amount/complexity of date to be reviewed. The actions taken would again result under the moderate category. This was determined due to meeting 2 points under category 1, including review of PCP notes and ordering of tests for palpitations, anxiety, and associated sweating. Finally, Liam’s case falls under the moderate category for morbidity/mortality of management. An SSRI will be initiated and titrated to reach a desired outcome. Prescription drug management falls under the moderate category. Due to 2/3 of the levels falling under the moderate level, the code was determined to be 99204.
The diagnosis code is set to capture the diagnosis and reason for visit, which is social phobia in this case. The code is meant to support medical necessity for services, and thus determine accuracy of reimbursement. The E/M code is used to determine severity of each presenting diagnosis and subsequent management. The providers level of work is captured and reimbursed based on diagnosis codes (AAPC, 2022). Third party payors use standards set by the HHS and are regulated by the state. The state determines their own rules of reimbursement based on which services they feel is medically indicated. For this reason, accurate diagnoses and corresponding treatments are required.
References
AAPC. (2022). Outpatient facility coding. Retrieved from https://www.aapc.com/outpatient-facility-coding-reimbursement.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. (5th ed.). American Psychiatric Publishing, INC
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Last post yesterday at 5:50 PM by Alero Ekata
Unit 5 Discussion
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Christine V Servando posted Feb 2, 2023 3:02 AM
Liam is experiencing social anxiety as supported by symptoms of sweating and heart palpitations whenever he leaves his room; he rarely attends class and has not reached out to his professors to try to talk about his grades; has a hard time concentrating, interacting with others, and busy worrying about what others will think of him; has chronic history of feeling uncomfortable with authority figures; and isolating more and turning down social invitations and gatherings. The symptoms experienced by the patient meets the criteria for social anxiety disorder with DSM-5 of F40.10 for Social Anxiety Disorder mapping to ICD-10 code of F40.10 for Social Phobia, unspecified (American Psychological Association, 2016). As the psychiatric diagnostic evaluation had medical assessment performed, the provider may use CPT code 90792 or an evaluation and management (E/M) code. This service integrates biopsychosocial and medical assessment that includes history taking, mental status exam, physical examination, and recommendations (Centers for Medicare & Medicaid Services, n.d.). Medical evaluation and referral are also needed for work-up on palpitations as necessary and patient’s BMI shows obesity and Liam will need further testing for EKG and metabolic levels such as CMP, lipid profile, and HBA1C.
In the United States, the health care system uses diagnostic codes for billing and reimbursement, used as a diagnostic tool for monitoring health care trends, quality care performance, disease prevalence, mortality, and utilization of resources. The diagnostic codes are used to designate a diagnosis associated with the visit and to determine necessity for treatment. Reimbursement may be affected or delayed when inappropriate diagnostic codes are utilized, moreover will not cover for the visit. The choice of what code to choose affects reimbursement as one code may differ from another and one code may have higher reimbursement service (Caskey et al., 2018). The International Classification of Disease (ICD) system was created for a precise tracking of diseases within a population. Through the years, it has become an important part of the payment structure of the US health care system along with the Current Procedural Terminology (CPT) coding system for medical procedures. The ICD system is designed and proportional to how the US health care system payment policy advances from volume to value (Hirsch et al., 2016).
References
American Psychological Association. (2016). ICD-10-CM code discrepancies found in DSM-5. https://www.apaservices.org/practice/reimbursement/icd-diagnostic/code-discrepancies#:~:text=For%20instance%2C%20DSM%2D5%20uses,diagnostic%20code%20for%20different%20presentations.
Caskey, R., Abutahoun,, A., Polick, A., Barnes,M., Srivastava, P., & Boyd, A. (2018). Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties. BMC Health Serv Res., Vol. 18, p. 328. doi: 10.1186/s12913-018-3110-1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935982/
Centers for Medicare & Medicaid Services. (n.d.). Retrieved 2/1/23. Psychiatric diagnostic evaluation and psychotherapy services. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57520&ver=23:~:text=If%20a%20psychiatric%20diagnostic%20evaluation,(E%2FM)%20code.
Hirsch, J., Nicola, G., McGinty, G., Liu, R.W., Barr, R.M., Chittle, M.D., & Manchikantie, L. (2016). ICD-10: History and context. American Journal of Neuroradiology, Vol. 37(4), pp. 596 – 599. doi: 10.3174/ajnr.A4696. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960170/