Accessing Your Coding Skills Discussion Responses Solution

Accessing Your Coding Skills Discussion Responses

Table of Contents

Order Number	Y47874HDUEW
Type of Project	Essay/Research Paper
Writer Level	PHD/MASTERS
Writing Style	APA/Harvard/MLA/CHICAGO
Citations	5
Page Count	3-15

Description/Paper 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.

1. What was the primary reason for the visit?

Chronic Pain and Depression were the primary reasons for the visit.

2. What is the keyword you will use to look up the primary reason?

Chronic Pain is the keyword used to look up the primary reason for the visit. The code is G89.4 for Chronic pain syndrome.

3. What other problems need to be coded.

Depression was coded: F33 for Major Depressive disorder, recurrent. Elevated Blood Pressure: R03.0 and Headache: R51.

4. What indexes do you need to use to determine code selection?

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.

5. How are the questions answered used in the reimbursement cycle: a step of the cycle, the purpose of the code, who generates to code, and how the monetary value is decided?

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

Excellent	The essay demonstrates exemplary comprehension of the relevant content by thoroughly as well as correctly discussing the relevant information; identifying as well as explaining all of the 3 fundamental aspects; using correct terminology; describing the reasoning next to key points/claims; as well as substantiating points with several accurate as well as illuminating examples, as necessary or useful. There are no gaps in the necessary answer.
Good	Scholarly sources that are credible are employed to successfully support statements that are, as the most part, clear as well as fairly expressed. With just a few minor inaccuracies, APA 6th Edition is utilized. There are a few small typos in the references and/or citations. There is some reliance on dubious sources.
Satisfactory	Because of certain improper terminology and/or confusing wording, the work is frequently confused and difficult to understand; thoughts may be disjointed, meandering, and/or repetitious. a lack of structure; and/or grammatical, spelling, and punctuation mistakes.
Poor	The essay demonstrates a lack of understanding of the related documents by failing to address or improperly addressing the relevant; failing to identify or incorrectly trying to explain key concepts/ideas; ignoring as well as incorrectly attempting to explain key points/claims as well as the rationale behind them; and/or inaccurately or improperly using terminology.
No Response	Essay displays great writing abilities, such as a clear as well as thought-provoking thesis, suitable and effective organization, vibrant and persuasive supporting materials, good diction as well as sentence skills, and faultless or almost perfect mechanics, such as spelling and grammar. The essay flawlessly achieves the assignment’s objectives.
Quality of Response	Because of its intelligent growth and mature manner, this study merits attention. It provides a compelling analysis of or reaction to the text, expanding on that response using well-chosen examples and arguments. The sixth paper demonstrates that its author can typically use appropriate words, employ advanced phrases successfully, and adhere to written English rules.
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