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-TR to ICD-10. 

To prepare: 

• Review the Learning Resources on coding, billing, reimbursement.
• Review the E/M patient case scenario provided.

Assignment:

• Assign DSM-5-TR 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-TR 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.   

Resources to consider:

• American Psychiatric Association. (2022).  ICD-10-CM Codes Update. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/updates-to-dsm-5-tr-criteria-text
  
• American Psychiatric Association. (2022). Changes to ICD-10-CM Codes for DSM-5 Diagnoses  https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/coding-updates
  
• 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. (2022). Numerical listing of DSM-5 diagnoses and codes (ICD-10-CM). In Diagnostic and statistical manual of mental disorders. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
  
• 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
  
  
• DeNisco, S. M. (2023). Role development for the nurse practitioner (3rd ed.). Jones & Bartlett Learning.
  • Chapter 17, “Reimbursement for Nurse Practitioner Services” (pp. 403-427)
  • Chapter 14, “Concepts and Challenges of the Professional Nurse Practitioner” (pp. 351-362)
  • Chapter 15, “Health Policy and the Nurse Practitioner” (pp. 367-384)
  • Chapter 16, “Mentoring and Lifelong Learning”  (pp. 389-399)

NOTE: Please use Resources/References not older than 5-years. (2019 – 2024)

Rubric