You will add your narrative answers to these questions to the bottom of the case scenario document and submit them altogether as one document.
What reimbursement billing code would you use for this session? Provide your justification for using this billing code.
Explain what pertinent information is required in documentation to support your chosen DSM-5-TR diagnoses, ICD-10 coding, and billing code.
Explain what pertinent documentation is missing from the case scenario and what other information would be helpful to narrow your coding and billing options. (There are at least 12 missing pertinent components of documentation).
Discuss legal and ethical dilemmas related to overbilling, upcoding, and fraudulent practices. Propose 2 strategies for promoting legal and ethical coding and billing practices within your future clinical roles.
Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
Resources:
American Psychiatric Association. (2024). CPT coding and reimbursementLinks to an external site.. https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-and-reimbursement
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. Section II. In Diagnostic and statistical manual of mental disordersLinks to an external site. (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. (2023). Medicare & mental health coverageLinks to an external site.. https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf
Centers for Medicare & Medicaid Services. (2023). Your billing responsibilitiesLinks to an external site.. 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)
Walden University Academic Skills Center. (2017). Developing SMART goalsLinks to an external site.. 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”