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. 

RESOURCES

Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources. 

· American Psychiatric Association. (2022).   . https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/updates-to-dsm-5-tr-criteria-text

· American Psychiatric Association. (2022).  . https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/coding-updates

· American Psychiatric Association. (2020).  . https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5

· American Psychiatric Association. (2013).  . 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).  .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).   (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).  . 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).  . 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: 

TO PREPARE

Reflect on the study plan you created in NRNP 6665. Did you accomplish your SMART goals? What areas of focus still present opportunities for growth

· Review this week’s Learning Resources on coding, billing, reimbursement.

· Review the E/M patient case scenario provided.

THE ASSIGNMENT

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

Then, in 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.