NURSING

The Assignment

Assign DSM-5 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 them altogether as one document.

Explain what pertinent information, generally, is required in documentation to support DSM-5 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.

Pathways Mental Health

Psychiatric Patient Evaluation

Instructions
Use the following case template to complete Week 2 Assignment 1. On page 5, assign DSM-5 and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit altogether as one document.

Identifying Information
Identification was verified by stating of their name and date of birth. Time spent for evaluation: 0900am-0957am

Chief Complaint
“My other provider retired. I don’t think I’m doing so well.”

HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD. Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.

Diagnostic Screening Results
Screen of symptoms in the past 2 weeks: PHQ 9 = 0 with symptoms rated as no difficulty in functioning Interpretation of Total Score Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression GAD 7 = 2 with symptoms rated as no difficulty in functioning Interpreting the Total Score: Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety MDQ screen negative PCL-5 Screen 32

Past Psychiatric and Substance Use Treatment
Entered mental health system when she was age 19 after raped by a stranger during a house burglary. Previous Psychiatric Hospitalizations: denied Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015 Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing) Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records

Substance Use History
Have you used/abused any of the following (include frequency/amt/last use): Substance Y/N Frequency/Last Use Tobacco products Y ½ ETOH Y last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially Cannabis N Cocaine Y last use 2015 Prescription stimulants Y last use 2015 Methamphetamine N Inhalants N Sedative/sleeping pills N Hallucinogens N Street Opioids N Prescription opioids N Other: specify (spice, K2, bath salts, etc.) Y reports one-time ecstasy use in 2015 Any history of substance related: Blackouts: + Tremors: – DUI: – D/T’s: – Seizures: – Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings

Psychosocial History
Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children. Employed at local tanning bed salon Education: High School Diploma Denied current legal issues.

Suicide / HOmicide Risk Assessment
RISK FACTORS FOR SUICIDE: Suicidal Ideas or plans – no Suicide gestures in past – no Psychiatric diagnosis – yes Physical Illness (chronic, medical) – no Childhood trauma – yes Cognition not intact – no Support system – yes Unemployment – no Stressful life events – yes Physical abuse – yes Sexual abuse – yes Family history of suicide – unknown Family history of mental illness – unknown Hopelessness – no Gender – female Marital status – single White race Access to means Substance abuse – in remission PROTECTIVE FACTORS FOR SUICIDE: Absence of psychosis – yes Access to adequate health care – yes Advice & help seeking – yes Resourcefulness/Survival skills – yes Children – no Sense of responsibility – yes Pregnancy – no; last menses one week ago, has Norplant Spirituality – yes Life satisfaction – “fair amount” Positive coping skills – yes Positive social support – yes Positive therapeutic relationship – yes Future oriented – yes Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied history of self-mutilation behaviors Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol. No required SAFETY PLAN related to low risk

Mental Status Examination
She is a 25 yo Russian female who looks her stated age. She is cooperative with examiner. She is neatly groomed and clean, dressed appropriately. There is mild psychomotor restlessness. Her speech is clear, coherent, normal in volume and tone, has strong cultural accent. Her thought process is ruminative. There is no evidence of looseness of association or flight of ideas. Her mood is anxious, mildly irritable, and her affect appropriate to her mood. She was smiling at times in an appropriate manner. She denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.

Clinical Impression
Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission. Moods are anxious and irritable. She has ongoing reported symptoms of re-experiencing, avoidance, and hyperarousal of her past trauma experiences; ongoing subsyndromal symptoms related to her past ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches. At the time of disposition, the client adamantly denies SI/HI ideations, plans or intent and has the ability to determine right from wrong, and can anticipate the potential consequences of behaviors and actions. She is a low risk for self-harm based on her current clinical presentation and her risk and protective factors.

Diagnostic Impression
[Student to provide DSM-5 and ICD-10 coding] Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.

Treatment Plan
Medication: Increase fluoxetine 40mg po daily for PTSD #30 1 RF Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF Instructed to call and report any adverse reactions. Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained. Not to drive or operate dangerous machinery if feeling sedated. Not to stop medication abruptly without discussing with providers. Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings. Discussed how drugs/ETOH affects mental health, physical health, sleep architecture. Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment. Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation. RTC in 30 days Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results Patient is amenable with this plan and agrees to follow treatment regimen as discussed.

Narrative Answers
[In 1-2 pages, address the following:
· Explain what pertinent information, generally, is required in documentation to support DSM-5 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.]
Add your answers here. Delete instructions and placeholder text when you add your answers.

we need to know what prevoious tx has the pt RECEIVED?

did she go to intensive tx, dbt,

when did the failed medication trial happen?

when was the flueoxitine prescribed?

we need moore information on pt’s adhereance to medication PLAN, whats her believe about medication, did she choose to follow a medication plan or not? was she refered to a trauma rx?

met with HER FROM 9am -9:57am medication mgmt & psychoeducation – spend 30mins on med mgmt & filling out paperwork and reviewed with pt,

cpt code

fluxitin is cyp2d6 inhibitor

atomoxitine is a cy2d6 substrate

vyvanse does not depend on cyp2d6

References

[Add APA-formatted citations for any sources you referenced]
Delete instructions and placeholder text when you add your citations.

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WK 2 ASSIGNMENT 1 DRAFT

Assignments: Each assignment must contain an INTRODUCTION and CONCLUSION page. Make sure you follow the Grading Rubrics to write the homework. Please review the rubrics for the assignment to make sure all the elements are present prior to submission.

(Selected Journal article MUST not be more that 5 years old)

Week 2: Coding/Billing and Study Plan

Reimbursement and the appropriate coding to support it are of paramount importance to the business side of the medical field. When a service is provided, a code is used to extract billable information from the medical documentation, which results in insurance reimbursements to the provider. Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses, and you will need to understand how to accurately code services for documentation, billing, and reimbursement.

This week, you analyze the relationships among documentation, coding, and billing in advanced practice nursing as you practice applying diagnostic criteria and service codes to a case study. You will also evaluate the progress you made on the study plan that you created in NRNP 6665 and develop additional goals to help you prepare for your nurse practitioner national certification exam.

Learning Objectives

Students will:

· Apply DSM-5 diagnosis criteria and ICD-10 codes to patient service documentation

· Analyze the relationships among documentation, coding, and billing in advanced practice nursing

· Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination

· Create a study plan for the nurse practitioner national certification examination

Assignment 1: 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 to ICD-10.

Photo Credit: Getty Images/Tetra images RF

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

· Review the E/M patient case scenario provided.

The Assignment
· Assign DSM-5 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 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.

Learning Resources

Required Readings (click to expand/reduce)

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. (2013). Numerical listing of DSM-5 diagnoses and codes (ICD-10-CM). In Diagnostic and statistical manual of mental disorders (5th ed.).https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/10.1176/appi.books.9780890425596.ICD10Num_list

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

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). Developing SMART goals. 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: E/M Patient Case Study

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Name: NRNP_6675_Week2_Assignment1_Rubric

· Grid View

· List View

 

Excellent 90%–100%

Good 80%–89%

Fair 70%–79%

Poor 0%–69%

In the E/M patient case scenario provided:

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

18 (18%) – 20 (20%)

DSM-5 and ICD-10 codes assigned to the scenario are correct, with no more than a minor error.

16 (16%) – 17 (17%)

DSM-5 and ICD-10 codes assigned to the scenario are mostly correct, with a few minor errors.

14 (14%) – 15 (15%)

DSM-5 and ICD-10 codes assigned to the scenario contain several errors.

0 (0%) – 13 (13%)

DSM-5 and ICD-10 codes assigned to the scenario contain significant errors, or response is missing.

In 1–2 pages, address the following:

• Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

23 (23%) – 25 (25%)

The response accurately and concisely explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

20 (20%) – 22 (22%)

The response accurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

18 (18%) – 19 (19%)

The response somewhat vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

0 (0%) – 17 (17%)

The response vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding, or the explanation is incomplete or missing.

• Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

23 (23%) – 25 (25%)

The response accurately and concisely identifies the pertinent misssing information from the case scenario and clearly identifies what additional information would narrow coding and billing options.

20 (20%) – 22 (22%)

The response accurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.

18 (18%) – 19 (19%)

The response somewhat vaguely or inaccurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.

0 (0%) – 17 (17%)

The response vaguely or inaccurately identifies the pertinent misssing information from the case scenario or partially identifies what additional information would narrow coding and billing options, or this information is incomplete or missing.

• Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.

14 (14%) – 15 (15%)

The response accurately and concisely explains how to improve documentation to support coding and billing for maximum reimbursement.

12 (12%) – 13 (13%)

The response accurately explains how to improve documentation to support coding and billing for maximum reimbursement.

11 (11%) – 11 (11%)

The response somewhat vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement.

0 (0%) – 10 (10%)

The response vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement, or response may be incomplete or missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. Purpose statement, introduction, and conclusion were not provided.

Written Expression and Formatting – English Writing Standards:

Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors

4 (4%) – 4 (4%)

Contains 1-2 grammar, spelling, and punctuation errors

3.5 (3.5%) – 3.5 (3.5%)

Contains 3-4 grammar, spelling, and punctuation errors

0 (0%) – 3 (3%)

Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Written Expression and Formatting –

The paper follows correct APA format for parenthetical/in-text citations and reference list.

5 (5%) – 5 (5%)

Uses correct APA format with no errors

4 (4%) – 4 (4%)

Contains 1-2 APA format errors

3.5 (3.5%) – 3.5 (3.5%)

Contains 3-4 APA format errors

0 (0%) – 3 (3%)

Contains five or more APA format errors

Total Points: 100

Name: NRNP_6675_Week2_Assignment1_Rubric

HINTS TO CONSIDER:

Please be sure to research and answer all questions following the Rubric above.

Hi,

Thoughts on this case: Stimulant use d/o needs more details. Was ADHD under treated leading to D/O? Consider drug to drug interactions between fluoxetine and Strattera. Increasing fluoxetine raises risk of serotonin syndrome even more. Symptoms patient C/O already suggest adverse effects and lack of efficacy with Strattera (Atomoxetine). Choose a stimulant that has no abuse potential (Vyvanse). Suggest a taper schedule for Strattera and D/C before increasing fluoxetine. Use adult ADHD self-report scale to measure current criteria met for ADHD and again for response to changes in medication.

Trauma history and treatment, coping skills need more details. Does patient need help with managing triggers? What does “good support” consist of?

30-day interval between appointments is not appropriate. Patient needs a sooner appointment for medication safety reasons.

I hope this helps for starters.

More HINTS:

· we need to know what prevoious tREATMENTS the pt RECEIVED?

· did shE receive intensive CARE TREATMENT, OR DIALECTICAL BEHAVIORAL THERAPY?

· when did the failed medication trial happen?

· when was the flueoxitine prescribed?

· we need moore information on pt’s adhereance to medication PLAN, what Is her believe about medication, did she choose to follow a medication plan or not? was she refered to a trauma TREATMENT?

· met with HER FROM 9am -9:57am medication mgmt & psychoeducation – spend 30mins on med mgmt & filling out paperwork and reviewed with pt

· look up cpt code for billing med mgmt & filling out paperwork documentation

· fluoxetine((Atomoxetine) is cyp2d6 INHIBITOR, atomoxitine is a cy2d6 SUBSTRATE. flUOXETINE and Atomoxitine are not the best combination drugs – do some research to back it the claim.

· vyvanse is a better combination with fluoxetine does not depend on cyp2d6

Week 2 Announcement
Posted on: Sunday, June 6, 2021 11:04:37 PM EDT

Week 2

Now who wants to be paid for the care they give, I do. This is very important if you are on production model and even if you are on hourly pay for when you ask for pay raises. I work in a private clinic and I am paid on percentage of recovery of billing. Prior in my time at the clinic, the billing department missed billing 10 visits for me and multiple for others as well and was beyond the date of when the insurance company would accept the bills. Many providers were not happy, so many providers now watch each visit billing and recovery. I really don’t have the time for that and hope they are doing their jobs now. But, if it was my primary employment, I would care more too. Knowing the codes and criteria for each billing code also will keep you out of trouble when insurance or government do audits of records. You do not want to be the provider to pay back money for errors in billing codes.

Assignment #1 due by day 7 of week 2:

Assign DSM-5 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 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.

NURSING