Medical Billing and Coding Essay

Part A 1 . Discuss two differences between inpatient and outpatient coding. Outpatient coding is much less complicated than inpatient coding. First, outpatient coding is limited to a length of stay less than 24 hours whereas inpatient stays are longer due to the intensity of services. Second, for outpatient services, physicians are paid using COP/HASPS codes, whereas, hospitals are paid for their hospitality using a complex formula (MS-DRUG) because of housing, feeding and nurturing the patient back to health.

During an inpatient stay, the hospital charges based on the amount of mime and effort spent on nursing a patient back to health so when it comes to normal birth vs. an operation for an elderly person, the hospital will charge based on the severity of the patient’s illness. When it comes to inpatient coding, coders have to be very attentive in order to correctly code the reason for the principal diagnosis because it is crucial to the MS-DRUG formula. As for the outpatient coding, the first listed diagnostic code indicates the reason for the encounter.

In conclusion, the outpatient coding summarizes all diagnoses and typically includes a single reoccurred whereas inpatient coding requires daily coding of each service on each day of hospitalizing. 2. COP Code: 21931 ICED-9-CM code: 239. 2 not correct 3. Discuss coding for obstetrics, including items covered by the global fee for antimatter and postpartum periods of normal pregnancy. Global coding for obstetrics is basically for the services and supplies needed for the antimatter, delivery, and postpartum period of a normal pregnancy.

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The antimatter period of pregnancy is the time of pregnancy from conception to the onset of delivery. The initial and subsequent history, all physical examinations, recording of blood pressure, weight, fetal heart tones, routine urinalysis, and monthly visits up to 28 weeks gestation are included in antimatter care. After 28 weeks, biweekly visits up to 36 weeks gestation, and weekly visits until delivery are also included in antimatter care. Delivery services included the hospital admission with history and physical, the management of uncomplicated labor, and the vaginal or cesarean delivery.

Episiotomy and the use of forceps are also included for antimatter care. For postpartum care, normal, uncomplicated hospital and office visits for 6 weeks after either vaginal or cesarean section delivery are included . Part B What is the difference between Excludes and Excludes notes in the ICED-II? 1. Excludes 1 meaner “not coded here,” which indicates that the code excluded should never be used at the same time as the code in this section. Two conditions may not be reported together.

Excludes 2 meaner “not included here,” which indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When assigning modifier -51 to multiple procedures, you have to be careful to not add the modifier to each procedure. Instead add it to the primary procedure which is the procedure with the highest relative value unit when the multiple procedures are performed on the same day or at the same session by the same provider.

In addition, if the second surgery is incidental to a major procedure then both services would be reported but the modifier -51 would only be added to the lesser of the two services. As for modifier -59, it is reported with codes from all sections of the COP manual except MIM codes. This modifier has been abused by providers excessively by submitting the surgery and follow up codes separately when the follow up should be already bundled together. Providers who have used the modifier -59 are claiming that the service was a part of another service but doing that is a lie. . What are the two types of immunity and how do they differ? Innate immunity, or nonspecific, immunity is the natural resistance with which a person is born. It provides resistance through several physical, chemical, and cellular approaches. While the adaptive immunity is sub-divided into two major types pending on how the immunity was introduced. Naturally acquired immunity occurs through contact of a disease, when the contact was not deliberate, whereas artificially acquired immunity develops only through deliberate actions such as vaccination.

Both naturally and artificially acquired immunity can be subdivided even further. Passive immunity is acquired through transfer of antibodies or activated T- cells. While, active immunity is induced in the host itself by antigen. 4. What are the three types of wound repair, and what must be documented to code them? The 3 types of wound repairs are simple, intermediate and complex. They are coded mainly by the length, complexity and site. To code a simple repair, a wound requires one layer suturing which involves the epidermis, dermis and subcutaneous tissue.

In order to properly code an intermediate repair, a closure should be of one or more layers of subcutaneous tissue and non-muscle fascia, in addition to the skin closure. Lastly, for the complex repair, the wound closure includes revision, debasement, extensive undermining, stints, or retention sutures and more than layered closure. To document these correctly, all simple sites should be grouped together; all intermediate sites should be grouped together and all complex sites should be grouped together. Group together the same classification, such as simple or intermediate. 5.

Explain how evaluation and management (E/M) codes are grouped. The MIM codes are based on the place of service, type of service and the patient status. Coding varies for the place of service therefore its important to find the correct code for the service provided in the hospital, office, emergency department, or nursing home. For could either be a consultation, admission, newborn care or an office visit. Lastly, it extremely important to indicate the patient as a new patient, an established patient outpatient or inpatient, so that the insurance can be billed correctly and the patient won’t have to overpay.

Part C 1 . Which of the following modifiers is used to indicate partial reduction or elimination of a pathology procedure? D. -52 2. COP Category II codes consist of four digits followed by one alpha character. C. 3. The electronic format required to send claims under HAIFA is called D. 5010. 4. The ICED-II-PC’S system uses a tool coders have never used before. What is it? B. Tables 5. During a breast biopsy, the physician removes an entire tumor and sends it to pathology. The physician performed Alan B. Occasional biopsy. 6.

Which of the following codes is used to report a barium enema with SUB? D. 74270 7. The only exception to the Uniformity Provision is B. Geographic practice cost adjustments. 8. M-codes are used to indicate types of A. Neoplasm. 9. Which of the following COP code ranges describes evocative/suppression testing reoccurred? A. 80400-80440 10. A radiology center that owns its own equipment, employs its own technicians, and employs its own radiologist who supervises, interprets, and reports on the findings will code C. Global radiological procedures. 2.


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