Analyzing The ICD-10-CM Transition And Post-Implementation Stages Essay

Analyzing The ICD-10-CM Transition And Post-Implementation Stages Essay

Evaluation Management (E/M)

Evaluation and Management E/M coding system is a medical coding technique that aids in the billing process for healthcare providers. In order to be paid for patient interactions by Medicaid, Medicare programs, or private health insurance companies in the United States, medical professionals are required to utilize the E/M coding system. The E/M coding system is the standardized criteria that private health insurance firms have chosen to use in order to determine the nature and complexity of patient problems. This enables practitioners to record the services they deliver and submit bills for them in order to get reimbursed for those services Analyzing The ICD-10-CM Transition And Post-Implementation Stages Essay.

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DSM-5 and ICD-10 Codes to Services Based Upon the Patient Case Scenario

Numerous kinds of kind of codes exist for various services, including ambulatory treatments, consultations, assessments, and treatments provided in emergency rooms. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) is a reference book that helps in the evaluation and diagnosis of psychiatric conditions (Kraemer et al., 2017). It does not, however, offer any guidance on how to deal with a mental health problem or illness. it does not contain a series of codes for psychiatric illnesses. ICD-10 codes, which stand for International Classification of Diseases, Tenth Revision, and Clinical Modification, offer more comprehensive details for assessing the efficiency of medical treatment as well as the cost-effectiveness of various medical procedures. This makes them suitable for use in facilitating the establishment of value-based billing and reimbursement frameworks (Desai & Eljazzar, 2018). The DSM-5 is used as a standardized framework for diagnosing psychiatric problems by psychiatric care providers, whereas the ICD-10 is used to issue reimbursement codes. This is the primary distinction in terms of how these two frameworks are put to use. In the case scenario, the diagnostic impression is anticipated to be coded in the following ways: F41.1 for Generalized anxiety disorder, 90792 is for the Psychiatric Diagnostic Evaluation, which also includes medical treatments and 90837 for any service that lasts more than 53 minutes.

Pertinent Information Required In Documentation to Support DSM-5 and ICD-10 Coding

Documenting correct DSM-5 and ICD-10 classification requires many pieces of information to be provided. According to Monestime et al. (2019), in the event that any information is absent, it may lead to substandard medical treatment being delivered to patients or the underpayment of medical practitioners by insurers or payers. critical components of DSM-5 and ICD-10 coding include Examining the patient’s history, arriving at a clinical decision, coordinating healthcare services, providing counseling, determining the severity of the illness, and determining when it occurred. These constituents are then broken down even further into their sub-elements. For instance, in the area of taking the patient’s history, one is needed to document the chief complaint as well as the history of the patient’s current condition, and also a thorough evaluation of the body’s systems and pertinent information about the individual’s personal, social, and family history.

The case scenario of a Russian woman client who is 25 years old covers a range of important pieces of documentation, one of which is the time consumed evaluating her. A comprehensive history of the ailment that the patient is currently suffering from is also provided. An assessment of the mental state, an evaluation of the risk of committing suicide, the history of the client’s drug usage, and a care regimen are additional essential pieces of information that are acquired throughout the assessment. The accurate application of the codes is required throughout the medical coding process. Accurate coding contributes to improved clinical, financial, and operational strategies for measuring performance via the use of coded data.

How to Improve Documentation to Support Coding and Billing for Maximum Reimbursement

By using productive technology like Electronic Health Records (EHRs), healthcare institutions have the ability to enhance their documentation processes and thereby increase their chances of receiving the highest possible reimbursement. The process of keeping these documents up to date is rather uncomplicated compared to maintaining conventional health records. In addition, medical professionals and other employees must be kept up to date on the different codes in use as well as the necessity of accurate coding on a consistent basis in order to reduce the likelihood of reimbursements being either delayed or left unfinished. Due to contractual obligations to users, health insurers and other providers need accurate and reliable documentation and coding to fulfill their obligations. In the case that there is a disagreement, they could ask for further details, including proof that the services they were offered were completed. A robust documentation strategy is thus essential in medical institutions in order to gain the best possible remuneration for the clinical services they offer Analyzing The ICD-10-CM Transition And Post-Implementation Stages Essay.

References

Desai, P., & Eljazzar, R. (2018). Post-implementation cost-analysis of the ICD-10-CM transition on small and medium-sized medical practices. Journal of Health & Medical Economics, 04(01). https://doi.org/10.21767/2471-9927.100037

Kraemer, H. C., Kupfer, D. J., Clarke, D. E., Narrow, W. E., & Regier, D. A. (2017). DSM-5: How reliable is reliable enough? American Journal of Psychiatry, 169(1), 13-15. https://doi.org/10.1176/appi.ajp.2011.11010050

Monestime, J. P., Mayer, R. W., & Blackwood, A. (2019). Analyzing the ICD-10-CM transition and post-implementation stages: a public health institution case study. Perspectives in health information management, 16(Spring). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462880/ Analyzing The ICD-10-CM Transition And Post-Implementation Stages Essay