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JtT 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 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.    Here are 2 Sources and I have attached another. You can use them if you want or if you have better ones feel free to use them https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5 https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-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. References [Add APA-formatted citations for any sources you referenced] Delete instructions and placeholder text when you add your citations. Page | 2 Walden University, LLC .MsftOfcThm_Accent1_lumMod_40_lumOff_60_Fill { fill:#B1D1E3; } .MsftOfcThm_Accent1_lumMod_60_lumOff_40_Fill { fill:#8ABAD4; } Insurance Implications of DSM-5 The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was developed to facilitate a seamless transition into immediate use by clinicians and insurers to maintain continuity of care. The new manual represents a step forward in more precisely identifying and diagnosing mental disorders. To help ensure ease of use, DSM-5 continues to use statistical codes contained in the U.S. Clinical Modifications (CM) of the World Health Organization’s (WHO’s) International Classification of Diseases (ICD). The ICD-9-CM contains the internationally approved statistical codes for all medical diseases or disorders but does not contain detailed descriptions of how to diagnose these conditions. Below are frequently asked questions especially pertinent to insurers and clinicians. Frequently Asked Questions When can DSM-5 be used for insurance purposes? Since DSM-5 is completely compatible with the HIPAA-approved ICD-9-CM coding system now in use by insurance companies, the revised criteria for mental disorders can be used immediately for diagnosing mental disorders (approval for use in the US by CMS is located here). However, the change in format from a multi-axial system in DSM-IV-TR may result in a brief delay while insurance companies update their claim forms and reporting procedures to accommodate DSM-5 changes. How will the previous multi-axial conditions be coded? DSM-5 combines the first three DSM-IV-TR axes into one list that contains all mental disorders, includ- ing personality disorders and intellectual disability, as well as other medical diagnoses. Although a single axis recording procedure was previously used for Medicare and Medicaid reporting, some insur- ance companies required clinicians to report on the status of all five DSM-IV-TR axes. Contributing psychosocial and environmental factors or other reasons for visits are now represented through an expanded selected set of ICD-9-CM V-codes and, from the forthcoming ICD-10-CM, Z-codes. These codes provide ways for clinicians to indicate other conditions or problems that may be a focus of clinical attention or otherwise affect the diagnosis, course, prognosis, or treatment of a mental disorder (such as relationship problems between patients and their intimate partners). These conditions may be coded along with the patient’s mental and other medical disorders if they are a focus of the current visit or help to explain the need for a treatment or test. Alternatively, they may be entered into the patient’s clinical record as useful information on circumstances that may affect the patient’s care. On October 1, 2014, the United States adopts ICD-10-CM as its standard coding system. How will diagnoses be coded then? DSM-5 contains both ICD-9-CM codes for immediate use and ICD-10-CM codes in parentheses. The inclusion of ICD-10-CM codes facilitates a cross-walk to the new coding system that will be implement- ed on October 1, 2014 for all U.S. health care providers and systems, as recommended by the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC-NCHS) and the Centers for Medicare and Medicaid Services (CMS). This feature will eliminate the need for separate training https://questions.cms.gov/faq.php?id=5005&faqId=1817 2 • Insurance Implications of DSM-5 on ICD-10-CM codes for mental disorders that is now being offered for all other diseases/disorders by other medical societies and vendors to prepare for the 2014 implementation. With the removal of the multiaxial system in DSM-5, how will disability and functioning be assessed? The Global Assessment of Functioning (GAF) scale, recommended for Axis V in the DSM-IV multiaxial assessment, combined assessment of symptom severity, dangerousness to self or others, and decre- ments in self-care and social functioning into a single global assessment. The GAF was used for deter- minations of medical necessity for treatment by many payers, and eligibility for short- and long-term disability compensation. Clinician-researchers at the APA have conceptualized need for treatment as based on assessments of diagnosis, severity of symptoms and diagnosis, dangerousness to self or others, and disability in social and self-care spheres. We do not believe that a single score from a global assessment, such as the GAF, conveys information to adequately assess each of these components, which are likely to vary indepen- dently over time. Further, we are concerned about evidence that the GAF requires specific training for proper use, and that good reliability and prediction of outcomes in routine clinical practice may depend on such training. Therefore, we are recommending that clinicians continue to assess the risk of suicidal and homicidal behavior (for example, see the APA’s Clinical Practice Guidelines for Suicidal Behaviors) and use avail- able standardized assessments for symptom severity, diagnostic severity, and disability such as the measures in Section III of DSM-5. For those who relied on the use of a GAF number, there will clearly be a transitional period from the GAF to the use of separate assessments of severity and disability. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was judged by the DSM-5 Disability Study Group to be the best current measure of disability for routine clinical use. The WHODAS 2.0 is based on the International Classification of Functioning, Disability, and Health (ICF) and is applicable to patients with any health condition, thereby bringing DSM-5 into greater alignment with other medical disciplines. It was tested in the DSM-5 field trials and found to be feasible and reliable in routine clinical evaluations. This change in the recommended assessment is consistent with WHO rec- ommendations to move toward a clear conceptual distinction between the disorders contained in the ICD and the disabilities resulting from disorders, which are described in the ICF. Sometimes different disorders or subtypes share the same diagnostic code. Is this an error? No. It is occasionally necessary to use the same code for more than one disorder. Because the DSM-5 diagnostic codes are limited to those contained in the ICD, some disorders must share codes for record- ing and billing purposes. For example, hoarding disorder and obsessive-compulsive disorder share the same codes (ICD-9-CM 300.3 and ICD-10-CM F42). Because there may be multiple disorders associated with a given ICD-9-CM or ICD-10-CM code, the DSM-5 diagnosis should be always be recorded by name in the medical record in addition to listing the code. http://www.psychiatry.org/practice/clinical-practice-guidelines http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures Insurance Implications of DSM-5 • 3 The names of some DSM-5 disorders do not match the names of the ICD disorders, even though the code is the same. Can you explain this? Because the DSM-5 diagnostic codes are limited to those contained in the ICD, new DSM-5 disorders were assigned the best available ICD codes. The names connected with these ICD codes sometimes do not match the DSM-5 names. For example, DSM-5 disruptive mood dysregulation disorder (DMDD) is not listed in the ICD. The best ICD-9-CM code available for DSM-5 use was 296.99 (other specified episodic mood disorder). For ICD-10-CM the code will be F34.8 (other persistent mood [affective] disorders). Please refer to the table below for other examples. APA will be working with CDC-NCHS and CMS to include new DSM-5 terms in the ICD-10-CM, and will inform clinicians and insurance companies when modifications are made. Because DSM-5 and ICD disorder names may not match, the DSM-5 diagnosis should always be record- ed by name in the medical record in addition to listing the code. How are DSM-5 and ICD related? DSM-5 and the ICD should be thought of as companion publications. DSM-5 contains the most up-to- date criteria for diagnosing mental disorders, along with extensive descriptive text, providing a common language for clinicians to communicate about their patients. The ICD contains the code numbers used in DSM-5 and all of medicine, needed for insurance reimbursement and for monitoring of morbidity and mortality statistics by national and international health agencies. The APA works closely with staff from the WHO, CMS, and CDC-NCHS to ensure that the two systems are maximally compatible. The CMS response to a Frequently Asked Question (FAQ) about the relationship between DSM and ICD- 9-CM can be found here. DSM-5 Disorder DSM-5/ICD-9-CM Code (in use through September 30, 2014) CD-9-CM Title DSM-5/ICD-10-CM Code (in use starting October 1, 2014) ICD-10-CM Title Social (pragmatic) communication dis- order 315.39 Other developmental speech or language disorder F80.89 Other developmental disorders of speech and language Disruptive mood dys- regulation disorder 296.99 Other specified epi- sodic mood disorder F34.8 Other persistent mood [affective] disorders Premenstrual dys- phoric disorder 625.4 Premenstrual tension syndromes N94.3 Premenstrual tension syndrome Hoarding disorder 300.3 Obsessive-compulsive disorders F42 Obsessive- compulsive disorder Other specified obses- sive compulsive and related disorder 300.3 Obsessive-compulsive disorders F42 Obsessive- compulsive disorder Unspecified obses- sive compulsive and related disorder 300.3 Obsessive-compulsive disorders F42 Obsessive- compulsive disorder Excoriation (skin pick- ing) disorder 698.4 Dermatitis factitia [artefacta] L98.1 Factitial dermatitis Binge eating disorder 307.51 Bulimia nervosa F50.8 Other eating disorders https://questions.cms.gov/faq.php?id=5005&faqId=1817 4 • Insurance Implications of DSM-5 How is information from DSM-5 used? DSM-5 is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. Clinicians use DSM-5 diagnoses to com- municate with their patients and with other clinicians, and to request reimbursement from insurance organizations. DSM-5 diagnoses may also be used by public health authorities for compiling and report- ing morbidity and mortality statistics. Another important role of DSM is to establish diagnoses for research on mental disorders. Only by hav- ing consistent and reliable diagnoses can researchers determine the risk factors and causes for specific disorders, and determine their incidence and prevalence rates. Can clinicians continue to use the DSM-IV-TR diagnostic criteria? Clinicians may use DSM-5 in their practices immediately. However, there may be brief delays while insurance companies update their claim forms and reporting procedures to accommodate DSM-5 changes, and clinicians should use DSM-IV-TR diagnoses and codes when required by a specific com- pany. Transition details are still being developed with CDC-NCHS, CMS, and private insurance agencies. The APA is working with these groups with the expectation that a transition to DSM-5 by the insurance industry can be made by December 31, 2013. As part of the transition to DSM-5, there will also need to be updates of questions in board certifica- tion examinations and quality assessments for medical record reviews. APA will be providing periodic updates of agreements with federal agencies, private insurance companies, and medical examination boards as they become available. DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. For more information, go to www. DSM5.org. APA is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treat- ment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org. For more information, please contact Eve Herold at 703-907-8640 or [email protected] © 2013 American Psychiatric Association Order DSM-5 and DSM-5 Collection at www.appi.org http://www.dsm5.org http://www.dsm5.org http://www.psychiatry.org mailto:press%40psych.org?subject=DSM-5%20Fact%20Sheet http://www.appi.org/dsm http://www.appi.org/