Insurance Claims Processing and Adjudication Unit 4 Discussion

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Northcentral Technical College *

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10530197

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Mechanical Engineering

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Apr 3, 2024

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The Code Set Standards include CPT, ICD-10 CM and PCS, and HCPCS Level II. There are specific formats and uses for each type of code and each type of job deals with a different type of coding. As you consider your future position in healthcare and coding answer the following: 1. What code set(s) do you find confusing and explain why. 2. Why is it important to understand the different Code Set Standards as a medical assistant, medical office administrator, medical coder, or medical billing and insurance specialist? 3. Which code set do you find challenging and how would you explain this code set to a coworker or a subordinate if you were asked to train them? 4. What questions would you ask about the codes sets if you were in training? It is important for medical assistants, medical office administrators, medical coders, and medical billing and insurance specialists to understand the different code set standards because their work with codes has a large impact on their patients. It could be while documenting an ICD-10-CM code in the patient’s file when documenting the diagnosis. If this code is originally documented in the patient’s file incorrectly, there is a good chance that the incorrect code will be used when submitting the patient’s claim. This incorrect code could cause a claim denial for the diagnosis being inconsistent with the procedure. If this claim isn’t corrected it could be sent to the patient as their responsibility for payment. This would all be due to the ICD-10 CM being originally incorrectly documented in their medical record. This is one example of why it is so important that medical assistants, medical coders, etc. need to fully understand all the different code sets. I find the ICD-10-CM code set to be the most difficult to work with. This is because of how specific the classification is. For example, choosing the correct ICD-10-CM for mixed anxiety and depressive disorder. It would be located under F41 – Other anxiety disorder, the following are the specific billable codes under F41:  F41.0 – “Panic disorder [episodic paroxysmal anxiety] (ICD10Data.com, 2023).”  F41.1 – “Generalized anxiety disorder (ICD10Data.com, 2023).”  F41.3 – “Other mixed anxiety disorders (ICD10Data.com, 2023).”  F41.8 – “Other specified anxiety disorders (ICD10Data.com, 2023).”  F41.9 – “Anxiety disorder, unspecified (ICD10Data.com, 2023).” Mixed anxiety and depressive disorder is under the ICD-10-CM code F41.8 (this is listed as additional conditions the code is applicable to). This additional work to find it is why I think the ICD-10-CM code set is so difficult. It can be very time-consuming and requires patience to find the exact right code to fit the condition perfectly. It is also easy to choose a code because it is "close enough", however it is important to make sure that the code is the best fit. I also think it requires practice to get used to how the code set works. Reference: ICD10Data.com. (2023). Other anxiety disorders F41-. https://www.icd10data.com/ICD10CM/Codes/F01- F99/F40-F48/F41-

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