NAME:_____________________ INSTITUTE HEALTH ED [IHE ...



MANUAL CODING AND BILLING #1A (EXERCISE)

DIRECTIONS:

* ( Using the case presentation attached, entitled “ ASSIGNMENT 6-4”, you are TO ACCOMPLISH THE FOLLOWING:

1. Define the patient record abbreviations (below) indicated as well as the additional coding found on page #108 attached.

2. Using the Patient Record No. 6-4, on a separate blank sheet (attached) of paper make an outline of all the charges to be made for this

patient in the format of Date, Charge Explanation, Code number and Amount Charged and turn this in with your work.

3. Complete an CMS 1500 claim form for this case posting all relevant data.

4. Complete a Financial Accounting Record with posted transactions.

SPECIFIC INDICATIONS:

1. After completion of your manual format for the case history along with charges and codes found as well as abbreviations, complete the CMS 1500 using the E / M guidelines for this case. Direct the claim to Aetna Life & Casualty Company, 125 Worthington Avenue, Albany, NY 12589. This assignment may or may not require more than one CMS 1500 claim form for completion. Hand in both when done. Refer to the attachment listing of amount charges for procedures to be used on the ledger and claim form. Date the claim August 27. Dr. Ulibarri is accepting assignment in this case. The patient met her deductible last June when seen by a previous physician.

2. Use your CPT and ICD-9 code books to look up all code numbers needed in this case. Record all transactions on the financial record and indicate when you have billed the primary insurance carrier.

3. On September 1st, the patient made an advanced payment of $200 (check #421) on this claim. Indicate this amount on your forms with appropriate justifications and balances. Post this payment on the financial accounting record and indicate the balance that will be billed to Aetna on the following day. The explanation of benefits (EOB) from this case is to be sent to the primary carrier with a completed CMS1500 claim form. Also post a 15 % Courtesy Adjustment for this claim. The basic formula for this claim is 20 / 80 %.

4. Pertinent Fee Schedules:

FEE SCHEDULES

Knee Surgery $650

EKG $45

OV#1 (99201) $75

MEDS $35

Abscess I & D $75

Injection $35

U / A $35

CBC $25

CBC+Diff $45

X-rays $20

Cholangiogram $90

U/A + Culture $60

Nitro Pads $55

Diuretics $40

MEDS (bactrim) $22.50

Ventolin $11

Double X-rays $40

CBC (auto / diff ) $45 (85025)

PSA (total) $275.00 (84152)

TURP $650.00 (57.49)

ULTRASD GUIDE FINE NEEDLE BX

(55700) $ 75.00

Chest P&A $45

Lat. X-Rays $45

Digoxin Inj. $25

B12 Inj. $40

Nitro (meds) $40

Bronchogram $150

CXR(AP/Lat) $75

OV HCN PF

Hx /SF MDM $134.99

[MEDICARE]

ABG O2 $85

PFT”s $125

OV C hx/exam

MC MDM $138.50

IV MEDS $25

OV PF

Hx /SF MDM $36.80

[MEDICARE]

Skene Excision $165

MRI (s contrast) $175

Suture 2-5 cms Laceratiion $125

ER and/or Physician Consult $85

Cauterization $65

Suture Removal Kit $45

Septoplasy $653

Professional Courtesy (-$55)

C x R (2views) $65

Elect Panel SMAC12 $45

CT Thorax/Contrast $125

IM Inj. Drug $25

C & S Test $45

Culture Transport $35

E / M CODE SLIP:

[pic]

PATIENT MEDICAL RECORD:

[pic]

ABBREVIATIONS & ADDITIONAL CODING:

[pic]

MANUAL RECORDING OF CHARGES: [ GRADED COMPONENT ]

FINANCIAL ACCOUNT STATEMENT (RECEIPT): [ GRADED COMPONENT ]

[pic]

NAME:_____________________ ACADEMY ALLIED HEALTH SCIENCES INSTRUCTOR: Dr. Domenech

COURSE: MEDICAL BILLING M. A. BASE CURRIC DATE:_________________________

PART ___ * MB 102 COMPONENT *

COMPLETION OF CMS 1500: [ GRADED COMPONENT ]

[pic]

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OLD PATIENTS (Established)

99211 OV#1 Level 1 $16.07

99212 OV#2 Level 2 $28.55

99213 OV#3 Level 3 $40.20

99214 OV#4 Level 4 $61.51

99215 OV#5 Level 5 $96.97

NEW PATIENTS

99201 OV#1 Level 1 $33.25

99202 OV#2 Level 2 $51.91

99203 OV#3 Level 3 $70.92

99204 OV#4 Level 4 $106.11

99204 OV#5 Level 5 $132.28

EMERGENCY DEPARTMENT

(New/Established Patient)

99281 PF hx/exam SF MDM $24.32

99282 EPF hx/exam LC MDM $37.02

99283 EPF hx/exam MC MDM $66.23

99284 D hx/exam MC MDM $100.71

99285 C hx/exam HC MDM $158.86

HOSPITAL

(Observation Svcs / New or Established)

99217 Discharge $66.88

99218 D hx/exam SF / LC MDM $74.22

99219 C hx/exam MC / MDM $117.75

99220 C hx/exam HC / MDM $147.48

DATE: CHARGE EXPLANATION: CODE #: AMOUNT CHARGED:

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