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What are the three factors upon which evaluation and management codes are based? What are the three key components of patient services? What are the four contributing factors that could affect correct code selection? Please explain each factor or element listed out.Mrs. London, a 55-year-old woman with diabetes, is referred to a dietitian by her physician because her physician believes that she is not eating properly. The dietitian spends an hour in the initial assessment of Mrs. London. Why is it important for a diabetic to maintain a proper diet, and how might a dietitian assist in improving the diet of a diabetic patient? How should the dietitian’s services be coded [Tips- A dietitian’s services are coded with the medical, nutritional therapy codes (i.e., 97802) and are reported in increments of 15 minutes. Think about the types of codes the dietitian would use (a) medical nutrition therapy code, (b) initial assessment and intervention code, (c) individual, face-to-face with the patient code, etc.]
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Module 1 Question 2
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Michael Wade posted Oct 18, 2023 12:30 AM
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1. Mrs. London, a 55-year-old woman with diabetes, is referred to a dietitian
by her physician because her physician believes that she is not eating
properly. The dietitian spends an hour in the initial assessment of Mrs.
London. Why is it important for a diabetic to maintain a proper diet, and
how might a dietitian assist in improving the diet of a diabetic patient?
How should the dietitian’s services be coded [Tips- A dietitian’s services are
coded with the medical, nutritional therapy codes (i.e., 97802) and are
reported in increments of 15 minutes. Think about the types of codes the
dietitian would use (a) medical nutrition therapy code, (b) initial
assessment and intervention code, (c) individual, face-to-face with the
patient code, etc.]
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•
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Maintaining a healthy diet is very important for individuals living with
diabetes. It helps them manage their weight and keep their blood sugar
levels in check, which, in turn, makes it easier to treat the condition
and prevent it from getting worse.
For someone with diabetes, seeking the guidance of a dietitian can be
incredibly beneficial in their effort to maintain a proper diet. Dietitians
possess valuable knowledge that allows them to advise individuals on
which foods are beneficial and which ones should be limited. They can
provide individuals with the essential building blocks to create meals
that not only align with their dietary needs but also seamlessly fit into
their daily lives.
When it comes to coding for nutritional therapy, specific codes like
97802 to 97804 are used. These codes are reported in increments of 15
minutes, meaning each 15-minute block of nutritional therapy is
assigned a code. For instance, if we take the case of Mrs. London, her
nutritional therapy was 1 hour so four 15-minute sessions, resulting in
the use of the nutritional therapy code x4 to accurately capture the
time and effort put into her nutritional counseling and support.
Module 1- Q2
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Chailan Campbell posted Oct 16, 2023 11:56 AM
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1.
Mrs. London, a 55-year-old woman with diabetes,
is referred to a dietitian by her physician because her
physician believes that she is not eating properly. The
dietitian spends an hour in the initial assessment of Mrs.
London. Why is it important for a diabetic to maintain a
proper diet, and how might a dietitian assist in improving
the diet of a diabetic patient? How should the dietitian’s
services be coded [Tips- A dietitian’s services are coded
with the medical, nutritional therapy codes (i.e., 97802)
and are reported in increments of 15 minutes. Think
about the types of codes the dietitian would use (a)
medical nutrition therapy code, (b) initial assessment and
intervention code, (c) individual, face-to-face with the
patient code, etc.]
Maintaining a proper diet is important for individuals
with diabetes, as it directly impacts their health and wellbeing. Diabetes is a condition characterized by abnormal
blood sugar levels, and nutrition plays a central role in
regulating these levels. For diabetics, consistent blood
sugar control is essential to prevent complications such
as hyperglycemia and hypoglycemia. Proper nutrition can
also help with weight management, another critical
aspect for many diabetics. Obesity is a significant risk
factor for Type 2 diabetes, and maintaining a healthy
weight can improve insulin sensitivity, making it easier to
manage blood sugar levels effectively. Diabetics are at an
increased risk of heart disease, and a heart-healthy diet
can help reduce this risk. Such a diet can contribute to
controlling cholesterol and blood pressure, both of which
are essential for cardiovascular health. It’s worth noting
that diabetes-related complications, including kidney
disease, neuropathy, and retinopathy, can be prevented
or minimized with good nutrition. Therefore, a balanced
diet has the potential to improve overall health and
quality of life for individuals living with diabetes.
In addition, dietitians educate patients on how different
foods affect their blood sugar levels and provide
strategies for monitoring these levels effectively. This
education empowers patients to make informed dietary
choices independently. In addition to educational
support, dietitians also offer emotional support,
motivation, and ongoing guidance to ensure patients can
make sustainable changes to their diets over the long
term.
Now, in regard to healthcare billing, coding is used to
accurately reflect the services provided. When it comes to
dietitian services, Current Procedural Terminology (CPT)
codes are used. The specific code selected typically
depends on the nature of the visit and the services
provided during the appointment. For the initial
assessment, a common code used might be “97802”
(HMSA 2023). The total time spent with the patient
determines the number of units. The selection of the
specific code should be in accordance with the guidelines
of the healthcare facility or insurance provider. It’s
essential for the dietitian to maintain thorough
documentation of the services rendered to support
accurate coding and billing (AAPC 2023).
“E/M Coding History, Exam and MDM
Components.” AAPC, www.aapc.com/resources/evaluatio
n-management-history#. Accessed 16 Oct. 2023.
Provider Resource Center ,
prc.hmsa.com/s/article/Coding-Guidelines-for-MedicalNutrition-Therapy. Accessed 16 Oct. 2023.
Module 1 Question 2
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Tara Sepe posted Oct 17, 2023 12:50 PM
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Mrs. London, a 55-year-old woman with diabetes, is
referred to a dietitian by her physician because her
physician believes that she is not eating properly. The
dietitian spends an hour in the initial assessment of Mrs.
London. Why is it important for a diabetic to maintain a
proper diet, and how might a dietitian assist in improving
the diet of a diabetic patient? How should the dietitian’s
services be coded?
There are many reasons as to why diabetics maintain a
proper diet. The first reason is physical reasons, such as
weight. Maintaining a proper and healthy diet can help
diabetics manage their weight. Being overweight comes
with many challenges including controlling blood sugar
and physical challenges. To go with that, controlling Mrs.
London’s blood sugar is essential to maintaining her
health. When eating healthy, your blood sugar is most
likely going to be at a “normal” rate. For example, Mrs.
London will not get sugar spikes and crashes, which
reduces the need for things like medication. Diabetics
are also at a high risk for heart disease. This, again, can
lead to more major issues, so it is essential that Mrs.
London maintains a healthy diet so she can avoid any
issues that come with heart disease.
Mrs. London’s dietitian must go over a few things and
educate her on how to maintain a proper diet for her
health. The dietitian should go over meal plans
specifically for Mrs. London. For example, the dietitian
should consider her age, activity level, etc. Another thing
the dietitian should really emphasize is portion
control/calorie counting. Portion control is an essential
step to making your health better, especially with Mrs.
London’s diabetes. The last thing the dietitian should
emphasize is how important exercise is, and the dietitian
can even come up with an exercise plan for her while
considering her age and other things.
While considering the codes for the dietitian’s services,
we must use Current Procedural Technology (CPT) codes.
A common code for medical nutrition therapy would be
97802-97804. CPT 97802 would be a code for
nutritional assessment; initial assessment. The dietitian’s
services are reported in increments of 15 minutes. For
example, if the patient spends an hour with the dietitian,
it would be reported as 97802 X 4, Medical nutritional
therapy, initial assessment and intervention, individual,
face-to-face with the patient, each 15 minutes.
Reference
Koesterman, J. L., & Buck, C. J. (2021). Buck’s the next
step: Advanced Medical Coding and Auditing,
2021/2022. Elsevier.
Module 1- Q1
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Chailan Campbell posted Oct 16, 2023 11:31 AM
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1. What are the three factors upon which evaluation
and management codes are based? What are the
three key components of patient services? What are
the four contributing factors that could affect
correct code selection? Please explain each factor or
element listed out.
The three factors upon which E/M codes are based are
history, examination, medical decision making (MDM).
History includes the patient’s medical history, present
illness, review of systems and past family and social
history, this level of detail and complexity of the history
documented plays a role in code selection. Examination
is the extent and complexity of the physical examination
done by the healthcare provider is an important factor.
The exam can range from a straightforward evaluation to
a comprehensive assessment. Now, for MDM, it is the
process of analyzing the patient’s condition, making a
diagnosis, and determining the appropriate treatment
plan. It will consider the data collected and reviewed, the
risk of the complications, as well as the management
options chosen (AAPC 2023)
According to my searches, the three components of
patient services in regard to coding in healthcare are also
history, examination, and MDM. In the healthcare
industry, the three components are empathy, two- way
communication, and eye to eye contact according to
NEJM Catalyst (NEJM Catalyst 2017).
The four contributing factors that could affect the correct
code selection is counseling, coordination of care, the
nature of the presenting problem, and facetime (Provider
News 2020). For counseling, if a significant amount of
time was spent on this, it will have an influence on the
code selection. For coordination of care, if the healthcare
provider spends time coordinating with other providers
or services, it can affect code selection. For the nature of
the present problem, the complexity and severity of the
patient’s presenting problem, along with the data
reviewed and risk assessment, are important when
determining the appropriate code.
Overall, proper code selection is essential for accurate
billing, documentation, and reimbursement in healthcare.
It relies on a detailed assessment of these factors to
ensure that the level of service provided is properly
reflected in the code given.
“E/M Coding History, Exam and MDM
Components.” AAPC, www.aapc.com/resources/evaluatio
n-management-history#. Accessed 16 Oct. 2023.
Provider News,
providernews.empireblue.com/articles/evaluation-andmanagement-services-correct-coding. Accessed 16 Oct.
2023.
What Is Patient-Centered Care? | Nejm Catalyst ,
catalyst.nejm.org/doi/full/10.1056/CAT.17.0559.
Accessed 16 Oct. 2023.
Module 1 Question 1
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Tara Sepe posted Oct 16, 2023 2:44 PM
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1. What are the three factors upon which evaluation
and management codes are based? What are the
three key components of patient services? What are
the four contributing factors that could affect
correct code selection? Please explain each factor or
element listed out.
The codes in the E/M section are based on place of
service, type of service, and patient status. Place of
service is the first step in choosing the correct E/M code.
Codes will vary based on the place of the service. For
example, as we learned in 368, there are different codes
for inpatient and outpatient settings. Next, the type of
service is the second step in choosing the correct E/M
code. Examples of types of service include consultation,
hospital admission, or an office visit. Lastly, patient
status has four types. First, there is new patient, and they
have not received professional services from a physician
within the past three years. Second, there is an
established patient. This is when they have received
services from a physician within the past three years. The
third is outpatient. Fourth, is inpatient.
The three key components are history, examination, and
medical decision-making. History includes the patient’s
medical history. Examination is when the extent is
determined by the physician while being medically
appropriate. This evaluates the patient and can include a
physical examination. Lastly, medical decision-making
includes the number and complexity of the problems that
are addressed at an encounter, as well as the amount of
data to be analyzed.
The four contributory factors are counseling,
coordination of care, the nature of the presenting
problem, and time. Counseling is a service that
physicians provide to patients and their families. It
involves a discussion of diagnostic results, impressions,
and recommended diagnostic studies. Coordination of
care is when a physician might arrange for other services
to be provided to the patient, such as arrangements for
admittance to a long-term nursing facility. The nature of
presenting the problem is described by the CPT as “a
disease, condition, illness, injury, symptom, sign,
finding, complaint, or other reason for the encounter,
with or without a diagnosis being established at the time
of the encounter”. There are also five types of presenting
the problem: minimal, self-limited, low severity,
moderate severity, and high severity. Lastly, time is
measured in two ways. There is face-to-face time and
unit/floor time.
Reference
Koesterman, J. L., & Buck, C. J. (2021). Buck’s the next
step: Advanced Medical Coding and Auditing,
2021/2022. Elsevier.
Module 1 Question 1
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Katie Corcoran posted Oct 17, 2023 10:59 AM
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1. What are the three factors upon which evaluation
and management codes are based? What are the
three key components of patient services? What are
the four contributing factors that could affect
correct code selection? Please explain each factor or
element listed out.
Based on service location, service kind, and patient
status, the codes in the E/M sector are assigned. To
select the right E/M code, start with the location of the
service. Based on where the service is provided, different
codes will apply. For instance, the codes for inpatient
and outpatient settings differ, as we discovered in 368.
The next consideration when selecting the right E/M
code is the type of service. Consultation, hospital
admission, and office visit are a few examples of
different service types. Finally, there are four different
categories of patient status. The first case involves a new
patient who hasn’t sought medical advice from a
professional in the previous three years. Second, a
patient is already in place. They have worked within the
last three years as a doctor. Outpatient care is the third.
Inpatient is the fourth.
History, examination, and medical judgment are the
three main components. The patient’s medical
background is included in the history. When a doctor
performs an examination, they decide the extent in a way
that is proper for medicine. This assesses the patient and
could involve a physical examination. The quantity and
complexity of the issues addressed during an encounter
and the amount of data that needs to be examined are
also factors in medical decision-making.
The four contributing variables are counseling, care
planning, the type of problem being presented, and time.
Medical professionals offer counseling to patients and
their families. Discussions of the diagnostic findings,
opinions, and suggested diagnostic studies are included.
When a doctor coordinates care, additional services for
the patient may be provided, such as arrangements for
admission to a long-term nursing facility. The CPT
defines the problem’s nature as “a disease, condition,
illness, injury, symptom, sign, finding, complaint, or
other reason for the encounter, with or without a
diagnosis being established at the time of the
encounter.” The problem can be presented in one of five
ways: minimum, self-limited, low severity, moderate
severity, or high severity. Finally, there are two ways to
measure time. Face-to-face time and unit/floor time
both exist.
Reference
Koesterman, J. L., & Buck, C. J. (2021). Buck’s the next
step: Advanced Medical Coding and Auditing,
2021/2022. Elsevier.
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