4.21 Case Study

Competency IV.1RM
Determine diagnosis and procedure codes and groupings according to official guidelines.

Competency IV.1
Validate assignment of diagnostic and procedural codes and groupings in accordance with official guidelines

As the coding manager at a facility in Ohio, you receive accounts from the billing
department with potential coding issues prior to billing. It is your job to investigate the
account and ensure the proper codes have been assigned. Today, there is a medical necessity edit that has not been cleared concerning Epoetin administration. The codes assigned to this outpatient account were:
I10
N18.6
D64.9
E10.9
T82.868A

1. Read the following information from this chart and determine what the coding error(s) is or are.
2. Identify if you will be able to clear the medical necessity edit based on the documentation

Patient Name: Joe Smith
MR#3654777
Acct. # 0000325414
DOS: 10/28/15
Discharge date: 10/29/15
Mr. Smith arrives today with the thrombosis of his AV graft. He was unable to receive his dialysis treatment today and will undergo a thrombectomy procedure to restore graft function. He is a 54-year-old with hypertension and diabetes taken to the OR and prepped and draped in the usual sterile fashion. An incision was made permitting access to the graft. A graftotomy was done and a Fogarty catheter inserted to pull back the thrombosis. After the successful removal of the thrombosis, an injection was performed of the anastomotic area to ensure that the graft was functional. Incision into the graft was then closed, as was the access incision. The patient was taken to the recovery room in stable condition. He will be observed overnight, and receive his dialysis tomorrow prior to discharge. He is also to receive an injection of Epoetin for his anemia.

 

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Use the following guidelines when doing your writing assignments Writing Guidelines Content: 1. Major points are stated clearly and are supported by research, specific details, examples, and/or analysis. 2. The content links theory to relevant examples and uses the vocabulary of the theory correctly. 3. The content presented is relevant comprehensive, accurate, and believable. Organization and Structure: 1. The paper is well organized, clear, and effectively structured. 2. The tone is appropriate to the content and assignment. 3. Jargon avoided. 4. There is an introduction to gain the audience's attention, provides sufficient background information on the topic, and previews major points. 5. Paragraph transitions are present, logical, and maintain the flow throughout the paper. 6. There is a conclusion that is logical, flows from the presentation, and reviews the major points. Mechanics and Formatting: 1. The paper including tables, graphs, headings, title page, and reference page - is consistent with APA or MLA formatting guidelines. 2. Intellectual property is recognized with in-text citations and a reference page. 3. Rules of spelling, grammar, usage, and punctuation are followed. Use the following guidelines when doing your writing assignments Writing Guidelines Content: 1. Major points are stated clearly and are supported by research, specific details, examples, and/or analysis. 2. The content links theory to relevant examples and uses the vocabulary of the theory correctly. 3. The content presented is relevant comprehensive, accurate, and believable. Organization and Structure: 1. The paper is well organized, clear, and effectively structured. 2. The tone is appropriate to the content and assignment. 3. Jargon avoided. 4. There is an introduction to gain the audience's attention, provides sufficient background information on the topic, and previews major points. 5. Paragraph transitions are present, logical, and maintain the flow throughout the paper. 6. There is a conclusion that is logical, flows from the presentation, and reviews the major points. Mechanics and Formatting: 1. The paper including tables, graphs, headings, title page, and reference page - is consistent with APA or MLA formatting guidelines. 2. Intellectual property is recognized with in-text citations and a reference page. 3. Rules of spelling, grammar, usage, and punctuation are followed.