Coding Case Study #1 In the cases that follow, you play the role of a medical insurance specialist who is preparing HIPAA claims for transmission Assume that you are working with the practice's PMP to enter the transactions. The information you enter is based on the patient information form and the encounter form Claim control numbers are created by adding the eight-digit date to the patient account number, as in AA026-10042029. A copayment of $15 is collected from each Oxford PPO patient at the time of the visit. A copayment of $10 is collected for Oxford HMO Note For these case studies, do not subtract the copayment from the charges, the payer's allowed fees have already been reduced by the amount of the copayment. Provider Information Billing Provider Valley Associates, PC NPI 1476543215 Address 1400 West Center Street, Toledo, OH 43601-0213 Telephone 555-967-0303 Employer ID Number 16-1234567 Rendering Provider Christopher M. Connolly, MD NPI 8877365552 Oxford PPO Provider Number Oxford HMO Provider Number Assignment Accepts 1011 2567 VALLEY ASSOCIATES, PC Christopher M. Connolly, MD - Internal Medicine 555-967-0303 NPI 8877365552 1:00 pm PATIENT NAME SmithJosephine PATIENT NO AA035 VICPT DESCRIPTION OFFICE VISITS New Patient U Problem Focused UI Expanded Lill Detailed LIV Comp/Mod. LV Comp./High Established Patient LI Minimum Lil Problem Focused Lill Expanded LIV Detailed LV Comp/Hiob APPT DATE/TIME 10/9/2029 DX 1. 110 benign cosential hypertension 2. 3. 4. FEE DESCRIPTION MCPT FEE PROCEDURES Diagnostic Anoscopy ECG Completo 93000 70 I&D. Abscess Pap Smear Removal of Cerumen Removal 1 Losion Removal 2.14 Losions Removal 15+ Lesons Rhythm ECG w/Report 62 Rhythm ECG w/Tracing Sigmoldoscopy, dlag 99213 LABORAT Bach Encounter Form for Case 7.4 Name Josephine Smith Sex F Birthdate 05/04/1994 Marital Status Married Address 9 Brook Rd. Alliance, OH 44601-1812 Telephone 555-214-3349 Employer Central Ohio Oil Race White Ethnicity Not Hispanic or Latino Preferred Language English Insured Self Health Plan Oxford Freedom HMO Insurance ID Number 610327842X Policy Number 195803 Group Number G0404 Copayment/Deductible Amount $10 copay Benefits Y Signature on File 01/01/2029 Condition Unrelated to Employment, Auto Accident, or Other Accident Questions: A. What diagnosis code is being reported on the claim? B. What amount is being billed on the claim? C. What two data elements should be reported because a referral is involved