Final Examination Student Review Sheet (Manual Billing#1)
SECTION X: CASE STUDY: { MANUAL & ADVANCED CODING }: ( 7 PTS): DIRECTIONS:
* Using the case presentation attached, entitled “ ASSIGNMENT 6-4”, you are TO ACCOMPLISH THE FOLLOWING:
- Define the patient record abbreviations (below) indicated as well as the additional coding found on page #108 attached.
- Using the Patient Record No. 6-4, on aseparate 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.
- Complete anCMS 1500 claim form for this case posting all relevant data.
- Complete a Financial Accounting Record with posted transactions.
SPECIFIC INDICATIONS:
- 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, NY12589. 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.
- 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.
- 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 cmsLaceratiion $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 $35
E / M CODE SLIP:
PATIENT MEDICAL RECORD:
ABBREVIATIONS & ADDITIONAL CODING:
MANUAL RECORDING OF CHARGES: [ GRADED COMPONENT ]
FINANCIAL ACCOUNT STATEMENT (RECEIPT): [ GRADED COMPONENT ]
COMPLETION OF CMS 1500: [ GRADED COMPONENT ]
FINAL EXAM { MR. BILLY RUBIN } “ MANUAL BILLING !”
MANUAL BILLING AND CHARGES
DATE DESCRIPTIONCODEAMOUNT
8/7/09OV EST PF (hx/px) LC MDM99282$ 37.02
CBC (auto / diff )85025$ 45.00
VENIPUNCTURE36415$ 55.00
PSA (total)84152$ 275.00
8/14/09OV EST PF (hx/px) LC MDM99282$ 37.02
ULTRASD GUIDE FINE NEEDLE BX55700$ 75.00
8/16/09OV EST PF (hx/px) LC MDM99282$ 37.02
8/22/09HV PF (hx/px) SF MDM99281$ 145.92
(8/22-8/27= 6 days)[$24.32 X 6]
TURP57.49$ 650.00
8/27/09DISCHARGE99217$ 66.88
TOTALS$1,423.86
$1,423.86 x 0.15 = $ 213.58 given a 15 % discount !
$1,423.86 -213.58 $ 1,210.28
1,210.28 X 0.2 $ 242.06 20 % (patient )
$ 1,210.28 X 0.8 => $ 968.22 80 % (insurance)
$ 242.06 - $ 200 = $ 42.06 ( PT paid $ 200 in advance)
DX/ICD
URINARY HESITANCY 788.64
URINARY FREQUENCY 788.41
POST-VOID DRIBBLING 788.35