Dr. Smith notes the following data on Melissa’s chart: ICD-10-CM diagnosis code B27.90; CPT codes 86664 (Epstein-Barr Virus Antibody Panel), 87653 (rapid strep test), 87880 (strep culture) and 99214 (Level 4, 25-minute exam). Melissa receives a copy of her statement and a copy is sent to the medical and health services manager, who processes the diagnosis codes and CPT codes, then sends the information to Melissa’s insurance provider.
As Dr. Smith leaves the room, the health coach enters to provide Melissa with more information about mono. The health coach informs her that she will need to rest and drink plenty of fluids, and that her condition should improve in a few weeks. She also stresses the importance of maintaining good personal hygiene by telling her not to share drinks, utensils or her toothbrush with others, to wash her hands often and avoid sharing bodily fluids (through kissing, for example). She reminds Melissa that she can take pain relievers if needed, but not aspirin, and that she must avoid sports as directed by Dr. Smith. As the health coach leaves, she tells Melissa that if she has any more questions or starts to feel worse, an advisor is available for consultation through her PHR.
Review Melissa’s Story: The medical and health services manager is responsible for:
Processing Melissa’s diagnosis and CPT codes
Having Melissa read and sign the HIPAA notice
Diagnosing Melissa’s condition
Taking Melissa’s vital signs
Review Melissa’s Story: The health coach is responsible for all of the following EXCEPT:
Reviewing the physician’s directions
Providing more information about mono
Stressing the importance of good hygiene
Entering Melissa’s results into her EHR
Review Melissa’s Story: How many people worked on Melissa’s PCP case?
1-3
4-5
6-7
8-10
ICD-10-CM Diagnosis code: The abbreviated way to refer to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).("ICD-10 Code Set to Replace ICD-9." American Medical Association. N.p., n.d. Web. 26 August 2014.)
Current Procedural Terminology (CPT): A formal classification of diagnostic and therapeutic procedures performed by physicians and other health care providers, published in annual revisions since 1996 by the American Medical Association (AMA). Each procedure is assigned a 5-digit code. The system was developed by the Health Care Financing Administration (HCFA) to assist in the assignment of the reimbursement amounts to providers by Medicare carriers. Many managed care and other insurance carriers base their reimbursements on the values established by HCFA. ("Definition: Current Procedural Terminology." Current Procedural Terminology. N.p., n.d. Web. 5 August 2014.)