Module 06 Written Assignment: How Correct Coding affects Billing and Reimbursement


1. A 90-year-old white female with a known history of hypertensive kidney disease is referred by her regular internal medicine physician for a cystoscopy. She was treated for urinary tract infection but microscopic hematuria is persistent. A cystourethroscopy was performed under general anesthesia. The urologist removed a small 0.6 cm tumor from the lateral wall of the bladder. The specimen was sent to pathology. A squamous cell carcinoma was diagnosed. 

The reported diagnosis codes were: R31.21, C67.2, I12.9, N18.9

The reported procedure codes were: 52000, 52234

· Identify the error in the claim and explain why it might be improperly paid or denied (3 points)

· Describe how this error could be remedied (3 points) 

· Explain in a few sentences the impact of reporting the code(s) incorrectly. Think about reimbursement, compliance, coder performance, reporting, and any other processes that are affected by coding and claim submission. (4 points)