EVALUATION AND MANAGEMENT (E/M) Insurance coding and billing is complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to the service that you provided.

NRNP_6675_Week2_Assignment1_Rubric

NRNP_6675_Week2_Assignment1_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeIn the E/M patient case scenario provided:• Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.

20 to >17.0 pts

Excellent 90%–100%

DSM-5 and ICD-10 codes assigned to the scenario are correct, with no more than a minor error.

17 to >15.0 pts

Good 80%–89%

DSM-5 and ICD-10 codes assigned to the scenario are mostly correct, with a few minor errors.

15 to >13.0 pts

Fair 70%–79%

DSM-5 and ICD-10 codes assigned to the scenario contain several errors.

13 to >0 pts

Poor 0%–69%

DSM-5 and ICD-10 codes assigned to the scenario contain significant errors, or response is missing.

20 pts

This criterion is linked to a Learning OutcomeIn 1–2 pages, address the following: • Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

25 to >22.0 pts

Excellent 90%–100%

The response accurately and concisely explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

22 to >19.0 pts

Good 80%–89%

The response accurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

19 to >17.0 pts

Fair 70%–79%

The response somewhat vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding.

17 to >0 pts

Poor 0%–69%

The response vaguely or inaccurately explains what pertinent documentation information is required to support DSM-5 and ICD-10 coding, or the explanation is incomplete or missing.

25 pts

This criterion is linked to a Learning Outcome• Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

25 to >22.0 pts

Excellent 90%–100%

The response accurately and concisely identifies the pertinent misssing information from the case scenario and clearly identifies what additional information would narrow coding and billing options.

22 to >19.0 pts

Good 80%–89%

The response accurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.

19 to >17.0 pts

Fair 70%–79%

The response somewhat vaguely or inaccurately identifies the pertinent misssing information from the case scenario and identifies what additional information would narrow coding and billing options.

17 to >0 pts

Poor 0%–69%

The response vaguely or inaccurately identifies the pertinent misssing information from the case scenario or partially identifies what additional information would narrow coding and billing options, or this information is incomplete or missing.

25 pts

This criterion is linked to a Learning Outcome• Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.

15 to >13.0 pts

Excellent 90%–100%

The response accurately and concisely explains how to improve documentation to support coding and billing for maximum reimbursement.

13 to >11.0 pts

Good 80%–89%

The response accurately explains how to improve documentation to support coding and billing for maximum reimbursement.

11 to >10.0 pts

Fair 70%–79%

The response somewhat vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement.

10 to >0 pts

Poor 0%–69%

The response vaguely or inaccurately explains how to improve documentation to support coding and billing for maximum reimbursement, or response may be incomplete or missing.

15 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting - Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent 90%–100%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.... A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 pts

Good 80%–89%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.... Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3.5 to >3.0 pts

Fair 70%–79%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.... Purpose, introduction, and conclusion of the assignment are vague or off topic.

3 to >0 pts

Poor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time.... Purpose statement, introduction, and conclusion were not provided.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting - English Writing Standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.5 pts

Good 80%–89%

Contains 1-2 grammar, spelling, and punctuation errors

3.5 to >3.0 pts

Fair 70%–79%

Contains 3-4 grammar, spelling, and punctuation errors

3 to >0 pts

Poor 0%–69%

Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting - The paper follows correct APA format for parenthetical/in-text citations and reference list.

5 to >4.0 pts

Excellent 90%–100%

Uses correct APA format with no errors

4 to >3.5 pts

Good 80%–89%

Contains 1-2 APA format errors

3.5 to >3.0 pts

Fair 70%–79%

Contains 3-4 APA format errors

3 to >0 pts

Poor 0%–69%

Contains five or more APA format errors

5 pts

Total Points: 100