How will the claim demonstrate the medical necessity for the exams?

A 16-year-old female who has asthma has an Emergency Department visit for angina, shortness of breath, and wheezing. The doctor performs a chest x-ray, breathing treatments, and a Nuclear Medicine Stress Test utilizing a treadmill while monitoring the patient’s heart palpitations. While the patient is in the ED, the doctor evaluates her asthma and changes her prescription medication.

Review the chapter and consider the following questions:

1. How would you select the ICD-9 and CPT codes for the procedural claim (encounter) for the ED visit?

2. What diagnosis and procedure codes will result in full reimbursement for the procedures rendered?

3. How will the claim demonstrate the medical necessity for the exams?

After reading the required chapter on EHR Coding and Reimbursement complete and submit the following:

-Begin your case study with an introduction explaining the purpose of the case study. •

-Explain and answer the questions listed above. Be descriptive on the steps necessary to perform the above scenario. Defend your response and use terminology related to the scenario.

-Describe billing upcoding and downcoding. Describe the penalties related to performing these tasks. Is there a chance for the scenario listed above to be upcoded or downcoded? Explain your response.