NURS 6550: Week 1: Medicolegal Considerations and the Role of the Advanced Practice Nurse Essay Assignment Paper

As the description suggests, the acute care setting is the highest level of acuity for advanced practice nurses. In this setting, advanced practice nurses take on multiple roles and responsibilities as they perform comprehensive health assessments, communicate with multidisciplinary care teams, develop treatment plans that meet the individual needs of patients, and document the care they provide.

This week, as you begin to explore the role of the advanced practice nurse in the acute care setting, you will examine medicolegal responsibilities of advanced practice nurses in relation to documenting and coding the services they provide to patients. You also will explore laws and regulations that determine the roles and scope of practice for advanced practice nurses.

Learning Objectives

By the end of this week, students will:

• Analyze medicolegal responsibilities of advanced practice nurses
• Compare medical coding in primary and acute care settings
• Evaluate laws and regulations for advanced practice nurses

Learning Resources

Required Readings

Note: The information presented in this course is vital. As a result, numerous resources are provided in various formats to facilitate your competence in caring for patients in acute care settings. When multiple resources are available on the same topic, select those that best meet your personal learning needs.

Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current medical diagnosis & treatment (57th ed.). New York, NY: McGraw Hill.

 

• Chapter 2, “Common Symptoms” (pp. 19-44)
• Chapter 4, “Geriatric Disorders” (pp. 55–71)
• Chapter 5, “Palliative Care & Pain Management” (pp. 72-99)

American Academy of Professional Coders. (2017). What is a CPT? Retrieved from https://www.aapc.com/resources/medical-coding/cpt.aspx

American Association of Nurse Practitioners. (2018). Reimbursement. Retrieved from https://www.aanp.org/practice/business-practice-management/reimbursement

American Association of Nurse Practitioners. (2014). State practice environment. Retrieved from http://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment

American Nurses Credentialing Center. (2014a). Adult-gerontology acute care nurse practitioner. Retrieved from http://www.nursecredentialing.org/AdultGeroAcuteCareNP

Centers for Disease Control and Prevention. (2014b). International classification of diseases, tenth revision, clinical modification (ICD-10-CM). Retrieved from http://www.cdc.gov/nchs/icd/icd10cm.htm

Centers for Medicare & Medicaid Services. (n.d.-a). ICD-10 code lookup. Retrieved June 8, 2016, from https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx

Centers for Medicare & Medicaid Services. (2014). ICD-10 provider resources. Retrieved from http://cms.gov/Medicare/Coding/ICD10/ProviderResources.html?gclid=CPzM-sn72b8CFQwEaQodCXEATA

i-Human Patients, Inc. (2014). i-Human patients case player student manual.

Throughout this course, you will be required to complete case study assignments with i-Human Patients. This manual provides guidance on accessing and using these simulations. It is highly recommended that you explore the manual’s various training resources in preparation for the upcoming assignments.

i-Human: Explanation of assignment

Please make yourself familiar with information related to the iHuman assignments (found below in Required Media section).

River-Bou, W. & Brown, D. (2014). Thrombolytic Therapy. Retrieved from http://emedicine.medscape.com/article/811234-overview

Clinical Practicum Information

Nurse Practitioner (NP) Student Clinical Orientation (PowerPoint file)

Document: Practicum Manual (PDF)

NURS 6550: Week 1: Medicolegal Considerations and the Role of the Advanced Practice Nurse Essay Assignment Paper

Required Media

i-Human Patients Cases. (2014p). Marvin Webster, Jr. [Video file]. Retrieved from https://ih2.i-human.com/users/sign_in

 

You are HIGHLY encouraged to explore this practice case to become familiar with the i-Human Patients interface and to start making the transition between the live patient encounter and the virtual patient encounter. (No grade will be assigned for this practice case, but it must be completed in Week 1 in order to receive feedback.)

Note: You should have received an e-mail with your i-Human Patients login and password information. If you have not received this information, please contact the course Instructor.

University of Virginia. (2013b). Critical thinking & technology assessment. Retrieved from http://www.med-ed.virginia.edu/courses/rad/tech/index.html

University of Virginia. (2013m). Medical informed consent. Retrieved from http://www.med-ed.virginia.edu/courses/rad/consent/index.html

University of Virginia. (2013n). Patient confidentiality for health care providers. Retrieved from http://www.med-ed.virginia.edu/courses/rad/confidentiality/index.html

University of Virginia. (2013q). The radiology request & report. Retrieved from http://www.med-ed.virginia.edu/courses/rad/request/index.html

Optional Resources

American Nurses Credentialing Center. (2014b). Adult-gerontology acute care nurse practitioner exam sample questions. Retrieved from http://www.nursecredentialing.org/AGACNP-SampleTet.aspx

Certification Organization for the American Association of Critical-Care Nurses. (2014). ACNPC-AG exam handbook.

Retrieved from http://www.aacn.org/wd/certifications/docs/acnpc-ag-exam-handbook.pdf

Godara, H., Hirbe, A., Nassif, M., Otepka, H., & Rosenstock, A. (2014). The Washington manual of medical therapeutics (34th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F.A. Davis.

Discussion: Medicolegal Considerations

As an advanced practice nurse (APN), you will be responsible for identifying the ICD-10 diagnosis code, CPT code for procedures, and the E&M code for billing of services. Most nurses have not been involved in the coding of diagnoses or procedures, so these systems are probably unfamiliar to you. In this discussion, we will explore all three coding systems.

International Classification of Disease, 10th Edition, (ICD-10) is the system used to identify the diagnosis for the patient. The system is very specific and selecting the correct code can facilitate the approval of procedures as well as correct billing of services.

Current Procedural Terminology (CPT) are codes that identify procedures that have been completed or tests that are requested. Most CPT codes are related to what is considered appropriate ICD-10 codes. For instance, you would not code a bronchoscopy 0BJ08ZZ and relate it to a diagnosis code of low back pain M54.5. The reimbursement would probably be denied because the diagnosis and procedure do not correlate.

Evaluation and management (E&M) codes are used to determine the complexity of services provided to the patient. Specific documentation must be included in the patient visit note to support the E&M code billed. Improper coding, undercoding, or overcoding can have serious implications for patients, providers, and the provider’s care setting. For this Discussion, you will examine potential coding issues in case studies and consider the medicolegal responsibilities of the advanced practice nurse.

Case Study 1

The APN working in urgent care sees a patient with a right ankle sprain. What ICD-10 code would be appropriate for this patient encounter? What additional information and documentation is needed for a correct ICD-10 to be identified?

Case Study 2

The APN inserts a radial arterial line in an ICU patient with a hypertensive crisis. What ICD-10 and CPT code would be appropriate for this procedure? Identify any additional information and documentation that is needed for correct coding.

Case Study 3

Samantha Smith is an APRN that wrote this note on a patient in the hospital.

Name: Mr. Xxxxx

Patient and wife in to review the evaluation for SIADH (secretion of inappropriate diuretic hormone). His sodium is now corrected to 136 with water restriction.
CT shows old right frontal infarction which he denies having any symptoms of. There is mild cerebral atrophy consistent with age.
CT of chest shows 2 mm nodule in right apex, possible granuloma.
CT abdomen unremarkable.

Impression:

1. SIADH, improved
2. Pulmonary nodule, small
3. Frontal CVA, asymptomatic
4. Rule out macro vascular disease

Plan:

1. Monitor pulmonary nodule with repeat CT scan in 6 months
2. Pulmonary medicine consult
3. Neurology consult. He will schedule
4. Carotid duplex study
5. Continue fluid restriction

Samantha, the APN, billed Medicare a 99233 and provided this note as documentation of the service.

Questions:

1. What level of E&M coding does this note qualify for? Select one of the following and explain why this level of coding is appropriate. 99231, 99232, 99233, 99234
2. What levels of history, examination, and medical decision making are included in the note?
3. What elements are missing in this note that would help qualify it for a higher level of coding and reimbursement? What suggestions would you make to the APN to expand her documentation to bill at a higher level?

Case Study 4

Lisa Smith, an acute care advanced practice nurse, is making hospital rounds on the same patients her colleague nurse practitioner saw yesterday. It took her 50 minutes to see 10 of her patients and 30 minutes to see each of the remaining patients on her list. She used the same code for all visits—99233.

Questions:

1. Is the AG-ACNP’s use of the same billing code (99233) appropriate for all of the patient’s seen based on the amount of time spent with each patient?
2. What level of documentation must be included in each note to support this code?
3. How does the selection of this one code impact clinical practice and billing?

To prepare:

• Select one of the provided case studies. (Note- your instructor may assign the case to be completed)
• Review the information provided and prepare answers to the questions posed in the case study.

Post on or before Day 3 a summary of your answers related to the case study selected.  Discuss the medicolegal implications for coding and how it would impact the role and responsibilities of the advanced practice nurse.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you. Share additional insights or alternative perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!