Sample Nursing Essay Paper on Evaluation and Management Codes with Highest Denial Rate

            There is an underlying problem for the coding system in assessment and management. Most practitioners are unsure of the correct Current Procedural Code, therefore, leading to high rates of denial of service. Nevertheless, there are available solutions that can help in mitigating the issue. The evaluation and management codes that tend to have the highest rate of denial are M86, M80, CO-B15, CO-18, and global surgery codes. The codes pose a problem because of the issues listed in each code below:


In this code, there can be a denial of service because of payment for the same or similar services in a given period. The code poses a problem because it may be difficult to distinguish between the same or similar services.


There can be a denial of service when performed in the same session or date as the initial processed service for a particular patient. This code poses a problem because there are chances that a patient is given the same session or time as a previously processed service.


In this code, there can be adjustments in payment because the procedure requires that a qualifying service is received and then covered. The code poses a problem when the service or process has not yet been received.


In this code, there can be a denial of service if there exists a duplicate service. If there are the same services submitted for the same patient on the same date of service and by the service doctor, this can be termed as duplicate service (Olsen et al. 78). The code poses a threat because the chances of such conditions happening to a patient cannot be ruled out.

Global Surgery Denials

The typical global days are 090, 010, 000, XXX, YYY, and ZZZ. They are determined by the Centers for Medicare and Medicaid Services (CMS) (Vines et al. 98). For instance, XXX means global days does not apply. The code poses a threat because practitioners may interpret it.

How to Solve the Issue of Denial of Service

For the Case of M86, there should be a thorough check of the claim status to verify that the denial is not based on the information of the previous payments. The CGS Interactive Voice Response Unit can determine the status of a claim.

            In M80 and B-15, the issue can be resolved by checking the Correct Coding Initiative (CCI) edits before submitting a claim. The CCI edits are updated after three months in each year. The Modifier Referral Tool can be used to give specific information on modifiers, which are used to denote the exceptions to CCI.

            For CO-18, there should be verification of the claim status to ensure that claim duplication is not based on the previous information about payment. The CGS Interactive Voice Response Unit can also be used to determine the status of a claim.

            To avoid Global Surgery Denials, all employees should be trained to enable them to determine the code accurately, and therefore, attach appropriate modifiers. Employees should familiarize with the different global days and their interpretation.

Place of Service

32 is a code for a nursing facility. The facility provides skilled nursing care to residents. Other services such as rehabilitation for the sick, disabled, or injured people are also offered regularly. 41 is the code for a land ambulance (Beaman 206). The vehicle is specially designed, equipped, and has trained staff to provide lifesaving and transportation services for the sick or the injured people. It is essential to have the correct codes for the place of service to avoid denial of service, which is a common problem caused by inconsistent codes.  Proper measures should be implemented at all levels to eliminate the denial of service problem. It is vital to have training that seeks to address the issue before it escalates to higher levels and causes poor service delivery. For instance, the various codes should be known by practitioners to avoid making mistakes.

Works Cited

Beaman, Nina. Pearson’s Comprehensive Medical Assisting: Administrative and Clinical                                    Competencies. Upper Saddle River, N.J: Pearson, 2011.

Vines, Deborah, Ann Braceland, Elizabeth Rollins, and Susan Miller. Comprehensive Health             Insurance: Billing, Coding, and Reimbursement. 2018.

Olsen, Michael D, Eliza C.-Y. Tse, and Joseph J. West. Strategic Management in the Hospitals.                   Upper Saddle River, N.J: Pearson Prentice Hall, 2018. Print.