ICD-10 Coding Tips

Beginners Guide To Coding Fractures Using ICD-10-CM- Part 1

I have to admit, I was a little disturbed this week after reading through comments on a Facebook post. The post was about the different 7th characters and what they mean and when to add them. This is something that can be confusing for sure. The question was fine–it was the answers that scared me a little. I realized after reading that post, that many coders (not even new coders–I’m talking about experienced coders–do not understand seventh character A.

If you have your ICD-10-CM book around, please look in the beginning section of Chapter 19. Or just to make it easier–here is a pic from my book:

 

 

Please see what I’ve underlined above. “The 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” The key is active treatment. That is what the A means. It has nothing to do with the provider seeing the patient. For example, if someone goes to the ER and it turns out he/she has a broken wrist–that encounter will be coded with 7th character A. Say this same person now follows up with their regular doctor the following day–the fracture is still coded with an A. It doesn’t change based on the provider or anything like that. It has to do with whether or not the patient is receiving active treatment. This patient is still receiving active treatment, so it’s still coded with seventh character A.

I can write many more posts about fracture coding (and I will if that’s something you guys are interested in) but I felt like I had to post about this. It is all here in the guidelines.

Are any of you looking for practice reports to code? There are some available. There are 15 x-ray reports and for each one you code the ICD-10-CM and CPT. Rationales are included at the end. Click the button below for more info.

Questions? Please feel free to comment below or email me at midnightmedicalcoding@gmail.com.

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CAC

Will CAC (Computer Assisted Coding) Replace Medical Coders?

So, here’s a question I see posted in different FB groups every once in a while–Will CAC (Computer Assisted Coding) ever replace medical coders? There is a long and short answer. The short answer is No. The longer answer–still No, but there’s more to it than meets the eye.

We all know there are some computer programs out there that make coding easier. These programs pick up on key words in documentation and for lack of better word–the computer ‘codes’ it. But here’s the thing-computers may be good at picking up on key words, but they can’t think. Computers are not aware of coding rules and guidelines, modifiers, excludes 1 notes…etc. So what happens is, the CAC just codes whatever keywords it picks up on, but it may be all wrong because it doesn’t know the rules. Here is what I mean:

Sometimes, it codes the reason for the exam plus the findings. According to ICD-10-CM coding guidelines, that is incorrect. When there are findings that explain the reason for the exam, the report is coded to the finding. Another thing I’ve seen CAC software do is put about 5 or 6 diagnosis codes on a simple report, like an abdominal ultrasound. It’s not wrong per se, but really? Do we need to code every single incidental diagnosis? No. Incidentals don’t need to be coded, but I’ll save that for another post.

Here is another common mistake that I’ve seen on audits done by CAC software. If you’ve coded radiology, you know how radiologists love to say “consistent with.” So, say you’re coding a chest x-ray and the report says, “findings consistent with pneumonia.” According to ICD-10-CM Coding Guidelines, you would not code the pneumonia because it is not definitive (this is outpatient coding, by the way. Inpatient coding has different rules on this). Many times the CAC software picks up on the word “pneumonia” and codes it. That is not how that report should have been coded because of the “consistent with.” It would be coded to the symptoms or a definite finding in the report. So, like I said earlier, CAC does not think. Does not know coding rules.

My guess is though (and this is only a guess) is that maybe in the future, most coders will be just checking the codes that CAC software came up with, and having more of an auditing role. Many places use CAC and have success with it, but there are also people checking the codes before it goes out. At the end of the day, there will always be a need for coders. Coders do way more than assign codes based on keywords. We think and have an in depth knowledge that just can’t be replaced by a computer. Besides, would any doctor out there want their billing/coding not even checked by a qualified person before it goes out? Probably not.

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Midnight Medical Coding Stars

Practice Report To Code

Everyone knows that coding takes practice, right? I mean it would be really nice if we just woke up one day, and knew how to code all the different specialties. (I admit I still have nightmares about learning how to code E/M).

 

Looking back, I remember a teacher I had who used to say, “The more you practice, the better you get.” That couldn’t be more true when it comes to medical coding. If you don’t practice EVER, you just won’t become familiar with certain types of reports. The problem is though–practice reports are hard to come by. There’s not too much out there, especially for diagnostic radiology coding.

But have no fear–I have reports that I can share. Each one is a diagnostic radiology report (x-rays, ultrasounds, ct, cta, mri, mra, duplex) For each one, you code the CPT and ICD-10-CM code, and then check your work. I am always available for questions–feel free to email me (midnightmedicalcoding@gmail.com).

So, everyone get a pencil and piece of paper if you’re old school like me, or use a tablet/device to take notes on.

For this report, please code the CPT and ICD-10-CM code.

**These reports are HIPAA compliant and do not contain PHI.

Ready for the answers? No cheating…

 

 

So, did you get the right answers? It’s okay if you didn’t. Remember–all types of coding take practice. Want to have a shot at practicing radiology coding? The good news is–I have more practice reports available! Each week I post a new report for you to code. Right now there are 20 reports available immediately and a new one will be added each Monday.

Join the Midnight Medical Coding Stars. That is a membership-only area where I post all of the reports.

 

I can’t just share these reports with the whole world. This is special and it’s reserved for only certain people. It is only $4.99 per month. That is a steal. That’s less than 1 Starbucks coffee.

 

I hope you’ll join us!

 

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ICD-10-CM Book Tabs

How To Tab The ICD-10-CM Book

For a long time, I didn’t tab any of my coding books. Well, wait that might not be entirely true. I used to have 1 tab for the Neoplasm Table and that’s it. Not sure why I never put the time in to tab the books the right way. But the long and short of it is, I already thought I was a great coder–why did I need to tab my books?

 

 

But then as I was getting things together and planning the x-ray cpt coding class, I was thinking about all the ways that would make coding easier for my students and I did a 180. I started thinking about the tabs again and how beneficial it would be. So, I made a set of tabs to put on my book to show as an example. Later on, when I was working, I realized how much faster I was coding. It was like night and day.

 

 

Every coder I know, whether they’re a newbie or not, worries about not coding fast enough. If you work as a production coder, you need to think about whether or not  you are meeting your company’s production requirements. Speaking of which, if you’re not, there are things you can do to improve productivity–see this freebie. So, anyway, back to the books. I’ve put together a quick video showing you how to tab the ICD-10-CM book. See below:

 

If you want to tab your books, but there’s too much on you plate– you can purchase a set of these tabs:) The ones you see in this video are a sample. What you see is what you get. These tabs have gotten great reviews–please see the sidebar on the right of your computer.

Price is $18.99 + $3.50 shipping.

Product is shipped in 1-3 business days.


Make a long story short, these tabs really do work and make life easier. If you’re still on the fence about it, go here to see more pics. Please feel free to reach out to me at midnightmedicalcoding@gmail.com if you have any questions.

 

 

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common coding mistakes, ICD-10-CM Coding Tips

ICD-10-CM Coding Tip About The M50 Series

Say what you will, but there are tons of ICD-10-CM Codes used for the different spine conditions. Even if you are not a newbie coder–it can be confusing. This post is not about all the different codes, but just one specific note for the M50 series. If you look at M50, you will see, ‘Note: Code to the most superior level of the disorder.’ If you’ve never noticed this before, please go check it out in the ICD-10 book right now. Below is a pic of my book and the note is highlighted in orange.

Here is a pic from my book.

So the long and short of it is, you only need to code the disorder for the highest level that’s documented in the report. So say if you’re coding an MRI and the dx is cervical disc disorders with myelopathy, and it’s documented at the C3-C4 level and also C5-C6 in the report–you would only code M50.01. You do not need the code M50.021. I can’t tell you how many times I see coders make this mistake. Here’s the kicker, sometimes it’s not even coders who make this mistake. Sometimes it’s a coding engine. But bear in mind though that there’s no way a coding engine can ‘know’ all the rules. But as coders we have no excuse. When all is said and done, we really just have to know this stuff.

 

 

 

 

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Coding Course

Intro To X-Ray CPT Coding Class Is On Sale!

 

Intro To X-Ray CPT Coding- Learn The 50 Most Common X-Ray CPT Codes is on sale. Today only! There are literally hundreds of CPT codes used in diagnostic radiology coding. Trouble is, these codes are not focused on in many general coding classes. This leaves new coders barely scraping by once they’re on the job, especially if they’re expected to know these codes already. If you’re a newbie or a coder in another specialty who wants to learn the basics of X-Ray CPT coding-this is the class to sign up for! It is all online and self-paced. You can email the instructor (that’s me-Lindsay Della Vella BS, COC) anytime if you have questions. This class is backed up by great reviews from former and current students. I hope you’ll join us! Price is $39.99. Today Only. Payment plan available.

Go HERE to see what exactly is include in the class, read reviews and sign up!

Coding Course

My First Day Working As A Medical Coder

On the first day of my first coding job, I didn’t know what I was doing. I really didn’t. I never coded a real radiology report before. I guess I read a few in my coding classes, but it was something that wasn’t focused on.

Everything I knew about radiology was just based on my life experiences up to that point. I knew what a wrist x-ray was because I needed one before (broke my wrist rollerblading). I knew what an ultrasound was because I have kids and had my fair share of prenatal ultrasounds.

I kind of knew what an MRI was because the machine looked scary to me and I couldn’t see myself ever being brave enough to go in one if needed. I didn’t know what a CT was. Never heard of a CTA or MRA. Didn’t know what spectral doppler was. Needless to say I was confused at my first coding job. I didn’t know what any of this stuff was. I was fortunate enough to have an awesome mentor who helped me with CPT coding and even some diagnosis coding here and there.

But I know not everyone is as lucky as I was. Not everyone has a mentor. Or maybe you don’t feel comfortable asking a coworker for help. Even though I’m not a new coder anymore, I didn’t forget what it was like being new. How I was afraid of coding everything wrong. How I was afraid that I really did not know what I was doing and was not going to make it as a coder.

 

Some of you may know this already–but I’ve put together a new diagnostic radiology coding course. It is geared towards new radiology coders or coders in another specialty who want to learn more about it. It focuses on the CPT coding of x-rays. By the time you finish the course, you will know how to code the CPT for a variety of x-rays. You will be familiar with 50 of the most common ones used and will be prepared for ‘real life’ diagnostic radiology coding. It is all online and self-paced.

Please see the link below for a full description of the course. You’ll see the exact format and what is included. Scroll down the page and you will see a FAQ section and what my students are saying about the class. I hope you’ll join us!

 

Click Here for more info, to see class reviews and to sign up!

 

Click HERE for more info, to see class reviews and to sign up.

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Coding Course

On Sale Now!

Are you a medical coder or medical coding student who wants to learn more about diagnostic radiology coding?

There are A LOT of codes in the CPT book and you’re probably only familiar with the ones you use everyday.

So, if you’re a coder in another specialty, or a coding student, you might not know that much about the CPT coding of x-ray’s just because you haven’t had the opportunity to code them yet, or maybe it’s something that really wasn’t focused on in your regular coding classes.

Our new online coding class is available now! It focuses on the CPT coding of x-rays. You will code HIPAA compliant reports after each lesson and do coding practice exercises, take quizzes (your score is available immediately after submitting it) and there is test at the end. Supplemental info/sources/links are also provided. It is all online and self-paced.

The instructor (me- Lindsay Della Vella!) is available 24/7 through email for questions.

This class is getting excellent reviews from fellow coders who have already completed it. I hope you join us!

It is on sale NOW for $39.99! Offer expires Sunday at 5 pm EST.

Click the link to sign up and for more info.
https://bit.ly/2wSf6hF

Still have questions? Feel free to email me at midnightmedicalcoding@gmail.com

Uncategorized

CPT Coding Course

x-ray class cover

Enrolling now!

  • Go here to sign up and for more info.
  • You’ll have access to the class until December 31, 2019.
  • Price is $49.99. Payment plan available.

This class is designed for new coders or coders in other specialties looking to learn more about diagnostic radiology coding. It is 10 modules long and includes videos, power point presentations, practice coding exercises, supplemental reading materials, quizzes and a test. It is all completed at your own pace and I’m always available for questions/concerns.

Coding Course

Diagnostic Radiology Online Coding Course

Midnight Medical Coding will be offering an online diagnostic radiology coding course starting in January 2019! This course focuses on x-ray CPT coding. You’ll learn the most common codes, how to look them up in the book and you’ll practice coding HIPAA compliant reports.

The course is done at your own pace and I’m always available for questions. There’s 9 modules (may ultimately end up being 10) which includes videos for instruction, pdf downloads, quizzes and practice coding exercises.

Students will also have the option of joining a private Facebook group just for people who take this course. That is where I can always be reached and I’ll also be sharing supplemental materials there. It also will be a place for students just to connect and talk to each other.

I’m super excited about this! Cost is $50.00 and you will have access to the course to December 2019.

If you want to stay in the loop and be notified when this course becomes available please go to: https://midnightmedicalcoding.podia.com/intro-to-x-ray-cpt-… and sign up for updates.

x-ray class cover