Quick Guide: Elements of HPI For E/M Coding

July 30, 2019August 16, 2019 Lindsay Della Vella

Okay, I’m the first to admit that I don’t like coding E/M. When I was first starting out and looking for coding jobs, I would do my best to avoid applying for anything that had any E/M mentioned in the job description. I ultimately lucked out, and got into radiology coding, which I love. Then later when I moved on…guess what my first assignment was–doing an E/M audit! I was lucky (again) that I had wonderful coworkers to help me along the way. But I do distinctively remember crying over it one day while working on it. It just wasn’t my thing. But over time, that has changed (a little bit) and now I can do an E/M audit with less problems (and less crying). But it still is confusing and every time I work on anything E/M, I have to review everything to refresh my memory.

One part that I think can be a little confusing is going over the HPI and counting up the elements. In theory, you would think this would be the easy part. Maybe it is for some people, but not for me. So I review this and it helps, so I thought I’d share it here. This comes directly from the CMS website:

History of Present Illness (HPI) HPI is a chronological description of the development of the patients’ present illness from the first sign and/or symptom or from the previous encounter to the present. HPI elements are:

Location (example: left leg)

Quality (example: aching, burning, radiating pain)

Severity (example: 10 on a scale of 1 to 10)

Duration (example: started 3 days ago)

Timing (example: constant or comes and goes)

Context (example: lifted large object at work)

Modifying factors (example: better when heat is applied)

Associated signs and symptoms (example: numbness in toes)

SOURCE: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

So, that’s it! Does this list at least help a little bit? I could attempt to go on and on about E/M and try to explain it in more detail, but I don’t want to confuse anyone even more. I feel like E/M is something that can only be learned by coding practice cases or just learned over time. I will share the audit sheet I use though. It is from Novitas and you can find it here. Please note though–this is the 1995 guidelines.

If you’re looking for the 1997 guidelines/specialty exam score sheets, go here.

These are by no means the only score sheets available. This is just what I personally use, so I thought I would share it on the blog.

Thanks for reading,

Lindsay

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medical biller, Medical coder

What Is The Difference Between A Medical Coder and a Medical Biller?

July 20, 2019August 16, 2019 Lindsay Della Vella

If you’re in the medical field, or are currently taking a medical coding and billing class, you’ve no doubt heard the words “medical coder” and “medical biller.” You might even think these jobs are the same because the names sound similar. Sometimes (especially in smaller practices) these roles are combined. But even though these positions are definitely related, each one is different. Here is a breakdown of the differences in a very general way.

Medical coders read the patient reports and assign ICD-10-CM and CPT, HCPCS (or ICD-10-PCS if you’re an inpatient coder) codes. It takes a great deal of knowledge of not only the code sets you’re using, but of disease processes and terminology. You will also need to know about the different insurances you’re billing and their requirements. Basically you have to know your stuff. The simple fact of the matter is–it takes time to get to the level where you can do this completely independently. Bear in mind– many medical coding jobs have production and accuracy requirements. To add insult to injury–if you do not meet these requirements, many times you could be fired. Can anyone say stressful? On the plus side though, if you don’t like dealing with the public very much, you really don’t have to as a medical coder. Usually your job is completely behind the scenes. You also will need to have at least one certification from either AAPC or AHIMA. (There is a new certification for coders from AMBA, but it is not highly recognized yet. I believe it will be though in the future).

A medical biller usually work the claim denials and tries to fix them to get them paid. Many times they read patient EOB’s and eventually need to call the insurance company to figure things out. They also probably talk to patients either on the phone or in the office and explain their bills to them and/or ask for payment. To be a successful medical biller, you should have a basic understanding of the common codes used in your practice and what they mean. Usually a certification is not required but there are billing certifications available from AAPC and AMBA.

So, that is it in a nutshell. The tasks of medical coders and medical billers are related, but different. As a side note-working as a medical biller first, is a great stepping-stone to working as a medical coder later. Good luck to those of you just starting in the field!

Thanks for reading,

Lindsay

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Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

Reviews

Review of Asus USB Portable Monitor

June 24, 2019August 16, 2019 Lindsay Della Vella

Well, this isn’t specifically about coding, but it’s related. Anyone out there use 2 monitors for coding at home? For starters, in case you’re wondering but are afraid to ask–No this post does not have affiliate links and I don’t “get” anything for writing this. I wanted to write a review on a monitor I bought because I like it, and I think it could be beneficial to a medical coder.

Okay, well here is a pic of it.

What I like best about this monitor is that it uses a USB cable and you can move it. Why this is beneficial to me is plain and simple. I can move it upstairs and set it up with my laptop so I can hide from my kids and work. My house is too noisy over the summer and I need privacy and quiet or else I’ll mess up everything and my codes will be wrong. This monitor can be easily moved from one computer to another without 9878789 different wires. It just uses 1- a usb cable. So I can use it upstairs for now, and then once I’m ready to use my office again downstairs, when the kids go back to school, I can easily move it.

It also comes with a small case to put it in if you want to take it out with you and use with a laptop. The color of the screen is nice when it’s hooked up (sorry I don’t have a pic with it on) and overall it is a really good product.

Here is one thing though that is a little confusing. I learned this from reading other reviews on this, so it’s definitely worth mentioning. Trouble is, it is not plug and play. Bear in mind, it comes with a cd to download the drivers onto your computer. However, the disc is either outdated, or just does not work. To get this up and running, you have to download the drivers from display link. Just choose the operating system your computer uses and download the driver. Once it’s downloaded, you’ll be able to use the options to set up the second monitor and it’s very easy. If you didn’t know to use display link I think you’d be confused though.

Anyway, this is what I use at home when I’m working. I have my main monitor logged into whatever system I’m using at the time, and on this screen I put my coding spreadsheet. It works out great and I really like it.

So there you have it. If any of you are looking for a second monitor this one is as easy as 1, 2, 3.

Thanks for reading,

Lindsay

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Advice

5 Wrong Ways To Code Using ICD-10-CM

June 2, 2019August 16, 2019 Lindsay Della Vella

First things first. If you’ve been coding a while, I’m sure you’re already very familiar with the ICD-10-CM book and how to actually find a code in the book. But here’s the thing. There’s a right way to code, and a wrong way. I won’t get into whether or not you should use an encoder or anything like that. For this post, I’m just referring to using the ICD-10-CM book when coding. Okay- so here’s the first “wrong thing” you can do while coding:

Going Right To The Tabular. I know that you might be in a rush trying to get everything finished. Or maybe you kind of have an idea where the code is in the tabular. But if you skip looking in the index, you might miss something. There’s so much info there even if it’s not where the actual codes are. By skipping the index, you’re just guessing and might end up with the wrong code.

Using Google Without Checking The Book. Okay here is another one, but this one really gets under my skin. Google is great for a lot of things. It can sometimes help with coding but please, if you use Google–double check what it is telling you in the book. Google does not know coding rules and is just going off of keywords. It may lead you in the right direction overall–but you need to double check with the book and see if you’re correct. I had a coding manager tell me one time she coded something the way she did because “Google said.” Please don’t be that person. Use the book/references to back up your code choices.

Ignoring Excludes– Here is something that coding engines seem to do, and that’s ignoring excludes. The excludes are important. Some ICD-10-CM codes/conditions can not be coded with others and that’s the whole reason why the excludes are there. If you’re ignoring them, you might end up coding things together which shouldn’t be. Which leads me to my next point:

Ignoring Coding Guidelines– The guidelines are there for a reason–you need to follow them. I think most coders do a good job with this, but it’s important to remind everyone once in a while. Guidelines are there so you don’t have to guess or make stuff up. Review the guidelines every once in a while. You don’t have to memorize them.

Coding Symptoms When There Are Findings- For this one, I’m referring to outpatient coding. Don’t code symptoms when there are definitive findings. This is something I see sometimes, and I’m not really sure why coders make this mistake. You need to be careful of the wording of different radiology reports– you don’t want to code “probable,” “likely,” “suspected” diagnoses. But if it’s definite–code it!

So there you have it. How to code wrong-hopefully none of you are doing those things. Can anyone think of any others?

Thanks for reading-

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CPT

Cervical Spine Radiology CPT Codes

May 24, 2019 Lindsay Della Vella

To have a bright future as a medical coder, you have to have a pretty good understanding of anatomy. Bear in mind, you won't have to memorize every little thing. But it is necessary to have at least a basic understanding, and that's the tip of the ice burg really. The more you know, the better coder you'll be.

So, for purposes of this post, we'll just be talking about radiology CPT codes that have to do with the cervical spine. If you need to brush up on cervical spine anatomy, please see this video below.

Here are some of the common codes used-

X-Rays-72040, 72050, 72052

CT-72125, 72126, 72127

MRI-72141, 72142

There are many more codes that have to do with the cervical spine in the different sections of the CPT book. The ones listed above are commonly used in diagnostic radiology coding.

On the other hand...there are MANY different codes that have to do with the cervical spine in the ICD-10-CM book and are used in diagnostic radiology coding. I may talk about that in a different post though 🙂 For now though, there's this post about the M50 series that you can review.

Thanks for reading.

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Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

Diagnostic Radiology Coding Basics

New Facebook Group

May 23, 2019 Lindsay Della Vella

Hey Everyone,

I just started a new Facebook group. This is a public group, open to medical coders or medical coding students and it will focus on diagnostic radiology coding. Please consider joining us there!

Here is the link to it

Thanks!

Lindsay

Midnight Medical Coding Products You Might Be Interested In:

Learn The 50 Most Common X-Ray CPT Codes-

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15 Question Practice Coding Test

Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

Advice

4 Proven Ways To Stay Up To Date In The Medical Coding Industry

May 4, 2019May 4, 2019 Lindsay Della Vella

It's not secret that the medical coding world is always changing. Every year there are new codes and new guidelines. You have to buy new books and read through the new codes and make sure you understand them. But there is more to it than that. You have to continue on with your own professional growth and development in your own specialty and maybe even learn about new specialties. So how on Earth do you do all this on top of everything else going on in your life? Here is a list of 4 ways to help you keep up with the ever changing medical coding world.

Read medical coding publications. I'm sure many of you read AAPC's magazine to get the 1 CEU credit. But it is a good idea to read this magazine anyway. There's lots of good articles here that will keep you up to date. Not just coding but overall changes/trends in the industry so you're not left in the dark.

Go to AAPC meetings. I know I'm talking a lot about AAPC here, but that is because it is what I'm familiar with. Every month there are local chapter meetings, and if you go you will get to network with other coders and also earn CEU's. I hate to say this, but it took me years to go to meetings because I just couldn't do it. My kids were young and I just couldn't swing it. However, at the time I did sign up to be on their email list. So I kept up that way for a while until I could finally make the meetings. I'm not sure if AHIMA does something similar. If you are certified through them, definitely look into it and see what they have to offer.

Network with other coders. If you can't get to AAPC meetings, another way to network with coders is online. If you're part of Facebook medical coding groups, you will have the opportunity to just talk to other coders and see what's going on in the coding world in general. Make a long story short, some of the best coders I know, I have not met in real life. But I've known them through Facebook for years and I consider them not only peers, but good friends.

Always look for ways to expand your own knowledge. This could be hard to do, but one of the ways you can stay up to date with the coding world is to keep an eye on other specialties that you're not currently coding. For example, even if you're not an E/M coder, big changes are coming in the next few years. It helps to keep up with these things just so your knowledge overall stays relevant, and you know what you're talking about. Here's another idea too. Get books and read up on different specialties if it's something you're interested in and just want to learn it. For example, even though I only audit diagnostic radiology, I've been spending time reading up on interventional radiology. It takes a long time to learn and I'm no where near ready to code it in real life. But it's something I'm interested in and might want to do someday, so I figure, why not.

Anyone else have any other suggestions? What do you do to stay up to date in the coding world?

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Learn The 50 Most Common X-Ray CPT Codes-

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Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2019 or 2018 ICD-10-CM book from any publisher.

Practice Report To Code

April 20, 2019August 16, 2019 Lindsay Della Vella

For the blog post this week, I thought I’d share a report to code. This is a HIPAA compliant report and does not contain any PHI. Answers included at the bottom. Please feel free to comment or email me at midnightmedicalcoding@gmail.com if you have any questions 🙂

Ok- what do you think the ICD-10-CM and CPT codes are for this report?

Ready for the answers? Scroll down the page…

Thanks for those of you who participated in this!

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News

Eli Global, LLC Charged With Public Corruption and Bribery

April 7, 2019 Lindsay Della Vella

Ok, you might have read the title of this post and wondered why I’d even be writing about this. This is after all a medical coding blog right? Eli Global, LLC probably does not ring a bell. At least for me it didn’t when I first read about this. I was like Eli Global, LLC? Never heard of them. Moving on.

But here’s the thing. Eli Global, LLC is a huge company that has many companies under it’s umbrella, and one of those companies is AAPC. You’ve heard of AAPC right? AAPC is one of the main organizations that certifies coders and many of us (myself included) have gotten at least one coding certification through them over the years. So, the owner of Eli Global, LLC (and also AAPC) is under investigation now for different illegal things.

I don’t want this post to be about my opinion on this. I’ll go along with the whole innocent-until-proven-guilty-thing, but I have to admit, this is concerning to me. I’ll post links to some different articles and you can form your own conclusions:

Articles:

The United States Justice Department

Subpoena

Insurance News

The Hill

Triangle Business Journal

Well, maybe I’ll just put one of my opinions in this post and that’s it. So, in order to be a certified coder, it is just expected that we have high standards. AAPC even has a Code of Ethics. Here it is:

Code of Ethics

AAPC has a code of ethics which addresses coding professionalism and compliance integrity. The eight components of AAPC’s Code of Ethics are:

Maintain and enhance the dignity, status, integrity, competence, and standards of our profession.
Respect the privacy of others and honor confidentiality.
Strive to achieve the highest quality, effectiveness, and dignity in both the process and products of professional work.
Advance the profession through continued professional development and education by acquiring and maintaining professional competence.
Know and respect existing federal, state, and local laws, regulations, certifications, and licensing requirements applicable to professional work.
Use only legal and ethical principles that reflect the profession’s core values, and report activity that is perceived to violate this Code of Ethics to the AAPC Ethics Committee.
Accurately represent the credential(s) earned and the status of AAPC membership.
Avoid actions and circumstances that may appear to compromise good business judgment or create a conflict between personal and professional interests.

Hopefully it’s not too much of a stretch for the owner of AAPC to follow it’s own Code of Ethics. I’ll leave it at that.

Thanks for reading.

-Lindsay Della Vella BS, COC

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Practice coding the ICD-10-CM and CPT codes of HIPAA compliant X-ray reports. Answers and rationales provided.

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Advice

3 Things Your Medical Coding School Did Not Tell You

April 2, 2019 Lindsay Della Vella

Ok, before you even read this post, please keep in mind that this post is not about one specific coding school. There are literally hundreds of medical coding schools out there and some are undoubtedly better than others. This post is just my response to social media threads I see out there where people talk about dropping thousands of dollars on a medical coding course/school and still had no idea they needed to take a certification exam. Had no idea it would be hard to get a coding job. And who also had no idea that working from home shouldn’t just be an expectation. That is only the tip of the ice burg. It saddens me to think that coding schools do not give their students the heads-up about the real coding world. But it also bothers me that some (not all) potential coders do not research and do their homework and look around. It’s important to at least get a feel for the coding world before jumping into it. So, in case your new to the coding world, please read this list below. It might help you decide if coding is really right for you.

“School coding” is not the same as coding in real life. Let me explain. When you are in coding school, you are still just learning. You are in the process of forming the foundation for your future. It’s important that you get an overview of all the different areas of coding, and get a basic understanding. So since the goal at this point is learning how everything kind of goes together, everything will be presented to you in a way that’s clear without leaving much room for guesswork. An example would be–if you have an E/M coding question–it tells you right in the question what all the different levels are for each area. You don’t have to fill out the actual audit sheet and get the level yourself. This is okay–you are learning and it’s not expected that you can do this right off the bat. It bothers me though that coding schools don’t seem to let students know that it is not like this in real life. Don’t get me wrong–some doctors are better than others about documentation and sometimes the report is very clear and easy to understand. Other times, well, not so much.

The next thing many new coders don’t know is very similar to the last one, but has to do with insurance. Different insurances have different rules. Many coding schools do not even mention the idea of insurances. I can see why they wouldn’t. You are learning how to code and it’s probably best not to complicate things by throwing the idea of insurance and different rules into the mix. Again though, I think it would be beneficial to the student if this is at least mentioned at some point. An example off the top of my head– some insurances still use a modifier 59. Some don’t, and use the different X modifiers. Some even have rules that would sound weird to a coder. An example would be, I remember there was one particular insurance that required a 59 be added to both a 76856 and 76830 on the same claim. The CPT book would say this is a no-no, but that is how this one insurance wanted it. I’m sure there are many more examples out there. The point being though–insurances have rules. It’s not expected you know them right out of the gate, but I wish schools would tell new coders that this is actually a thing. Once you throw federal payers into this (Medicare)–they have rules too. Many insurances follow what Medicare does, but some do not. You will learn all of this on the job, but again, this is something just to be aware of.

Ok, one last thing that new coders may not realize is that working remote is not a guarantee. Many schools try to sell the idea that you can work from home from day 1 and make lots of money all while tending to other things. Sometimes these schools even have a picture of a young mom coding with her baby sitting on her lap. This makes my blood boil. Yes, some people have been fortunate enough to work from home from the beginning. Is it the norm? No. And while taking care of a baby? Definitely no. I feel like they just put pictures like that to sell you on the idea that you can stay home, raise your kids, and work at the same time. And they make it look easy. I won’t go on a tangent too much here, but I heard a saying once and it kind of stayed with me. It said, “Women are expected to work like they don’t have kids, and raise kids, like they don’t have to work.” I know there are million different situations out there, and yes, it is possible to work from home and still have kids. That’s not what this is about. I don’t like how schools set people up with the idea that it’s an expectation and everyone and anyone can do it.

Anyway, all I can say is just do your homework before getting into the field. It is a great field to be in, with many different possibilities. I absolutely love it, and I can not even see myself doing anything else. A great way to get an idea for what it is really like is by networking and talking to other coders. They can also share their experiences. It may even lead to a job offer down the line. You can go to local AAPC chapter meetings and join different coding Facebook groups out there to meet other coders.

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Here are some of the common codes used-

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Code of Ethics

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