Coding Guidelines

Can You Code Symptoms And A Definitive Diagnosis Together?

If you’ve been an outpatient coder for a while, you may know the answer to this off the top of your head. However, if you’re new to coding, you may not, so I thought it would be helpful to go over this guideline real quick. Before we even get started, I just wanted to say that as a general rule, in outpatient coding, you would not code the symptoms and the findings together. For example, let’s take a radiology coding example because I admit I’m biased and it’s my favorite. Say if a patient goes to get an x-ray of their elbow for pain, and it turns out, they have a fracture, you would code the fracture and not the pain, since the fracture is the finding. Pretty easy, right? But there is a guideline that I admit, I didn’t really even think about until not that long ago. You can turn to it in your ICD-10-CM book. It is in the front of the book in the guidelines, for chapter 18, b. Here is a pic just to make it easier:

 

So basically what this guideline is saying is that sometimes you can assign symptoms when it’s not associated with the definitive diagnosis. You would code the diagnosis first, then the symptoms. This is something I don’t see too often in radiology coding. Is this something you’ve coded before? Does anyone have an example they can share? Anyway, then it goes on to say that signs and symptoms associated with a definitive diagnosis are not coded with the diagnosis. This is the part that most coders seem to know.

Anyone have any comments on this? Examples? Please share in the comments below.

 

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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.

 

 

 

 

 

 

 

 

 

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Questions

Diagnostic Radiology Coding Questions?

Hey Everyone,

For this weeks blog post, I thought I’d have you guys ask me questions. What questions do YOU have about diagnostic radiology coding? It can be about CPT, ICD-10, guidelines etc. Is there anything you’d want me to answer? Please post in the comments below or send me an email at midnightmedicalcoding@gmail.com.

I’ll post the questions and the answer in the blog post for next week.

 

Thanks!

 

 

 

 

 

 

 

 

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

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.

 

 

 

 

 

 

 

 

 

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Diagnostic Radiology Coding Basics

10 Things You Need To Know Before Coding Diagnostic Radiology

For this week’s post, I thought I’d talk about just some general things relating to diagnostic radiology coding.  Bear in mind, this isn’t the be-all-end-all, everything-you-need-to-know guide. This is just what I would tell a new coder who had limited experience with this specialty in a nutshell.

  1. First things first–radiologists can be vague in their documentation. They like to use words like “consistent with,” “probable,” “rule-out” etc.  In the outpatient setting–you do not code uncertain diagnoses. So if you come across a report with these terms, do not code it. A common phrase I see in the impression on chest x-rays is “consistent with pneumonia.” Since it is not definitive, you would not code the pneumonia–you would code whatever the symptoms are. There is a coding clinic however that states that the use of the words “Evidence of” is not a vague term–so you can code the condition.
  2.  When you’re coding, refer to the impression. If there is a finding, it will be listed here, and this is where you code from. If there are no findings, you would code the history/symptoms stated on the report.
  3. When you’re coding x-rays, you count up the number of views to get the CPT. Sometimes the radiologists may mention images–do not count images. It is not the same thing as views. (If you want to learn more about x-ray coding, don’t miss the boat on our online class).
  4. Another thing to keep in mind is to always follow all client specific guidelines. For example, do you code an addendum? Do you need to add a modifier 26? All of these types of questions will be answered in your client guidelines. (A good rule of thumb is to review your client guidelines before reaching out to the lead coder for questions).
  5. Know the difference between limited and complete ultrasounds (refer to the CPT book).
  6. Know the difference between all the different OB ultrasounds (refer to the CPT book).
  7.  CTA’s must state 3D in the documentation.
  8. Know whether or not you need to code the contrast for MRI and CT scans. Do you code contrast waste? Again, review client guidelines on these types of questions.
  9. Know whether or not you need to code incidentals. The answer to this is generally no, but this is another client guideline type question.
  10. Last but not least, know how to code fractures. If this is new to you, see this previous blog post.

So there you have it. Hopefully this list helped you figure out a little more about diagnostic radiology coding.

Thanks for reading-

 

 

 

 

 

 

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Question Practice Coding Test

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

 

 

 

 

 

Join the Midnight Medical Coding Stars- A membership only area where one HIPAA compliant diagnostic radiology report is added each week for you to code the ICD-10-CM and CPT codes. Answers provided.

 

Join the Midnight Medical Coding Stars

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

 

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modifiers

Difference Between Modifiers 76 and 77

For this week, I thought I’d talk about 2 common modifiers used in diagnostic radiology–modifier 76 and 77. Let’s be honest though–talking about modifiers is probably not the most exciting coding thing to talk about–but it’s important. I’ll do my best to explain it in such a way that you actually read the whole article without getting bored– 🙂

So–modifier 76. If you look at the CPT book it says-

Ok, so the keywords here are ‘Repeat Procedure’ and ‘Same Physician.”

 

Now let’s look at modifier 77:

 

The keywords to look at here are ‘Repeat Procedure‘ by “Another Physician.’

So the difference between these modifiers is that modifier 76 is for a repeat procedure by the same physician on the same day, and modifier 77 is for a repeat procedure by a different physician on the same day.

In diagnostic radiology, I would say these modifiers are most commonly used on x-rays. Sometimes the same patient might need the same x-ray taken a few times during the course of the day. It could be x-rays for broken bones or chest x-rays to monitor different issues over time.

 

Le’ts look at a very common code- 71045. This is the CPT code for a 1 view chest x-ray.

 

Say if a patient had:

A 71045 was done at 8 am- read by Dr Smith, then later the same day

A 71045- done at 2 pm- read by Dr Smith

So basically this patient had 71045 done twice the same day. To bill these out, you have to add a modifier. In this case, this is the same procedure, read by the same physician. What modifier would you use?

You would add a modifier 76 to show that it’s a repeat CPT read by same radiologist. The 76 would go on the 71045 billed at 2 pm.

 

Let’s look at another example:

Say if a patient had:

71045 done at 9 am, read by Dr Smith, then later the same day

71045 done at 2 pm ready by Dr Jones

Now which modifier would you use? You would use a modifier 77 to show that this patient had 2 separate 71045’s done the same day, but NOT read by the same dr. You would add a modifier 77 on the 71045 from 2 pm. Does this make sense? You would use these modifiers to bill out 2 separate 71045’s the same day. You’re just trying to tell the insurance company if the same radiologist read the films or not. If you forget to add these modifiers, the insurance company most likely will think you made a mistake and billed out the same exam twice and deny one.

**Just a reminder–always follow client specific guidelines and insurance specific guidelines.

Questions? Feel free to comment below or email me at mightmedicalcoding@gmail.com.

 

Thanks for reading-

Lindsay

 

Midnight Medical Coding Products You Might Be Interested In:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Questions Practice Coding Test

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

 

 

 

 

 

Join the Midnight Medical Coding Stars- A membership only area where one HIPAA compliant diagnostic radiology report is added each week for you to code the ICD-10-CM and CPT codes. Answers provided.

 

Join the Midnight Medical Coding Stars

 

 

 

 

 

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs.

 

 

 

 

 

 

 

 

 

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ICD-10 Coding Tips

Beginners Guide To Coding Fractures Using ICD-10-CM-Part 2

Ok, as a follow up to last weeks post about 7th character A, for this week I thought I’d talk about 7th character D and more just about fracture coding in general. Here is a pic from my book:

 

Please see the pic where I have the star. It says 7th character D is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Ok, just like I mentioned in the last blog post,  the 7th character is not determined by provider or how many visits the patient has had, or anything like that. It just has to do with if the patient is in the healing/recovery phase or not. Examples of the recovery phase: if the patient is having x-rays to determine how a fracture is healing= 7th character D. Sometimes keywords in the report help as well. A radiologist will never say “patient is now in recovery/healing phase.” Keywords for healing is if the documentation mentions “callus formation.” Callus formation means the bones are healing.

Just in general, here are some more facts about fracture coding. These are all found in the ICD-10-CM Book in the guidelines about fracture coding. All fractures default to a displaced fracture if it is not documented as displaced or nondisplaced. (Displaced basically just means the bones are not lined up right). If the report specifies ‘nondisplaced’ fracture, then code it as nondisplaced.

All fractures default to a “closed” fracture if it’s not documented. Closed fracture means that there’s a broken bone but it is not coming out through the skin. This is really gross to think about but since we’re coders, we have to. Basically, if the report states “open fracture,” you’d code it as open fracture. But what that means is that the bone is so broken and messed up that you’d be able to see it. It’s through the skin (these are very bad fractures, sometimes from gunshot wounds and those types of injuries). Don’t worry–I will never post any real pics of fractures or anything on this site. Even though I can read reports for work, I can not look at real pictures or video of anything medical without completely losing it and feeling sick. Not sure if everyone is like that, but I’m the worst. It’s amazing I can even work as a coder I’m so bad with it.

Here are some different types of fractures, but these are drawings so I can handle it 🙂

 

 

Do you have any questions about fracture coding? Please comment below or email me at midnightmedicalcoding@gmail.com.

Thanks for reading-

Lindsay

 

Other Midnight Medical Coding Products you may be interested in:

 

Learn The 50 Most Common X-Ray CPT Codes-

Self-paced online course. Getting awesome reviews from fellow coders.

 

 

 

15 Questions Practice Coding Test

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

 

 

 

 

 

Join the Midnight Medical Coding Stars- A membership only area where one HIPAA compliant diagnostic radiology report is added each week for you to code the ICD-10-CM and CPT codes. Answers provided.

 

Join the Midnight Medical Coding Stars

 

 

 

 

 

 

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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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