Tag: icd-10 cm

Diagnostic Radiology Coding Basics, Questions

Got Coding Questions?

Lindsay Della Vella

 

First things first, the medical coding world is tough right now. I don’t have exact numbers, but many coders in all different specialties are furloughed or laid off due to Covid-19. I’d like to think that most of us will get our jobs back, but that’s not really what this post is about. Make a long story short, I think now is a good time to either brush up on coding, or learn something new, and I’d like to help other coders do that. So, if you have coding questions related to ICD-10-CM or the radiology section of the CPT book–please feel free to send me the questions and I’ll answer them in the next blog post!

Coding CPT questions can be about:

x-rays

ultrasounds

duplex

mammograms

MRI’s

MRA’s

CT scans

CTA’s

ICD-10-CM codes commonly used in radiology–such as fracture codes, injury codes, pain, screening codes etc.

Common modifiers used–such as 59, X modifiers 76 etc.

You can comment below, or you can email me (Lindsay) at midnightmedicalcoding@gmail.com

 

Midnight Medical Coding Products You Might Be Interested In:

 

Tabs for the ICD-10-CM Book: Get 60 printed, multi-colored, double-sided tabs. These can be used on any 2020 or 2019 ICD-10-CM book from any publisher.

 

 

 

Advice

5 Weird But Essential Things For Medical Coders

Lindsay Della Vella

So I’ve been thinking about all the extra things I use on a daily basis for my job. I’m not talking about coding books or office supplies or anything like that. I’m talking about little things that just make the day a little easier and just more comfortable. Everything included here are products I really use and have purchased myself–but it’s just an honest review. In other words–I don’t make money if you click on a link here and buy the same products. Just wanted to get that out of the way.

 

Okay the first one is this USB number pad. This might sound weird, but you know when you’re coding, you probably use the keypad numbers on the right of your keyboard. I didn’t find this out until recently but not all keyboards have those numbers there. It might not sound like a big deal, but if your job is inputting numbers…well you kind of need this to be there. I’m using an older laptop for a job now and low and behold…it does not have these numbers on the side. But you can order this USB keypad and voila! Problem solved.

To be a medical coder, your computer has to have these keys!

Not sure how many of you out there have to do this, but at the end of a shift, I have to put together a production log. It’s not a big deal–it’s just a list of all the encounters coded for that day. But the problem is, by that point, my hands kind of hurt and are tired. Hopefully I don’t sound like too much of an old lady, but I bought these compression gloves and they really help my hand feel better.

 

 

I’m not old but I sometimes wear these

The next most important thing that I need everyday is a decent coffee mug. I know that probably sounds ridiculous, but if you’re anything like me you have to have at least one cup of coffee before opening your first chart to code for the day. The problem with me though is, I have spilled coffee on my books more than I’d like to admit. These books are expensive and not only that, they have to last the whole year. By the end of September, my ICD-10-CM book has pages ripping out a little, the cover is messed up and I know for a fact that coffee has spilled on it at least twice since I bought it. Every year I say that I will try to keep my books in better shape, and one way I do that is by using a travel coffee mug, even if I’m working from home. Obviously there are about a million different ones to choose from, but I’ll post a sample pic anyway.

 

The next thing I use every day is this portable USB monitor. It’s very good quality for the price and isn’t that hard to set up. What I like about it most is that I can easily unhook it from one laptop and use with another. I wrote a full review on this already–for more info go here.

 

Okay the last thing that I’ll mention in this post is to get a seat cushion. This might not be necessary if you already have a decent chair, but I don’t. So, I bought this one not too long ago and I really like it.

Anything else? What other things do you use every day as a medial coder?

Thanks for reading,

Lindsay

 

Midnight Medical Coding Products You Might Be Interested In:

 

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.

 

 

 

 

 

 

 

 

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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CPT

Cervical Spine Radiology CPT Codes

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.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association

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.

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

New Facebook Group

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-

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.

 

 

Practice Report To Code

Practice Report To Code

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!

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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Coding Guidelines

Can You Code Symptoms And A Definitive Diagnosis Together?

Lindsay Della Vella

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.

 

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.

 

 

 

 

 

 

 

 

 

In case you didn’t see it in the email we sent out–the coding class is on sale for $39.99. This weekend only. CLICK HERE for more info and to sign up.

 

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Questions

Diagnostic Radiology Coding Questions?

Lindsay Della Vella

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

Lindsay Della Vella

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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ICD-10 Coding Tips

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

Lindsay Della Vella

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?

Lindsay Della Vella

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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