Tag: icd-10 cm

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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Midnight Medical Coding Stars

Practice Report To Code

Lindsay Della Vella

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

Lindsay Della Vella

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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Coding Course

Diagnostic Radiology Online Coding Course

Lindsay Della Vella

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

coding challenge

Coding Challenge 7

Lindsay Della Vella

Please code the CPT and ICD-10-CM code for this report. This report is HIPAA compliant and does not contain PHI.

 

Exam- Right hip including pelvis 2-3 views

Date- June 4, 2018

#1111222222

Exam-Hip x-ray right including pelvis 2-3 views

Clinical History- Right hip pain

Comparison- hip x ray 2/4/17

Technique- 2 views of the right hip and 1 ap view of the pelvis was performed

Findings: Pelvis ring intact. The sacroiliac joints are symmetric. No right hip fracture or dislocation. Punctate ossific density adjacent to the right hip. Left hip unremarkable.

Soft tissue- normal

Impression:

No right hip fracture or dislocation. Punctate ossific density adjacent to the right hip most likely related to degenerative changes.

 

Thank you for referring your patient.

Go here for the answers

coding challenge

Coding Challenge 6

Lindsay Della Vella

Please read the report below and code the CPT and the ICD-10-CM Code. Please keep in mind that these reports are designed to be as realistic as possible, but everything is HIPAA compliant so the information is not real.

*For the tomo, please use the HCPCS code.

***************************************************************

Procedure- Bilateral Diagnostic Mammogram with Tomo

History- Bilateral breast pain for 2 weeks

Technique- Full field mammography was performed. Bilateral breast tomosynthesis was preformed in the MLO and CC projections. CAD was used as an aid for interpreting this exam.

Comparison: Prior mammo from April 2017

Density- There are scattered fibroglandular densities

Findings: There is no suspicious mass, microcalcifications,  or unexplained distortions.

Impression: No dominant mass or secondary signs of malignancy within either breast. Annual screenings recommended. BIRADS ASSESSMENT- (2) Benign findings.

Signed Dr. J.

Go Here To Check Your Answers

Youtube tutorial

X-Ray Coding–A Walk-Through With Examples

Lindsay Della Vella

If you’re new to radiology coding, or just want to learn more about it, this is a good video for you to watch. It is a quick 5 minute tutorial where I go over the format of an x ray report and the elements that should be included. There is also a practice report in it for you to code the cpt and icd-10 code.

Thank you for watching this tutorial!

 

 

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