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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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

coding challenge

Coding Challenge 7

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

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

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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coding challenge

Coding Challenge 5

Please code the ICD-10-CM and CPT code for this report. To check your answers, click the link at the bottom of the report.

ABC Hospital

Patient Name- Jon Doe

Date- 1/1/18

Referring Dr- Dr Smith

Exam- US Renal

—————————————————————————————————————–

Procedure- US Renal

History- Routine check of renal cysts

Technique-2D images

Findings- Complete evaluation of the right kidney. Right kidney is normal in size with no hydronephrosis. No calculus. Simple cyst measuring 1.4 x 2.1 x 3.6 located mid portion. Simple cyst #2 measuring 1.7x 1.9 x 1.6 located upper pole.

RT kidney retroperitoneal measurements- length 9.71 AP 5.04 cm. width 5.52 cm

Complete evaluation of the left kidney. The kidney is normal in size with no hydronephrosis. Complex cyst measuring 2.2x 1.2x 1.5 located mid portion. Visualized portion of the IVC are normal. Proximal and abdominal aorta obscured by bowel gas.

LT kidney retroperitoneal measurements- length 11.50 cm AP width 6.25 cam

The bladder is normal.

Prostate is normal.

Impression- No hydronephrosis. Bilateral renal cysts.

Signed by Dr Michaels 4:00 pm 1/1/18

Go here to check your answers!

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Uncategorized

Why It’s Beneficial To Know How To Code Diagnostic Radiology

I just wanted to shed some light on something. I’m not sure if this is the best topic for one of my first blog posts, but here it is anyway. The other day, the topic of off-shoring came up in a coding discussion. It is a sensitive subject and we can’t pull the wool over our eyes and pretend it’s not there. But I don’t want new coders to feel that they should avoid learning diagnostic radiology coding, thinking it would be a waste of time and abandon ship. The fact is that coding in ALL specialties can end up going off-shore. This is something that happens in any coding specialty and is not diagnostic radiology coding-specific. Say what you will, but this is something that most coders are well aware of, and I have never heard of that fact alone being the sole reason that someone does not pursue radiology coding.

Another thing to keep in mind too, is that coding needs to be audited. Not just radiology coding but all coding, no matter where it is coded originally. Usually the coding gets audited here in the USA. Now, I’m sure there are exceptions to this somewhere out there, but in my experience this has been the case. In order to audit it, you have to know how to code it first right? So if it is something you’re interested in, don’t miss the boat!

Another reason to learn diagnostic radiology coding is because it is a good account for new coders to get their feet wet. Why do they start with the radiology accounts? Because it is easier than starting with other types of coding, say brain surgeries, transplants etc. While it’s true that it is easier than some types of coding, it has it’s own set of rules, and is a specialty in and of itself. If you are a diagnostic radiology coder, not only will you become proficient in aspects of CPT coding, you will become familiar with all sections of the ICD-10-CM book. You use a full range of codes which is a very valuable skill set. Even if you decide not to stay in diagnostic radiology coding–these skills transfer over to other coding specialties.

So, to make a long story short, there are many different coding specialties, and unfortunately some coding does end up going offshore, in ALL specialties. But you would be doing yourself a disservice if you decide not to learn diagnostic radiology coding based on that alone. There are thousands of radiologists in this country and many of them see the benefits of having the coding of their practice stay in the US. Not only that, radiology coding lends itself to learning so many different aspects of CPT and ICD-10-CM coding and these skills are valuable for any coder to have.
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