[CCO] Certification Coaching Organization LLC http://www.cco.us Medical Certifications - Learn It - Get Certified - Stay Certified Fri, 26 Aug 2016 19:14:17 +0000 en-US hourly 1 Free Medical Coding Practice Exams – CPC Practice Exam and More! http://www.cco.us/free-medical-coding-practice-exams-cpc-practice-exam/ http://www.cco.us/free-medical-coding-practice-exams-cpc-practice-exam/#respond Wed, 24 Aug 2016 10:14:21 +0000 http://www.cco.us/?p=28017 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

Free Medical Coding Practice Exams – One of the things that we always constantly get from our community is yes, we sell courses, and yes, we sell lower-priced courses to help with your coding and higher priced, but we also have a lot of FREE resources from our YouTube channel, to […]

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Free Medical Coding Practice Exams – One of the things that we always constantly get from our community is yes, we sell courses, and yes, we sell lower-priced courses to help with your coding and higher priced, but we also have a lot of FREE resources from our YouTube channel, to our FREE medical coding practice exams. Maybe Chandra and Alicia, you could talk a little bit about these practice exams and this link here at the bottom, everything that’s there, if you want to click on that. Basically, we got Free Medical Coding Practice Exams, we’ve got Free Reports & Handouts, we got Free Job Aid Tools, and this is all that I could fit on this slide, there’s more; so go ahead, Alicia.

Alicia: I was just going to mention that someone I noticed in the chat said something about the modifier tool, they had said, and that’s there. You can get it here. Chandra, I’ll let her say a few things while I click on this link and see if we can get that to open up.

VIDEO: Free Medical Coding Practice Exams – CPC Practice Exam

 

Chandra: I just put the link on the chat, directly to the page that lists all the opportunistic infections for HIV because we were getting that question a whole lot in the chat questions. So, if you’re looking for that, make sure you look at that group chat that I just put up; you can pull that link down.

Alicia: I would say by and large, the Free CPC Practice Exam is one of the things that is often asked for. That’s part of our proven process. You take a course and you take as many practice exams as you can get your hands on and by and large they’re not too expensive, but people can get nickel and dimed as well. So, we have got some free practice exams not only just for the CPC but…

Free Medical Coding Practice Exams – CPC Practice Exam and MoreChandra: Another one for the COC, and we have ICD-10 practice exam. We’ve got several others that are in the works, so we try and get them out and coming out as soon as we can for some of the more common credentials that we are seeing people sign up for. So, if we don’t have one now that doesn’t mean we won’t ever have one, that means we’re working diligently and we’re working it out. Poor Ruth and Sylvia and all our people that help us create this content, validate content, and all of that.

Alicia: Like Chandra said, to validate it too, because it’s one thing to have them written but it’s another one for all of us to go back and put our two cents in. I know Chandra was working on the CRC one and showed that to some friends last week and several people said, “You’re just mean.” [Laughs] But really, truly, it’s the guidelines that you need to know these guidelines. For these practice exams, it’s not that they’re trying to be tricky and everything, and if you’re exposed to it, you’ll remember it. That’s what I like to say.

Free Handouts & Reports, lots of good stuff. The Job Tools articles, we want to be your subject matter experts; so therefore we want to have some articles that are pertinent to your needs. This is always helpful when you let us know what you need.

Boyd: We also have a phone number, can call us if they get stuck sometimes as I understand it. Do you want to talk about that, Alicia, a little bit?

Free Medical Coding Practice Exams - CPC Practice Exam and More!Alicia: Let’s go the main CCO page here. Kudos to Jesus and Boyd who made it so easy to navigate, I think that’s really helpful. Right here, this little chat question right here will be a good place for you to ask individual questions about a particular course. Sometimes I’m on live, but I’ll get a ticket on it, I can answer a question for you. That phone number that Boyd was mentioning… If there’s something you know that’s on the CCO website, but you weren’t able to find it, right here is a search bar where you can go in and put like, “free exam” or “ICD-10 manual.”

Right there, there’s the 800 number; (877) 225-0713 and will get a hold of somebody. You’ll get a live person, but if they’re not able to answer your question, it will go to one of us and we will get back with you right away. You don’t have to worry about keep leaving messages and messages, somebody is going to answer the phone for you live. Anyway, go back to our slides because I think it’s really close to my turn.

Boyd: It is!

Related Free Medical Coding Practice Exams Posts:

Free Medical Coding Practice Exams – CPC Practice Exam and More!

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CRC Pre Employment Questions | CRC Coding Tips http://www.cco.us/crc-pre-employment-questions-crc-coding-tips/ http://www.cco.us/crc-pre-employment-questions-crc-coding-tips/#respond Mon, 22 Aug 2016 10:26:47 +0000 http://www.cco.us/?p=27996 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

Q: CRC Pre employment Questions – “What is a good example of a CRC pre-employment question? What are employers looking for?” A: CKD Stage V requiring dialysis, AV fistula patent. This is what you need to know, you break this down really quickly. These are things that you need to […]

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Q: CRC Pre employment Questions – “What is a good example of a CRC pre-employment question? What are employers looking for?”

A: CKD Stage V requiring dialysis, AV fistula patent. This is what you need to know, you break this down really quickly. These are things that you need to have memorized and I’m really good about telling you. You just need to be aware of this or this is what you need to have memorized. If you’re at this point where you’re taking a CRC pre-employment exam, then you need to have this stuff memorized. You need to know CKD as chronic kidney disease; that there is more than one stage of CKD, 1 – 5.

Dialysis is treatment for CKD, AV is arteriovenous, a fistula is access point. When you see AV fistula that means that they have been set up to get dialysis, it’s literally where they plug you in. To get your dialysis patent, it just means, that’s how they’re saying that everything is fine with the fistula in the arm and that it’s stable. It’s open and unobstructed is the definition, but again it looks good. You have to know that, memorized, and again you probably do.

Let’s break down some differences between stage 4 CKD and stage 5 CKD. You don’t need to know the numbers and the lab work and stuff that differentiates between 4 and 5, you just need to know that there is lab work and numbers that will take you from stage 4 CKD to stage 5. You’re not a clinician, you’re not a provider, you don’t have to have that memorized, you just need to know the difference.

VIDEO: CRC Pre Employment Questions | CRC Coding Tips

CKD 4 is you really got a problem with the reduced kidney function, it’s classified as severely reduced. Then, CKD 5 is very severely reduced. Like, “OK, that’s so similar,” but stage 5 is a little different because you’re going to see end stage or ESRF or ESRD (end stage renal disease). That is going to pop up and be a part of stage 5; we’re moving into end stage renal disease if we’re not already there. So, be aware of that.

1-4 that’s compromised kidney function. By the time you get to 5, you’re looking at ESRD. Also, the reason you need to know this, is because you need to understand the disease process. With risk adjustment, you’re looking at a year’s worth of documentation, so if you’re working with a person that starts the year out with CKD4 then their lab works, they’re changing their diagnosis with 5, and then you can probably expect, “Hey, we’ve got end stage renal disease in the future, possibly this year.” So, you’re constantly thinking the disease process.

Again, you don’t need to have these codes memorized; however, knowing that CKD 5 is N18.5, but there’s an Includes [note] with that. This is where they can get you. You need to be aware that when you’re dealing with CKD5 that if the CKD5 requires dialysis, it jumps and now it’s N18.6. The codes change. If you’re not aware of that, then you’re going to put down the wrong code and then you’re probably going to have the wrong HCC, etc., etc.

CRC Pre Employment Questions | CRC Coding Tips - Certification Coaching OrgIf you are coding then N18.6, which is end-stage renal disease, because our CKD 5 patient is on dialysis, then you also need to be aware of the Z code, Z99.2 for a status code for dialysis. Very important. So, we’re looking at what codes now? Again, Z99.2, dialysis, there’s a whole list of status codes that you’re going to be very familiar with when you’re doing risk adjustment course.

In fact, we just talked about this on our Wednesday night Student Support Call on all of these status codes that are commonly overlooked, that risk adjusts. Z99.2 is one. So, you always want to be familiar with any type of Excludes that go with that. I threw this in as well because if your patient is not just CKD – this particular one isn’t – that they may have hypertensive chronic kidney disease. That changes the coding because there’s a causal relationship between hypertension and CKD. This one isn’t applicable for the scenario but be aware of that. That’s one of those things you need to have memorized.

I12.0 would be hypertensive CKD stage 5 and then again you would be doing the N18.5 or N18.6; if they were stage 5 chronic kidney disease, hypertensive, and they were getting dialysis, it would be N18.6 because we were just told that a CKD 5 on dialysis makes them an N18.6, the ESRD. The rationale that we give you with this particular scenario is how you look up the codes because you’re looking them up, from scratch I like to say, so you’re going to the Index. Unlike when you’re testing, you’re not really going to the Index, you’re focusing on the Tabular that give you the choices.

Pre-employment exams, real world coding, you live by the Index and you always reference the Tabular. You’re going to look under Disease, Kidney, Chronic, Stage 5; but the Tabular list includes the Excludes 1. Now, under the N18.5 saying that you have to go to the N18.6 if they are on dialysis, and then the additional code is mentioned in there. The way it’s defined, the Z99.2, dependence on renal dialysis; so you look back at that and you say, “Well, do I need to code for the fistula?” because that’s the thing. You don’t have to code for a fistula because they’re on dialysis. When you look at the description, it tells you Z99.2 dependence on renal dialysis, but the fistula is surgically created for dialysis. That’s all put in there with that Z99.2, so don’t be adding another code regarding the patient having a fistula.

Just wrapping up, I wanted to show you what those AV fistulas look like and where they’re at in the arm, because if you have a patient, the documentation was AV fistula, it’s going to be mentioned mostly likely more than once. But definitely when he does a review of the body systems and stuff, it will be mentioned, and that’s a heads-up, “Hey! He’s probably on dialysis,” we get to put that Z99.2.

Chandra, did you want to add something on there because I went through that pretty fast.

Chandra: People are really excited that you cover this in the chat, Alicia. People that are studying for their CPC and their COC are going, “Hey, this makes this come together for me, from a diagnosis’ standpoint not just for risk adjustment, which is great.” I will point out all of the answers that we went through here is an ICD-10. For the pre-employment exam that we developed, we give you an answer key for both I9 and for I10 so depending on which employers you’re looking at.

Somebody else asked, “What are most employers using?” Many employers are testing you on both right now. Just because they’re wrapping up I9 and starting I10, and last year was a mix, so they’re actually testing on both. But what I wanted to go back to here was two things: One, somebody asked, if you’re using N18.6, the end stage renal disease, and we know by definition that they have to be on dialysis to use that code.

Why do I need the Z99.2? That’s a great question, most people would say because the Tabular tells you, you have to under N18.6. It says you need that code so you better put it on there.

CRC Pre Employment Questions | CRC Coding Tips - Certification Coaching OrgAlicia: Actually, use additional code.

Chandra: If you scroll up Alicia to where you have the Z99.2 and it lists those excludes notes, this is where I’m going to explain why we have to have that code.

We use the N18.6 to say that the patient has end stage renal disease, or they have stage 5 kidney disease requiring dialysis. It means if they don’t have dialysis, things are going to go from bad to worse pretty quickly.

I’m just reminding you this code comes into use with the N18.6; so you have N18.6 to say they have the end stage renal disease. Then you have the Z99.2 to say they’re dependent on renal dialysis. If you noticed under the Excludes 1 note there’s actually two exceptions where this code would not be the appropriate one to use with N18.6.

It was funny because somebody asked this question really early in the chat before we ever got to this question today, so I was excited about this. If the patient is coming in for that fitting and adjustment of their catheter, yeah they may be dependent on renal dialysis, but that’s not why you’re seeing them today. That’s not related to the N18.6. Instead, today, yeah they still haven’t have end stage renal disease, we need that in N18.6, but instead we want to code first, the whole reason they’re here is for us to pay attention to that dialysis catheter. We got to change something with it, we’ve got to fit it, we’ve got to adjust it, we’ve got to move something, something is not working right. That’s where we would use this [that is, Z49.0-] in front of the N18.6 and the Z99.2 wouldn’t be on there at all because they’re not just dependent on it, they’re not just coming in for dialysis, we had to do something.

The noncompliance code, the Z91.15 is another code that we could use in combination with N18.6, because in N18.6 says they have end stage renal disease or stage 5 kidney disease requiring dialysis. But if they’re not doing the dialysis, we wouldn’t want to use Z99.2, they’re not complying with what they need and instead we would use the Z91.15 to say, “Oh, they need it but they’re not having it done,” and that flags a number of things with the insurance carrier.

Is there anything I left out?

Alicia: No. But that is an interesting thing to just know as far as the disease process, too. One thing is that in our student call last night we had a scenario with the HIV patient who was an N18.4 or 5, I can’t remember, but he had AV fistula but he hadn’t started dialysis yet so you don’t get tripped up just because they have a fistula and it stated twice in the documentation that he had not started dialysis and that they were wanting him to. So, you can’t use Z99.2, he had not started it.

On the disease process side, noncompliance was renal dialysis. I’ve had patients as well as encounters where the people have decided to stop dialysis for various reasons, it’s not an easy thing to do. Usually, when they’ve been on dialysis and they choose to stop dialysis we’re talking 5 to 7 days left for them, but it’s pertinent that that would be considered noncompliance with renal dialysis. They’re not status Z99.2 anymore, they’re now a Z91.15. Like Chandra said, that changes the payer perspective, that changes a lot of scenarios, so you want to be very careful to pick up on the documentation.

This overall, as explaining this and these little nuances, that really is what makes the person who is a coder, I think really go into that next advanced level to where they’re starting to specialize in something. You need to be aware of these little nuances, that’s what makes you a great coder.

CRC Pre Employment Questions | CRC Coding Tips - Certification Coaching OrgChandra: The only other thing I want to say is somebody in the chat asked, “I understand all of that, but Z49.01 “which is one of the encounter for fitting and adjustment of the catheter, it’s specifically for extracorporeal dialysis “why would they not code that with the dependence on renal dialysis?” The answer to that is because that Z49.01 by definition, you’re not going to have a dialysis catheter if you’re not on dialysis. It’s not the same thing as AV fistula. This is, we’re cleaning the actual catheter that they have, so there’s no need. The Z99.2 in that case would be redundant. It’s kind of included or bundled into that encounter for fitting and adjustment.

Alicia: That gets confusing especially when you’re new to coding. It’s like, some stuff, seems redundant, why are you making me code it? Then, other times it’s how do I know it’s bundled in? Part of that ends up because you understand the disease process, understand why they would do that. Why do they need those two codes to explain it versus with this one code it explains everything. So, that comes with practice and understanding the disease process.

Just keep in mind too there’s more than one type of dialysis, and so as you go and do your studying about dialysis, if you’re not familiar with how it’s done, one is they go through the arm, another is they do it into the abdomen. Little heads up, do some investigating and increase your knowledge based on that.

Related CRC Pre Employment Questions Posts:

CRC Pre Employment Questions | CRC Coding Tips - Certification Coaching Org

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August 2016 CCO Graduates and CPC Exam Passers – Week 1 http://www.cco.us/august-cco-graduates-cpc-exam-passers/ http://www.cco.us/august-cco-graduates-cpc-exam-passers/#comments Fri, 19 Aug 2016 08:49:54 +0000 http://www.cco.us/?p=27939 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

 “All our dreams can come true, if we have the courage to pursue them.”  — Walt Disney Congratulations to our new CCO graduates who are among the 2016 COC, CRC, CPB and CPC Exam Passers. Wohooooo!!! What a proud day. You did it! We just couldn’t be happier for you! You deserve […]

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August 2016 CCO Graduates and CPC Exam Passers - Week 1

 All our dreams can come true, if we have the courage to pursue them.” 

— Walt Disney

Congratulations to our new CCO graduates who are among the 2016 COC, CRC, CPB and CPC Exam Passers. Wohooooo!!! What a proud day. You did it! We just couldn’t be happier for you! You deserve the name what you earn with your talent; you deserve the joy, what you achieve from your hard work. I’m sure today will be only the first of many proud, successful moments for you. Don’t give up in your dreams, even not for a moment and go ahead always to climb the highs of success. All the best and huge congratulations, graduates. BIG THUMBS UP to:

  • Marquette Johnson Green CPC 07/16/2016 Using CPC Blitz

  • Dave Tidwell CPC 06/04/2016 Using CPC Blitz

  • Mary Yabut CPC 07/23/2016 Using CPC Course (PBC)

  • Susan Bonenfant CPC 07/23/2016 Using PBC Course, Practice Exams

  • Denise Hess CRC 08/01/2016 Using CRC Blitz, CPC Blitz, Practice Exams

  • Jeanette Springer COC 09/12/2015 Using COC Blitz

  • Terrance Parmegiani CPC 07/16/2016 Using CPC Blitz, Practice Exams

  • Denise Frazier CPC 07/29/2016 Using CPC Blitz, Practice Exams

  • Melanie Bleem CPB 08/06/2016 Using CPB Course, Practice Exams

  • Kathy Maloney CPC 08/10/2016 Using CPC Blitz, Practice Exams

  • Justin Bustamante CPC 08/06/2016 Using CPC Blitz, Practice Exams

  • Sharon Andersen CRC 08/06/2016 Using CRC Blitz

Related August 2016 CCO Graduates and Exam Passers:

 

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CCO BHAT™ System for Medical Coding Manuals http://www.cco.us/cco-bhat-system-medical-coding-manuals/ http://www.cco.us/cco-bhat-system-medical-coding-manuals/#comments Wed, 17 Aug 2016 10:57:23 +0000 http://www.cco.us/?p=27929 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

CCO BHAT™ System with Barbara Chippini Boyd:  Hi everybody. This is Boyd here at CCO.us along with our fellow medical coder, Barbara Chippini, CPC, CCS. Hello, Barbara. How are you today? Barbara: I am fine. Hello. How are you? Boyd: I’m excellent because I’m talking to you and we’re talking about […]

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CCO BHAT™ System with Barbara Chippini

Boyd:  Hi everybody. This is Boyd here at CCO.us along with our fellow medical coder, Barbara Chippini, CPC, CCS. Hello, Barbara. How are you today?

Barbara: I am fine. Hello. How are you?

Boyd: I’m excellent because I’m talking to you and we’re talking about the Bubble and Highlighting Technique which is now transformed into the BHAT Technique. So we’re interviewing you today to ask you a little bit about how you got started with this because I understand you’re one of the original people who heard about this technique back in 2000. Can you tell us a little bit about your first time hearing about bubbling and highlighting?

Barbara: First time bubbling and highlighting, I took a course taught by Laureen when her school was called A+ Medical Education [?] back in 2000. I have my original CPT Manual here. I couldn’t get rid of it. It’s what got me into coding and –

Boyd: Unique because it’s a three-ring binder, the last time that it was actually done.

VIDEO: CCO BHAT™ System for Medical Coding Manuals

Barbara: Well, it is. Many people will not notice this. This is a three-ring binder. It is the last time they published it in that and I kept it. I also kept it to see how CPT has grown and how many pages this book was and how thick it is now for all the new coders, and to see all the changes. There are things in 2000 that are no longer done now.

Boyd: So what did it look like back then? Has it changed that much since then, the whole technique?

Barbara: Certain rules and guidelines have changed, but a lot of the things, the basic structure has stayed the same. The surgery section and we would… Laureen would teach us to highlight and bubble, and highlight certain sections. I’m hoping that you can see this. These are circles that are around like codes and inside each bubble we would put a note that is specific just for that area, that bubble, and we would go through the entire section and just put the like codes. And it would help us keep focused when we were taking the board exam or that was the instruction back in the day. It was very time-consuming. I hated it as a student. I didn’t think that it would make much sense.

But after taking the CPC exam, I found that this was one of the most beneficial things that I could spend my time on.

What we would do is each week, Laureen would teach us a different section. So part of our homework was bubble and highlight, so that we were ready for her instructions so we could put the notes that pertained to each bubble to get ready for the board exam. So over the years, I taught for Laureen. And since 2001, I’ve been bubbling and highlighting her book for all of her classes. And I also bubble and highlight for myself because I find it still assists me in my day-to-day work as an auditor when auditing outpatient claims. That I can go to my old books, see in the past years what was bubbled, what the notes were; then go to this year, see what’s changed, change the notes. But also to keep those and also I can lend them out to my fellow auditors.

If they’ve never worked, say, in the nervous system and they’re auditing outpatient claims or physician claims in the nervous system, maybe they only did office work E/M codes. But now they’re in the auditing world, I say, “Well, here’s the nervous section and here’s the set of codes and these were the rules back two years ago. So you’re going to be doing all the 2014 claims, you’re going to need these. And you’re doing 2015, so they changed, so here’s my copy of my book for this year.”

So it’s a method that’s tried and true since the year 2000, since we started doing it. And like I said, we do it every year going forward and we’re… it’s 2016, you do the math.

Boyd: We won’t go there.

CPT Manual Bubble and Highlighting Technique Explained - CCO BHAT™ System for Medical Coding ManualsBarbara: It doesn’t seem that long and when Laureen told me that they were now, you know, calling it “the BHAT cave” and did I have anything or would I be interviewed for it and I said, “I’ve got one for you. I have the original CPT 2000 Manual from back in the day.”

Boyd: Awesome. Well, thank you for keeping that in your archives, your personal archives. Not a lot of people will go through that, so we really appreciate that.

Barbara: Some people keep their first reader.

Boyd: Right. I know I have some music books that I do that with, so I fully understand that. Now, obviously you said that you would teach this to other students through the years, this technique. Can you tell a little bit about what the student aspect of that, the reaction of learning this technique and how they kind of deal with that?

Barbara: Sure. Again, it was quite like mine. They thought that is so time-consuming. Many of the students have full-time jobs and they’re trying to fit this in because it was one night a week. It was taught over 20 weeks, every week would be a different section of CPT and then the ICD-9 and the HCPCS thrown in there. So it was 20 weeks, each week they had to do this. But as I would say to them, the bubbling and the highlighting, you could really do on your downtime. I did it on the train going to Philadelphia when I went to work. So that part, you really didn’t need to focus on as much. It was just circling the like codes, highlighting the differences in the like codes from the parent code above. You didn’t really need to be reading it. You just needed to be able to eye where it was indented, find the semicolon, highlight, highlight, highlight, circle. What I would tell everyone, circle it first, then go through and highlight it.

And like I said, I would do it on the train every year when I would do Laureen’s new book and my new book. Sit there on the train an hour and a half to Philadelphia, an hour and a half home – highlight, highlight, highlight, circle, circle, circle, circle. And then when we were ready to teach it, it was done and the students could put their notes in it or I could when I was done bubbling and highlighting the two books, then sit down and focus a few nights a week, and get hers ready and mine ready for teaching, transfer all the notes. That, you really needed to pay attention to. But the bubbling and highlighting was time-consuming. But each one of my students after taking the board exam – and Laureen could probably say the same thing – when I asked them what they would find the most useful or helpful in the class so we could expand next year, they said, “You know, that darn bubbling and highlighting, I hated it but it kept my focused on board exam and I didn’t get scattered. I could stay focused into ‘It’s not this bubble, I need to be over here because this bubble says this and this note says this is where I need to be.’”

Boyd: And my understanding is that it’s not just useful for the board exam, can you tell us a little bit about your own experience and also of your students, of people who have used this technique to go out into the coding world and use it in their own work?

CCO BHAT™ System for Medical Coding Manuals Barbara: Sure. Like I said, in the coding exam you have to learn a smattering of all, but most of the time you’re in a specialty. So if you’re in cardio and you’re a new coder there, you can go to the cardio section and you would have different bubbles. So if I try to find them here, different bubble sections like I think everybody knows somebody who has had a heart attack and maybe has had a cardiac catheterization. So you could go to the cardiac catheterization section and there are several different bubbles within that cardiac section. So, you would need to know if you had a cardiac cath, you need to be here. But if they do something else with it, we would have a note directing you to come over here and pick up this piece. But then if they did something else, there’s a note to come back over here because if they put a stent then you need to be over here. So they’re not all together. So by bubbling and highlighting them, you could figure out where you needed to be. You could say, “Okay, I’m picking up a code from here but I need to come all the way back here 3 or 4 pages behind to get the piece that was missing.”

So in my day-to-day work, I still use that technique and go back and I say, “Okay, this person had this done. The radiology piece is going to come from radiology, the surgery piece is going to come from cardio but my diagnostic part is going to come from medicine.” So I can put them all together and the notating directs you back to it. Sometimes you’ll have a code in the beginning of the book and it says “code also with,” but it’s 3 or 4 sections later.

Boyd: Yeah.

Barbara: So you put a note in this bubble “don’t forget to go to path and lab and add this one” or “don’t forget to go to radiology because there’s an intervention being done there but the surgery piece is over here.”

Boyd: And for the students who are looking at this or potential students that we have now being introduced to the BHAT Technique for the first time, what Barbara has just gone over is now available in our BHAT cave, as we’re calling it, to learn how to do this on your own. Let me see if I got them all straight now. We’ve got the CPT Manual, we’ve got our ICD-10 Manual. I think we have some more that we’re working on right now that it’s on these pages or you’re probably watching it. So that it’s not just for the CPC exam but it’s really across the board now that we’re expanding and using the BHAT Technique. And available in our BHAT membership through CCO –

Barbara: In the BHAT cave.

Boyd: Yeah, in the BHAT cave.

Barbara: Yeah, in the BHAT cave. And it’s great that it’s expanding now into ICD-10 and also in the HCPCS. It was something that we had originally done in CPT but it helps them focus when you’re taking any one of your board exams, your CPC or your CCS. You have questions in all three of those books.

Boyd: Right.

Barbara: That can be applied across the board.

Boyd: Well, thank you for spending time with us. I don’t want to keep you here too much longer. So, thank you, Barbara for sharing your experience using the Bubble and Highlighting Technique, and now the BHAT Technique 

Barbara: The BHAT Technique, love it.

Boyd: In the BHAT cave. So, thank you again for joining us here at CCO.us.

Barbara: You’re welcome. Thanks for having me.

Related CCO BHAT™ System for Medical Coding Manuals Posts:

CCO BHAT System for Medical Coding Manuals-Laureen-Jandroep

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RA Course Pearl GERD | Risk Adjustment Coding (CRC) Tips http://www.cco.us/ra-course-pearl-gerd-risk-adjustment/ http://www.cco.us/ra-course-pearl-gerd-risk-adjustment/#respond Mon, 15 Aug 2016 08:47:02 +0000 http://www.cco.us/?p=27908 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

VIDEO: RA Course Pearl GERD | Risk Adjustment Coding (CRC) Tips Alicia: RA Course Pearl GERD – The Pearl that Chandra mentioned, one that I had worked on was GERD, and I like to think of them as little pearls of wisdom. Let me just show you an overview of what it […]

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VIDEO: RA Course Pearl GERD | Risk Adjustment Coding (CRC) Tips

Alicia: RA Course Pearl GERD – The Pearl that Chandra mentioned, one that I had worked on was GERD, and I like to think of them as little pearls of wisdom. Let me just show you an overview of what it looks like. We don’t have to go into depth with it; I don’t need to read it. We’ll just give you a scan, a little clip here, and then we can wrap up.

Boyd: This is an example of something that’s in the course.

Alicia: Right. In the Pearls, there’s going to be like 20-plus Pearls right now, they’ll be expanded. Anything that risk adjusts, that’s a chronic condition, we intend to have a Pearl or a tool for you to go to.

This particular one was under GERD, but it also covers esophagitis, Barrett’s esophagus. It gives you the definition of GERD, esophageal reflux. You also get – I’m really into pictures, I’m a visual learner – we put that in there with the description.

Chandra: If you’re squeamish, you might want to look away for a few minutes while she scrolls.

Alicia: These aren’t bad in my opinion, but… The disease process and stuff, we also let you know what are the symptoms that you’re going to be reading about when you are doing the risk adjustment? You got to be able to draw lines.

Differential diagnosis – Barrett’s esophagus, when the stomach lining is changing the cell structure and going up into the esophagus, little things like that that will make you a better coder. There’s also some other types of esophagitis complications.

Similar diagnoses that may risk adjust – again, the anatomy, you got to know the anatomy of the whole digestive tract to really understand even something like GERD. The medications – common medications that are used for each of these – histamine blockers, proton pump inhibitors. Not only telling you what they are, but what they do. ICD-10 guidelines that are around this particular diagnosis or these diagnoses, we give you ICD-9 and ICD-10.

Chandra made these great graphs, she’s so good at these, that really helps you get through the guidelines and narrow down quickly. Then, down here at the bottom also, she has added through the 9, but also Coding Clinic References that may be applicable for you to know something that changes, a nuance, in a case.

Again, that is, I think we said about 8 pages of information that will really make these chronic conditions pop for you. You don’t have to have this stuff memorized because you can always reference it, but if you go through and you read these, it will make you a better diagnosis coder with these chronic conditions. Again, when you’re doing risk adjustment, you have to be able to draw a line. They can’t just say the patient has GERD, you have to be able to show that it’s current and that it’s being treated, and that could be a medication or him addressing the signs and the symptoms, and so on.

That’s a brief overview of what one of our Pearls look like. Again, we have 20-plus in the course and it will continue to grow just constantly. We’re constantly adding content.

Chandra: Can I add real quick, we got a lot of questions about: “Do I really need to know ICD-9 for risk adjustment?” Risk adjustment is based on a retrospective review forecasting for next year; so yes, the carriers are all collecting data from 2015 right now to justify their 2016 payment. Remember, we didn’t go to ICD-10 until October; so the first nine months of last year were all based on ICD-9 data. Most risk adjustment plans are still doing ICD-9 coding and review and require that their coders use and understand ICD-9 as well as ICD-10.

Related RA Course Pearl GERD Posts:

RA Course Pearl GERD | Risk Adjustment Coding Tips

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CRC Practice Exam Question | CRC Exam Work-through http://www.cco.us/crc-practice-exam-question-crc-exam/ http://www.cco.us/crc-practice-exam-question-crc-exam/#respond Fri, 12 Aug 2016 10:16:42 +0000 http://www.cco.us/?p=27745 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

Q: CRC Practice Exam Question – “What does a CRC Practice Exam Question look like? How do we work through an exam question? CRC Practice Exam Question: Mrs. White is diagnosed with acute combined systolic congestive and diastolic congestive heart failure which is due to hypertension with stage 5 chronic […]

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Q: CRC Practice Exam Question – “What does a CRC Practice Exam Question look like? How do we work through an exam question?

CRC Practice Exam Question:

Mrs. White is diagnosed with acute combined systolic congestive and diastolic congestive heart failure which is due to hypertension with stage 5 chronic kidney disease. What ICD-10-CM code(s) are we going to code for this particular scenario?

A. I50.42, I13.2, N18.5, Z99.2

B. I13.2, I50.41, N18.5

C. I13.2, I50.43, N18.5, Z99.2

D. I50.43, I13.2, N18.5

Alicia: Now, these are the things that jumped out at me. When it’s a crc practice exam or any practice exam, unlike a pre-employment exam, it’s going to be multiple choice, so they’re giving you the codes. And I like to say they know you know how to look up the codes, that’s really not the hard part, but can you pick the proper codes following the guidelines, get them in the right order, that’s a little different.

VIDEO: CRC Practice Exam Questions | CRC Practice Exam Work-through

The things that jumped out at this particular scenario is that we have something that’s acute; acute is a red flag term. The fact that the person has systolic and diastolic heart failure, congestive heart failure, that should be a red flag that there is a code for systolic congestive heart failure, and there’s a code for diastolic congestive heart failure; is there a code for a combined? Maybe.

Whenever you see the term “due to” – bam! Red flag should be going all over the place because that is pertinent; there is a causal relationship there. Now, hypertension, we have a heart disorder going on with hypertension but then they threw in CKD and with ICD-10, you probably already know that there is a causal relationship between hypertension and CKD, so there’s all kinds of things going on with this scenario. Again, it’s short and sweet; however, that one mistake can trip you up.

Here are our choices, we’re going to eyeball those choices for just a second, look at them and I’m going to tell you what my thought process is when I just look at these codes without looking them up yet in the Tabular. Again, four choices, kind of eyeballing them. Now, let’s scroll down here and let’s see how my brain thinks.

The first thing I noticed is that N18.5 is all the same, so that tells me that that’s a code I don’t need to look up. I don’t need to pay attention to that code right now, it’s going to be the same on every single choice. Now, some people choose to draw a line through it, so their brain doesn’t keep looking at it, that’s fine. But my eye automatically jumps to the Z99.2. I could rule out two of these really quickly if I look up Z99.2 to see if it’s applicable.

Are we going to be able to throw out “A” and “C” right away? That’s one thing that we’ve gotten down to two choices, so we’ve already saved a lot of time. Then, the next thing I’m going to look up is, Hey! Each one of this has I13.2, but I’m not going to draw a line through them like I did with N18.5 because the sequencing is different. That’s pertinent. That tells me that they obviously want me to know do I understand the sequencing between these codes. Then, the code that’s probably going to summate and give us the formal answer is the I50.42 and you notice that we have different characters after the point, so we got 43, 43, 41 and 42.

CRC Practice Exam Questions - CRC Exam LayoutLet’s see if we can narrow this down. Now, if you’ve done a lot of diagnosis coding and you’re family with your ICD-10 manual, you don’t have to have these codes memorized. Sometimes, you will; but let’s break down where they’re found in the manuals though. N codes tend to be revolving around the genitourinary, think of “n” for “nephrology”, kidneys; so without even looking this up, I’m going to assume this is the CKD code. And, the fact that it ends in 5, I just happen to know – make a note of this – that stage 1 ends in 1; stage 2, 2; 3, etc. So, I’m going to say this is a CKD [Stage] 5.

Then, Z codes, I happen to know are things that kind of help explain what’s going on in the scenario. Chandra mentioned it earlier about the Z code that she was talking about. When I go back and I look up there, I’m thinking, “Huh! I don’t see anything that flashes Z code to me,” because I’m thinking probably a status code. Without looking this up or if I look this up, I’m going to assume that it’s a status code, and to be quite honest, it is a status code. Z99.2 is for dialysis. Our patient, it’s not stated that they’re on dialysis.

Right there, I have knocked out “A” and “C.” So, you would look it up, you wouldn’t just know that Z99.2 is status dialysis. But when you did, you would say, “Well, this patient isn’t on dialysis, we’re going to knock out “A” and we’re going to knock out “C” right there, so now we’re down to “B” and “D.” Now, I13.2 is in a different sequence on each of those so I need to look up that code and see if there are any sequencing guidelines that are related to that, and then we also are given two separate choices .41 and .43 for the I50 code.

Now, backing up a little bit, I codes, if you remember probably the first ICD-10 code that you learned or memorized was I10 for hypertension. The way that I remember that all these little cardiology codes tend to be right there is because I think of the word “ischemia.” Let’s see, let’s run real quick through my thought process, Z99.2 status code allowed us to knock out “A” and “C.”

N18.5 don’t necessarily need to look it up because it’s already on every single choice and then the same location so I don’t have to worry about that, it just happens to be for CKD 5. And codes that are I codes tend to be cardiology codes and the I13.2 is in every choice, so now I just need to know the guidelines that surround these two codes. I’m going to go ahead and let you look at that.

Now, we actually talked about this – Laureen, Chandra and I – the other day about when you’re bubbling and highlighting or what you’re doing while you’re taking a test, some people have said highlighting is something that they like to do, have multiple highlighting colors and you can get one little highlighter that have several colors. Laureen had said just keep all the caps off, and know that by the end of the time you’re taking your test, you’re going to have to throw it away because it would be all dried out. You can do that.

I am really driven towards visual and color association, but that confuses me for the testing process. You got to be pretty good and it can be a time taker; so I tend to use circles and squares and other things with a pencil, you need to develop what works best for you and you do that by taking practice exams.

CRC Practice Exam Questions - CRC Exam Layout - Certification Coaching OrgLet’s scroll down and see do we know what the right answer is. Now, I could tell you what I think these codes are, but I’m not going to do that, I’m going to go and look at the answer because that is a practice exam. Now, let’s look at the rationale or the explanation that we give you that goes with our practice exams and you would get this explanation whether you got it correct, or you got it wrong because even if you miss it, sometimes that’s the best learning process because you’re going to remember it, like, “Oh! That’s what I didn’t get.”

The keywords I already said was a specified type of CHF (that was a pertinent thing), hypertension with stage 5 CKD. The rationale here, and I’ll tell where the little tricky part is because actually I looked at this one and I tried to eyeball it and do it without looking up in the Index or anything, I would just say, “I pick this one.” I don’t want to say Chandra caught me but when I read the rationales, like, “Oh! I think I would have missed that one,” because I would have jumped to a conclusion.

You’re going to first look up: failure/heart/diastolic (congestive), and then when you get there, there is a choice for combined and congestive systolic and diastolic and acute is always the right term, and that’s going to give you I50.41. That’s the proper code. Then, when you look at the Tabular, it’s going to tell you – this is the key – that I50 which states to code first the heart failure due to hypertension with CKD, which is the I13 code.

That’s the tricky part. If you don’t catch this, then your sequencing is going to be wrong. That question was specifically written to see all those other things, but do you know the sequencing, do you know to read the guidelines that tell you which code goes first? Then, when you check in the Tabular, it tells you to do (.2) for the hypertension and the stage 5 chronic kidney disease.

Then, you go on down, we did the N18.5; so ultimately our code, the correct answer is I13.2, I50.41, the chronic kidney code, and the Z99.2 is not used because the patient is not on dialysis.

Now, before I stop talking here, I just want to give you a heads-up, do a little study on N18.5 because there are times that an N18.5 is on dialysis and that changes the dynamics of some coding. Going back real quick, the answer was “B.” Let’s look again at how this was divided up and kind of the way this is the way my brain works, but you don’t have to have codes memorized, you don’t even have to necessarily know what letter starts which area, but as you get familiar, as you make your annotations in your ICD-10 manual and you go through the chapters in the course, this is going to resonate with you and it’s going to pop in your brain.

Never assume anything; don’t ever go so fast, which is a big fault of mine both assuming and going too fast, that you could slip up and make a mistake. So, I’m not saying run through that quick; however, take the time to break it down before you even have looked up a code and then get an idea of what do they want to make sure I know, and then confirm it. Look everything up in the Tabular, don’t guess, ever.

There you go, that is what a CRC practice exam question looks like. Now mind you, this is only the coding aspect. The CRC has so much more than just coding, in fact, it really doesn’t have a whole lot of coding in my opinion. But this is what one would look like. In our risk adjustment live student calls every Wednesday night that we do for our full students, we go through these and break these down and we’ll take specific exam questions every week that involve not just the coding. Isn’t that fun? I know that you’re as excited as I am when you see something like that, but the Blitz is what’s going to help you learn how to break down exam questions like this and make them pop.

Chandra: Can I jump in there? I just wanted to jump in on some of the conversation I’ve been having on the chat while you’ve been explaining everything to everybody. A couple of questions that I just wanted to clarify for the whole group because it seems like lots of people have these questions.

The first question that we got is: What does CRC stand for?

That is the Certified Risk Adjustment Coder. These practice exams that Alicia is talking about are practice exam questions. There are two practice exams that we have in development; they will be coming very soon. One is a free CRC practice exam, just like we do for the CPC and the COC. The other one will be a paid version, just like we have for the CPC and the COC. [Editor’s Note: Chandra misspoke; CCO currently does not have a Paid Version on the COC Practice Exam.]

But the question that I got was: Is there anything in the CRC Blitz that talks about how, strategies for these multiple choice questions?

Yes, there is a section of the Blitz where Laureen talks about how to take multiple choice exam, that sort of thing. But there was also a conversation that Alicia, Laureen, and some of the other instructors and I had earlier this week and something we’re excited about is we do have in the plans to have a session that we record where we show each of us taking on the same question so that you can see how differently we each think and how differently we each attack a question and you can see that there’s no wrong way or right way, it’s whatever works for you and whatever helps you get through it more quickly. That is something that we’ve gotten development, it’s coming on the way as well.

Alicia: I forgot. That’s right. That’s going to be exciting for a lot of people because, again, I think we learn differently. But things, like Chandra said, different viewpoints, you may resonate more with one person than another. Very exciting. There’s always good stuff coming from CCO, isn’t there?

Related CRC Practice Exam Question Posts:

CRC Practice Exam Questions | CRC Practice Exam Layout

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Slideshare: July 2016 Q&A Medical Coding Webinar http://www.cco.us/slideshare-july-2016-qa-medical-coding-webinar/ http://www.cco.us/slideshare-july-2016-qa-medical-coding-webinar/#respond Wed, 10 Aug 2016 10:33:05 +0000 http://www.cco.us/?p=27808 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

The July 2016 Q&A Medical Coding Webinar from Certification Coaching Org (CCO), discussed a variety of topics of interest to medical coders and billers. Topics covered included Timely Filing for Claims and Appeals, Coding for Fall on Steps with Hitting Head, Sequencing of Depression and Suicide Ideation Codes, Dependence vs. […]

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The July 2016 Q&A Medical Coding Webinar from Certification Coaching Org (CCO), discussed a variety of topics of interest to medical coders and billers. Topics covered included Timely Filing for Claims and Appeals, Coding for Fall on Steps with Hitting Head, Sequencing of Depression and Suicide Ideation Codes, Dependence vs. Severe Use Disorder, Laceration Repairs, ICD-10-PCS Coding for Measurement and Monitoring, and Nurse Visits (CPT® Code 99211). The CCO VIP opportunity and CCO’s Lunch & Learn Coding on FB Live, were also discussed. Attendees’ questions on various coding topics were answered. Educational topics were presented by Jo-Anne Sheehan, CPC, CPC-I, CPPM; Darcy Roy, CPC; Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC; Alicia Scott, CPC, CPC-I, CRC; and Laureen Jandroep, CPC, CPC-I, COC, CMSCS, CHCI, CPPM. The host for the webinar was Boyd Staszewski.

July 2016 Q&A Medical Coding Webinar

1. Certification Coaching Q&A Medical Coding Webinar July 2016

2. From the Medical Coding Community:

  • Jo-Anne Sheehan, CPC, CPC-I, CPPM CCO Sr. Instructor / Coach
  • Alicia Scott, CPC, CPC-I, CRC CCO Education Director
  • Laureen Jandroep, CPC, CPC-I, COC, CMSCS, CHCI, CPPM CCO Founder and CEO
  • Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COaaSC, CRC, CCC, CPPM CCO Program Director
  • Darcy Roy, CPC CCO Instructor Q&A

Hear and See Us Okay? Yes: Type #1 in Questions Box | No: Type #2 July 2016

3. WELCOME! First Time? Overview:

  • General webinar about all things medical certification and medical coding related.
  • Welcome to the CCO Community!
  • We can’t hear you 😉  You can ask a question in the chat: we will ATTEMPT to answer during the webinar BUT it’s not easy…
  • Stay to the end for free giveaway and CEU’s

4. First Webinar With Us? Poll How many CCO webinars have you attended?

5. July 2016 | Q&A Medical Coding Webinar Agenda: 90-120 min II: Q&A from the CCO Community I: Introduction

  • CCO News and Updates
    • JoAnne Sheehan:
      • Timely Filing for Claims and Appeals
    • Darcy Roy:
      • Coding for Fall on Steps with Hitting Head
    • Chandra Stephensen:
      • Sequencing of Depression and Suicide Ideation Codes
      • Dependence vs. Severe Use Disorder
      • Laceration Repairs
    • Alicia Scott:
      • ICD-10-PCS Coding for Measurement and Monitoring
    • Laureen Jandroep:
      • Nurse Visits (CPT® Code 99211)

6. This Month’s Q&A Medical Coding Webinar Agenda: 90-120 min IV: Your Questions in the Chat III: Close – @ 90 min-’ish’

  • Wrapup
  • Drawing
  • CEU Certificate Download Link
  • Ask Along the way in the Questions box.
  • NOTE: We can’t answer every question. IV: Your Questions in the Chat Ask Along the way in the Questions box. NOTE: We can’t answer every question. If your question isn’t selected, post it on our forum where fellow coders can help: http://www.cco.us/forum/

7. Why Stay To The End? Giveaway! Free Drawing of Your Choice of 1 of the following:

  • Blitz Video Package
  • 2 CEU Webinars
  • 1 Hour Session with Laureen or Alicia and…
  • Your AAPC CEU link for 1.5 CEUs (a change tonight)

8. CCO Graduates July Update

9. CONGRATS! CCO Courses Recent Exam Passers!

  • Brianna Kusnerz CPC 06/23/2016 Using CPC Blitz
  • Courtney Porter CPC 05/14/2016 Using CPC Blitz
  • Rosemary Cornelius CPC 06/04/2016 Using CPC Blitz
  • Joris Santiago CPC 05/07/2016 Using CPC Blitz
  • Tiffany Craft CPC 06/18/2016 Using CPC Blitz
  • Gretchen Kifer CPC 06/22/2016 Using CPC Blitz
  • Jenny Deffenbaugh CPC 06/18/2016 Using CPC Blitz
  • Shelly CPC 06/27/2016 Using CPC Blitz

10. CONGRATS! CCO Courses

  • Kimberly Werth CPC 06/18/2016 Using CPC Blitz
  • Elizabeth Denmark CPC 06/24/2016 Using CPC Blitz
  • Mitzi Doss CPC 06/18/2016 Using CPC Blitz
  • Julie Eiselt CPC 07/13/2016 Using CPC Blitz, CCO Practice Exams
  • Ambyr Wolff CPC 06/18/2016 Using CPC Blitz, Practice Exams
  • Latricia Wilds CPC 07/07/2016 Using CPC Blitz, Practice Exams
  • Joan Richards CPC 06/26/2016 Using CPC Blitz, Practice Exams
  • Kartika Budiarta CPB 06/24/2016 Using CPB Course (PBB)
  • Ruby Niner CPC 05/21/2016 Using CPC Course (PBC)

11. CONGRATS! Passed CPC Exam

  • Brianna Kusnerz CPC 06/23/2016 Using CPC Blitz
  • Courtney Porter CPC 05/14/2016 Using CPC Blitz
  • Rosemary Cornelius CPC 06/04/2016 Using CPC Blitz
  • Joris Santiago CPC 05/07/2016 Using CPC Blitz
  • Charmaine Frias CPC 03/20/2016 Using CPC Blitz
  • Tiffany Craft CPC 06/18/2016 Using CPC Blitz
  • Gretchen Kifer CPC 06/22/2016 Using CPC Blitz
  • Jenny Deffenbaugh CPC 06/18/2016 Using CPC Blitz
  • Ambyrr Wolff CPC 06/18/2016 Using CPC Blitz

12. CONGRATS! CCO Courses

  • Tonette Osby CPC 06/28/2016 Using CCO Practice Exams
  • Shibu Kuriachan CPC 07/02/2016 Using CPC Course (PBC)
  • Lisa Hilliard CPC 06/26/2016 Using CPC Course (PBC), Practice Exams
  • Akila Selvaraj CPC 07/14/2016 Using CPC Course (PBC), Practice Exams

13. Poll Poll Poll – Are You Certified?

14. Question: Please explain filing limits with insurance claim processing.  Answer Jo-Anne Sheehan, CPC, CPC-I, CPPM, COC CCO Sr. Instructor / Coach Timely Filing for Claims and Appeals

15. Introducing Darcy Roy CPC- CCO Instructor

16. Question: What (E) codes would I use for patient who fell on steps and hit head on steps? Answer Darcy Roy, CPC CCO Instructor Coding for Fall on Steps with Hitting Head

17. Testimonials and Reviews https://www.facebook.com/cco.us/reviews

18. Free Practice Exams Now Available http://www.cco.us/free-tools-reports-and-exams-for-medical-coding-and-billing/

19. Poll What AAPC coding credential do you HAVE?

20. Laceration Repairs Question: Could you do some scenarios with wound care at the next webinar? I am noticing a lot of those type questions on the CPC practice exams and am weak in that area. For example, an 11 year old girl fell from a chair and received two 3cm lacerations to her left arm with embedded glass etc. etc. face leg and arm needed layered closure wound repair and (whatever) needed superficial repair and (whatever) needed complex repair. Answer Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPPM, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC, CPPM CCO Program Director

21. Sequencing of Depression and Suicide Ideation Codes Question: I have a question about depression and suicide ideation. Should I code depression first and then suicide? Answer Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPPM, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC, CPPM CCO Program Director

22. Join Now! Limited Seats Available! Details & FREE Registration Now: http://www.cco.us/webinarvip Redeem RewardsDo Activities Get Points fun quiz social

23. Dependence vs. Severe Use Disorder Question: Can you code Dependence say for Alcohol if the provider states it as Alcohol Use Disorder-Severe? Since it does not say dependence but the provider says he is going by the DSM-V and it is dependence and they are not going to change the wording. ================ Can someone explain the smoking dependence codes? Does the physician have to document that a patient has a dependence in order to use these codes? Answer Chandra Stephenson, CPC, CIC, COC, CPB, CPCO, CPMA, CPPM, CPC-I, CCS, CANPC, CEMC, CFPC, CIMC, CGSC, COSC, CRC, CCC, CPPM CCO Program Director

24. Save Up To 22% with Review Blitz Bundles Until this Sunday, July 24th at 10pm Eastern, CCO is including our CPC Mini-Mock Practice Exam Bundle (3 exams valued at $69.95) to anyone that purchases either a: http://www.cco.us/blitz-bundles/ Let’s Go There Now: is an + + CPC Review Blitz Bundle COC Review Blitz Bundle or a

25. Testimonials and Reviews http://www.cco.us/testimonials/

26. ICD-10-PCS Coding for Measurement and Monitoring Question: Could you review how to code for measurement and monitoring in ICD-10-PCS with examples? ANSWER Alicia Scott, CPC, CPC-I, CRC CCO Education Director

27. Nurse Visits (CPT® Code 99211) Question: Can someone please discuss the 99211 CPT® Code? Answer Laureen Jandroep, CPC, CPC-I, COC, CMSCS, CHCI, CPPM CCO Founder and CEO

28. CCO Presents Free! Topics include: Need Presentations for Your Local AAPC Chapter? More Information: http://www.cco.us/remote-presentations/

  • The Local AAPC Chapter of Columbus GA for “EM Coding: Locate Your HEM in Time” – A Unique Way to Understanding EM Coding”
  • What is HCC/Risk Adjustment Coding
  • How to prepare for CPC Exam Modifiers – It’s All About The Money
  • How to “Prepare for ICD-10 Proficiency without Stress”
  • CPT Coding updates
  • Any section of the CPT Manual – Anesthesia, Integumentary, Digestive, Medicine
  • Any section of ICD manual or guidelines
  • Any topic you’d like developed!
  • “Cardiology Section of CPT” Jackson MS

29. New Blitz Reviews Ready for You

CPC Review

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2016 CPT Updates

30. Choice of Blitz Video Package or 2 CEU Webinars or 1 Hour Session with Laureen (or Alicia) Free Drawing! Your Choice of: Let’s Pick A Winner! or

31. Your Questions from the Chat Questions In The Chat- July 2016 Your Webinar Chat Team

32. LIKE us on Facebook http://facebook.com/cco.us Help Us Get The Word Out

33. Links Referenced in the Webinar:

34. Thanks For Coming! Got Value? http://www.cco.us/webinarvip

35. Happy Coding!

  • The Local AAPC Chapter of Columbus GA
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Code Rule for Contusion and Abrasion | CCO Medical Coding Tips http://www.cco.us/code-rule-for-contusion-and-abrasion/ http://www.cco.us/code-rule-for-contusion-and-abrasion/#respond Mon, 08 Aug 2016 10:23:57 +0000 http://www.cco.us/?p=27694 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

Q: Contusion and Abrasion — “Is the code rule for contusion and abrasion the same as ICD-9 was, i.e., code contusion only or do we code both now?” Chandra: A: The answer to that question is they’re both considered superficial injuries and they would be coded separately. If they’re in […]

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Q: Contusion and Abrasion — “Is the code rule for contusion and abrasion the same as ICD-9 was, i.e., code contusion only or do we code both now?”

Chandra: A: The answer to that question is they’re both considered superficial injuries and they would be coded separately. If they’re in the same location, the same body area, the same spot, the patient has both the contusion and abrasion, I typically would not assign a code for both of them. I would go with the more severe, talking to the physician as to what it was, because remember a contusion is bruise, under the skin, and abrasion actually scrapes the skin. Abrasion is actually usually considered a little bit more severe; but you need to work with your providers and find out what their take on it is because they don’t always see eye-to-eye with us, even eye-to-eye with one another. But develop your policy, most coders don’t code for both, but you can. There’s nothing that says you can’t.

VIDEO: Code Rule for Contusion and Abrasion

Alicia: Remember we code for statistical purposes, that’s our primary role, it just happens to be a convenient way to get paid. Whether you code for abrasion or contusion, it’s not going to change the way they get paid. You’re substantiating the CPT code in this scenario. Again, I always think of a person that’s been in a motorcycle accident and they’re always breaking down all of the injuries that are usually all… you got plenty contusion, abrasions, then you have avulsions and everything.

Related Code Rule for Contusion & Abrasion Posts:

Code Rule for Contusion and Abrasion

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When to Use HIV code and AIDS code? | Medical Coding Training http://www.cco.us/when-to-use-hiv-code-and-aids-code/ http://www.cco.us/when-to-use-hiv-code-and-aids-code/#respond Fri, 05 Aug 2016 10:05:46 +0000 http://www.cco.us/?p=27634 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

Q: “What is the difference between AIDS and HIV? How do I know when to use the AIDS code (B20) instead of the HIV code (Z21)? What role, if any, do ‘Opportunistic Infections’ play?” A: This is actually a common question that I have seen not only in my students, […]

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Q: “What is the difference between AIDS and HIV? How do I know when to use the AIDS code (B20) instead of the HIV code (Z21)? What role, if any, do ‘Opportunistic Infections’ play?”

A: This is actually a common question that I have seen not only in my students, but I’ve seen all over social media. The further we get into coding for risk adjustment, coding for inpatient environment, and just coding for good quality, the more we’re going to find, we as coders have to better understand clinical conditions and we can’t accept the providers to document explicitly in coder lingo. They don’t document in coder lingo, they document in physician verbiage. And, we need to quit expecting them to say clearly, “Oh, this patient has symptomatic HIV versus asymptomatic HIV” which is the difference in how the codes are worded.

Let’s take a minute and talk about the difference between the two conditions from a clinical perspective and then we’ll talk about the codes.

VIDEO: When to Use HIV code and AIDS code? | Medical Coding Training

What does HIV stands for?

HIV stands for Human Immunodeficiency virus. It is just that, it is a virus; however it is a virus that once a patient contracts it they’re going to have it for the rest of their lives. It’s not currently one that we have a cure for anywhere in the world. This virus attacks the body’s immune system – specifically it attacks the CD4 or T cells, and those are the cells that fight off infections. If we’ve got the body attacking their own immune system, it’s going to progressively get worse, there’s going to be more of these HIV virus cells develop in the patient’s body and it’s going to attack more and more of the immune system and they’re going to get weaker and weaker from a defense perspective, and they’re going to get sick a lot easier.

Once they get to the point that they have a diminished T cell amount, they don’t have very many of those cells left to try and fight off infection, or they’ve developed what we call an opportunistic infection; then, they have progressed from HIV (the virus that causes AIDS) to AIDS.

What does AIDS stands for?

When we talk about AIDS, AIDS stands for Acquired Immunodeficiency Syndrome. This is a term that many of us have heard before and are familiar with, it occurs, like I said when that HIV virus has replicated to the point that it has weakened that person’s immune system substantially.

Requirements for a person being diagnosed with AIDS:

1. They either have to have a T cell count or that CD4 count below 200 cells per cubic millimeter of blood (200 cells/mm3); so that’s very, very small amount.

2. Or, they have to be diagnosed with an opportunistic infection. If they’ve been diagnosed with an opportunistic infection, it doesn’t matter what their T cell or their CD4 count is. They by definition have AIDS.

When to Use HIV code and AIDS code? | Medical Coding TrainingThe Federal government actually has an HIV website out there, it’s called AIDS.gov. If you go to that AIDS website you’re going to find the same definitions that I have given you, the same clinical parameters on when a patient has reached the diagnostic criteria for AIDS, and you also can find if on that site you search in their little search box for opportunistic infection, that there are a list of more than 20 conditions that are considered opportunistic infections. An opportunistic infections is one of those that’s going to take advantage of that patient’s weakened immune system and basically take them to death’s door. It’s going to make them very, very, very, very sick and it could potentially kill them.

By definition, if a patient is HIV positive, then diagnosed with any one of these conditions on this list, they’re considered to have an AIDS’s defining condition and be progressed to the point of having AIDS. The HIV positive, the Z21, asymptomatic code, should not be used.

Now, there are a lot of conditions on here that are really common, but they are pretty much common to HIV patients. For example, Kaposi’s sarcoma or cryptococcosis, histoplasmosis. Those are things that we see and when we see them, most of the time, more often than not, they’re in an HIV patient. Some of them are conditions that we see in everybody. Things like herpes simplex, but then they put additional parameters on there to say, “Yeah, herpes simplex, but it has to be chronic ulcers lasting more than a month’s duration, or it has to be herpes simplex into bronchitis, pneumonitis, esophagitis.” It’s got to have progressed beyond just a basic case of herpes; so there’s all this clinical information here.

The reason I point this out, this is a good list to put in your ICD-10 manual somewhere, because if the physician’s documentation simply says, “Known HIV” and then list one of these conditions, like lymphoma, that patient automatically has AIDS and the Z21, asymptomatic code, should not be used. So, you may not have the provider documenting the phrase “AIDS” even though that code is substantiated and backed up by the documentation.

What is the difference between a B20 code and Z21 code?

The B20 is the code that we associated with AIDS and it is actually Human immunodeficiency virus (HIV) disease. The difference in the wording between B20 and Z21 is Z21 they use the phrase “asymptomatic.” The trick there is “asymptomatic” means that patient does not have an opportunistic infection and has not had an opportunistic infection since the time they were diagnosed. It does not mean they’re asymptomatic right now, because you can have a patient who is diagnosed with HIV, gets one of those opportunistic infections, like one of those really nasty kinds of pneumonia, and they’re successfully treated, the pneumonia resolves, guess what? They’re still considered a symptomatic HIV patient. Their pneumonia may have gone away, but their T cell count got below a level that they are still falling into the AIDS area or they were diagnosed with an opportunistic infection, which by definition means they have active symptomatic HIV.

When to Use HIV code and AIDS code? | Medical Coding TrainingSome of the common phrases that you’ll see documented that substantiate B20, that known HIV disease symptomatic, you could see the provider document the phrase AIDS (Acquired Immunodeficiency Syndrome). ARC is another one – not as many people are familiar with ARC. ARC stands for AIDS-related complex. That’s actually the diagnosis many providers use when a patient first starts showing signs of one of those opportunistic infections. By definition, as soon as they’re showing signs of an opportunistic infection, they’ve met the requirement for the symptomatic code and they get thrown there.

Or you may see a provider document symptomatic HIV. Conversely, you may see them write “Known HIV” or “HIV positive” and then document one of those opportunistic infections. Any of those are acceptable and substantiate using that code B20.

At the very bottom, I gave you the link to the AIDS.gov website. It is really, really helpful if you’re trying to understand AIDS and HIV and ARC and where everything fits in and how you’re supposed to use these codes. I definitely encourage you to take a look at that. If you’re one of our students, our Replay Club members, or have looked up in the annotations that we have in the ICD-10 manual, you’ll find that we do include that list of opportunistic infections in the notes that we suggest you make.

What we do is, next to the code B20, when we say “See list of OIs” and then we put those OIs on a blank area in the book, wherever you have room to write that list out, so that you always have that even if you don’t have access to the internet.

Just to recap, the difference between AIDS and HIV, HIV is the virus that leads to AIDS. They are coded separately, if the patient just has the virus and is not yet declined to the point that they have a low CD4 or T cell count below 200, they just have HIV, they just have the virus. If the virus replicates to the point they have that low T cell count or they developed an opportunistic infection, they have full-
blown AIDS or symptomatic HIV, which is coded using B20 and that’s where those opportunistic infections come in. That supports that diagnosis of symptomatic HIV.

Related HIV code & AIDS code Posts:

When to Use HIV code and AIDS code? | Medical Coding Training

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July 2016 CCO Graduates and CPC Exam Passers – Week 4 http://www.cco.us/july-2016-cco-graduates-cpc-exam-passers/ http://www.cco.us/july-2016-cco-graduates-cpc-exam-passers/#respond Wed, 03 Aug 2016 10:00:19 +0000 http://www.cco.us/?p=27652 Visit [CCO] Certification Coaching Organization LLC for more articles about [CCO] Certification Coaching Organization LLC - Medical Certifications - Learn It - Get Certified - Stay Certified.

   “The future belongs to those who believe in the beauty of their dreams.”  — Eleanor Roosevelt Twelve (12) of our new CCO graduates are among the 2016 CPB and CPC Exam Passers. Hooooray, you made it!!! You have come this far and there’s no stopping now. Continue to follow your passion as it will […]

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CCO Graduates and CPC Exam Passers 2016 

 The future belongs to those who believe in the beauty of their dreams.” 

— Eleanor Roosevelt

Twelve (12) of our new CCO graduates are among the 2016 CPB and CPC Exam Passers. Hooooray, you made it!!! You have come this far and there’s no stopping now. Continue to follow your passion as it will lead you to the fulfillment of your dreams. Congratulations graduates! Your serious efforts have paid off and you deserve every bit of it. Today begins a whole new chapter in your life. Today, you define the success with your hard work and dedication, honesty and courage. Believe in yourself as this is just the beginning of the bright path that’s filled with your hopes and dreams. The best is yet to come! BIG CONGRATS to:

  • Crystal Braddock  –  CPC  –   04/23/2016   –  Using CPC Blitz

  • Pamela Wolf   –  CPC   –  06/11/2016  –   Using CPC Blitz

  • Rosemarie Belan   –  CPC   –  07/16/2016   –  Using CPC Blitz

  • Jennifer Wilkerson   –  CPC   –  07/09/2016   –  Using CPC Course (PBC)

  • Malinda Wildey   –  CPC   –  03/22/2012   –  Using CPC Course (PBC)

  • Susan Dowe   –  CPB   –  07/19/2016   –  Using CPB Course (PBB)

  • Carolyn Cassady   –  CPC  –   07/16/2016   –  Using CPC Course (PBC)

  • Joell Peters   –  CPC  –   07/23/2016   –  Using CPC Blitz

  • Jennifer Steinlauf   –  CPC  –   07/16/2016   –  Using CPC Blitz

  • Patricia Perdue  –   CPC   –  07/28/2016   –  Using CPC Blitz

  • Gena Maher  –   CPC   –  07/23/2016   –  Using CPC Blitz, Practice Exams

  • Lisa Dietrich-Blocker   –  CPC   –  07/22/2016   –  Using CPC Blitz, PBC Course, MTA and Practice Exams

Related July 2016 CCO Graduates and Exam Passers:

 

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