Alicia: OK. Let’s look at a little cardiac case and let’s see how this knowledge plays out.

Q: Mrs. Plum has been diagnosed with left posterior tibial artery occlusion due to stenosis.

A: We’re going to do this in ICD-10-CM and ICD-9-CM. So, why anatomical knowledge is so important when you’re dealing with cardiac? Mrs. Plum has a left posterior tibial artery occlusion and it’s due to stenosis. So, what are we going to look up first? We’re going to look up an occlusion, that’s what she has. What she is being seen for – an occlusion of her artery.

If you go in ICD-10 you’re going to look in the alphabetic index first, because when you’re looking up codes you always want to go to the index first and you’re going to look under occlusion. Now, for occlusion, it’s divided anatomically. You’ll have artery, you’ll have all different types of things that can be occluded, but we’re doing artery.

Now, if you don’t know where the tibial artery is – let’s say you have no idea what tibial artery is, then you cannot code this diagnosis because you go to occlusion, you know it’s an artery, but then it indexes into lower extremities due to stenosis or stricture. If you don’t know that the tibial artery is next to the tibia in the lower leg, which is an extremity, a lower extremity, that’s all you get. It’s not going to give you any more information than that. It doesn’t mention tibia at all. So, you’re stuck if you don’t know that.

Cardiac Medical Coding Case Study – Video

It directs you to I77.1; it tells you when you get to this point that your code is I77.1. So, you go look up in the Tabular I77.1 and its stricture of artery, it never once mentions the tibia. It just tells you, you follow what the index says – OK, stricture of artery, that’s the right code.

This is what they do when they want to find those, also they do these ultrasounds of the leg and so she would’ve had one but it would have been down here on the lower part of the leg.

Now in ICD-9-CM, it’s listed a little bit different because it’s under occlusion and then it goes to arteries of the extremities. ICD-10-CM doesn’t do that. And then it says “lower,” and then it says “due to stricture or stenosis” which is all right, which is 447.1. So, 447.1 you go look at it in the Tabular, and it says, “Stricture of artery,” which does not mention which artery by any means. If you don’t know what you’re looking for or the anatomical areas, you’re up the creek without a paddle. That’s why it’s very important to be familiar.

Again, the tibia, most people know that that’s in the lower leg, but you have to think, “Well, how are they going to say lower leg?” They’re going to say “lower extremity.” That comes with time with just coding, everything picking up those terms. And you don’t want to spend all day looking for that because once you’re good to go, you don’t have time, you’ll always be doing research, but it’s this little stuff. If you have this common basic knowledge, you’re going to be able to pick up stuff faster, and that’s the key to be more proficient.

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About the Author:

Alicia has been working in the medical field for over 20 years. She first learned about medical coding while working in a medical records department at a resort town hospital near where she was raised. Through the years she has held several jobs in the medical field from, CNA, EMT, Pharmacy technician and Medial Records Abstractor and Analyst. Outside of the medical field she has worked as a Real Estate agent, and owned her own on-line retail business. The medical field has always been where she felt the most comfortable. Alicia has taught medical coding, billing and medical law and ethics at a private college. She also did contract work in HCC Risk Adjustment and discovered she really enjoyed ICD work. Because she loves to learn Alicia is working towards her Masters in Health Care Administration with an emphasis on education. Having taken many online classes through the years to complete her degree she feels very comfortable with both face to face and on-line learning. Alicia will tell you that not only does she love medical coding but she has a passion for teaching it. Alicia lives in the middle of Texas with her husband who is a Pastor, five of her six children, three dogs and two cats.

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