Alicia: OK. So, Laureen and I we’re talking, we talked about Practicode and we kept mentioning it but you haven’t really seen an example of what a case looks like in Practicode, and so what we thought maybe we try to do at the webinars is right there at the end, pull a Practicode case and code it; and so, we did it in ICD-9 and we did it in ICD-10 so that yo can kind of get a feel for how to do this. If you go back up to the top it is an actual case, OK.
Laureen: So you’re not going in to Practicode to do this, you’re doing it…?
Alicia: Yeah, because we have to have had Practicode, we could do that next time.
Laureen: Yeah I think so.
Alicia: Yeah, because this time we’ve had to have Practicode open, but it’s really easy to navigate, so we’ll practice this time with what they look like, and the next time we’ll actually go into Practicode. I’ll show you how to go in and pick that case out.
So, these are actual cases, and just real quickly scanning it, you can pick what you want and this was like a doctor’s office visit, so family practice. The pertinent information here is the chief complaint, so this patient is having sharp abdominal pains and fainting. Then you get into the HPI. Now this was set up a little differently, I separated it because the other thing that should be practiced as a coder is being able to find the information in the case, and this is what Practicode gives you. This is real world experience, not experience learning how to take a test; this is how you can read a report and pull out the information you need.
What does our patient have? They talked about a left lower quadrant and right lower quadrant pain, and then these are all the questions that the doctor asked the patient about the quality of the paid, the severity, what are the modifying factors. So nothing gives this person relief. And then you scroll down, you see associative symptoms: none. Then, this patient has an addiction to alcohol for 10 years and then it escalated over a year. I highlighted that because that’s pertinent, although you’ll find that the end they didn’t add that to the diagnosis.
Practicode Example Coding a Diabetes Case – Video
As I’m just scanning this, I’m highlighting in my head the stuff that I feel is pertinent that I probably can get a code out of. I scroll down… and alleviating factors, this has to do with the alcohol, so I notated that by making it a different color. All the associated symptoms you look, all of those say “no.” This isn’t pre-populated but he’s actually addressing that they’re not having any of these other problems.
The patient reported that they’re having dizziness, the quality, and it talks about that. Remember, outpatient setting, we’re only coding the diagnosis, not the signs and symptoms. It talks a little bit more about what makes them feel like they’re going to faint, and then I noted again – the patient has been drinking today, appears intoxicated – because that jumped out at me. They have no allergies, no known drug allergies (NKDA). Let’s see, no medications. Again, alcoholism is popping up at me because I’m thinking, “OK, I’ll get a code out of this.” And normally this is kind of clumped together but I divided it up on the individual lines because it’s easier for you to see.
Past medical history – you can pull codes out of this. The alcohol abuse, yes. She is diabetic. She hashypertension. There was no family medical history. Another thing that they’ve got here is a BMI. People don’t like to be called “obese” even in their medical record, so a lot of times doctors are getting around that by coding the BMI because a BMI of 33 – – you’re obese, but it’s much nicer to say that you have a diagnosis of a BMI of 33 versus morbid obesity. That’s something I notated.
The patient’s physician exam – This is where, before it was all asking the patient questions. Now, the doctors actually, physically, examining the patient. General appearance: healthy-appearing and obese. We can code that the person is obese, but it would be nicer to do the BMI. They can get around normally, and then the psychiatric, if the patient has problems down there in the bottom you can sometimes pull some codes for psychiatric especially for geriatric patients – scrolling down just a little bit more.
Mental status and orientation to time and place – those are not things that we’re going to be able to pull codes out of, but when you’re doing CPT and the E/M this stuff is all pertinent because they’re going to be clicking off, you get little checks for the stuff. Go ahead and scroll down and – let’s see vision, neck, and lymphs. See how they’re doing all these body systems: thyroid, they do the lungs, cardiovascular, heart, pulses, abdomen; and again, they’re having, there’s no rebounding or anything. Let’s see, tenderness left lower quadrant, right lower quadrant, and liver. Everything else is okay. Scroll down just a little bit more. We’re not pulling diagnoses off of this per say, we’re actually getting stuff to do the E/M.
Assessment and plan means diagnosis and how he’s going to treat it what’s his plan. He’s giving the patient a diagnosis of hypertension and he states its benign hypertension. In ICD-9 that makes a difference. In ICD-10 it does not. Obesity unspecified. He didn’t say morbid obesity, he just said obesity. And then the plan is they’re going to start a weight loss program. The patient has diabetes. Make sure you know with diabetes, they have diabetes, what type and is it uncontrolled or not? We
have diabetes type 2, uncontrolled and it has to state that it’s uncontrolled for you to be able to diagnose as uncontrolled. Otherwise, it’s just a regular 250.00 and even if the doctor does not state that it’s uncontrolled here, but states it up in the body of the report that it’s uncontrolled then you can use that. What are they going to do? They’re going to go over the diet and the guidelines again. Abdominal pain, unspecified site. They’re going to do a CT scan.
And when you’re doing like HCC coding and stuff, you have to have that doctor’s signature in a certain way. In ICD-10, essential primary hypertension… I10 covers all of those hypertensions that 401.9 or 401.1 that was broke down before. It’s all in brackets. Benign is still I10. Now, the patient has lower abdominal pain and you can code left lower quadrant and right lower quadrant in ICD-10 but you can’t code both. There’s not a code for right and left lower quadrant so you’re going to use R10.30 which is unspecified but it actually means that when you read the small print that it’s multiple sites.
E11.65 is type 2 diabetes that’s uncontrolled meaning with hyperglycemia. It’s worded a little bit different than it is in ICD-9. That’s E11.65. The diabetic codes did change a little bit and the rules changed just to have that. Now, obesity unspecified E66.9, but actually I would code the BMI which would be Z68.33 those are sort of interchangeable, again, because you were given the BMI. Otherwise, you can’t take things out of that review like blood pressure and stuff. BMI you can take out. 99214 for the E/M and then the explanation; the Practicode actually you go in, you code it. These are the codes that they came up with and I wouldn’t check them and I said I agree with them except for I would have coded the BMI maybe instead of the obesity, or you can code both. And then they give you an explanation as to why that these answers are correct. You get a rationale with Practicode.
In ICD-9, I went ahead and down below did all in ICD-9 so that you could see the difference, and again it does not matter per se what order you code these in. Most of the time people would code them in the order that the physician writes them, where he did a hypertension first, but it’s okay to code them in a different order. If, as long as you follow the guidelines for order of code in addition and stuff like that; but all of these diagnoses would be interchangeable.
The patient actually came in for abdominal pain, that was the chief complaint, so that might go first. The fact that they’re diabetic is a pretty severe thing, then hypertension, then obesity is probably the most ideal way to code it.
The 99214, I put the code for the BMI in ICD-9 there for you so that you could use that. Now, it depends why you’re coding. Coding for HCC is done a certain way. Coding for the physician’s office is done in a certain way. Coding for reviews and audits and stuff like that, it could be done in different ways for certain needs or for billing or something. But this is the great thing that Practicode does, they let you input the codes that you think are correct, then they give you rationale, and then they tell you like three different ways you could code it; so it’s fantastic. Lots of good practice.
Laureen: Are these the possible answer #3, this is yours or theirs?
Alicia: That’s theirs, that’s the ones they gave.
Laureen: I did pull up just a sample. It’s not the same exact one but just so they could visualize
what it looks like.
Alicia: Oh, yes. There’s your case and you can scroll down and look at all of your information and then what you can do is seek the diagnosis, the first diagnosis code on the right in ICD-10. You can put that in there and then if you want to put a Practicode –
Laureen: Let me cheat and show the answers
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