Practicode Example — Coding a Diabetes Case

Practicode Example —  Coding a Diabetes Case

Alicia: OK. So, Laureen and I we’re talking,
we talked about Practicode and we kept mentionin 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. 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
[laughs]. Alicia: Yeah. Let’s say you look at it and
you struggle and you say, “I just don’t know where to start” Just go hit “show answers,”
and they’re going to give you the information on how to code it with the explanation — Laureen: We didn’t put anything in, so it
graded as a “poor.” Alicia: Correct. You can go and do these more
than once and there’s like 150 in family practice, internal medicine ICD-10 practicum, 150; so
you can imagine that when you start and then you keep going, how you would get better.
What you have going for you was Practicode, real cases, not cases for test examples to
see if you know a guideline. Second, you get immediate rationale. Third, this is actually the format that if
you’re coding for a facility or a doctor’s office and you’re using a program because
you’re not going to be doing this stuff by hand. That’s exactly the way they do it. It
brings up the real life case, and then you literally plug in the information and it looks
just like that on the right, and then you submit it. And most programs will immediately
send it to your clearing house, or whoever it does to your insurance company it’s sent,
so you get real life experience with Practicode. Laureen: Yup. Here’s just an example of the
different categories that they have and they’re adding more all the time. And if you enroll
in Practicode through CCO we have unlimited access to all the exercises where on their
commercial site they limit it to like a set number of cases because this is a student
program through CCO, even if you’re a member not like an official student you still get
the access to all of the modules and the new ones to come for as long as you have your
Practicode membership. It is on a year-to-year basis. It’s pretty amazing; we’re very excited
about it. Alicia: It gets to show your improvement and
then you can walk into an employer and he says, “You just got certified, why should
I hire you?” “Well, because I love coding and I love it so much that I invested in my
career by doing practice codes,” tell him who Practicode is and say, “Look what they’ve
done and here’s a portfolio.” And you can show them – “See, I’ve been coding an ICD-10.
I feel very comfortable with it,” or, “Look, I particularly love surgery.” There’re some
great things that you can do with Practicode and on top of that Practicode is owned by
Aviacode? Laureen: Aviacode. Alicia: Aviacode and they hire new coders.
If you do this and this comes to their attention and
you’re really good, you bet they’ll hire you. They need more coders and they don’t care
that you’ve only been a coder for –you’ve been certified for three months. It’s quality
that they’re looking for. Laureen: Yup, alright. Thank you for that
very much.

3 Replies to “Practicode Example — Coding a Diabetes Case”

  1. Thank you for the demo and the information that you provided.  The instant feedback is extremely valuable because it can help keep us on track and understand where we are making mistakes.  One of my instructors explained to me that it is more important to understand why I picked the wrong code (or the wrong answer) than knowing the answer right off.  In other words, this is a tremendous learning tool.  I can perfect my coding skills!   Thank you!

  2. Please help, your video is very helpful and I appreciate what you guys and the company is doing for coders like me. I have a question, why was the abdominal pain coded? (not chronic or acute)

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