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 exampleof what a case looks like in practicode, and so what we thought maybe we try to do at thewebinars is right there at the end, pull a practicode case and code it; and so, we didit 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 practicodeto do this, you're doing it...? alicia: yeah, because we have to have hadpracticode, we could do that next time. laureen: yeah i think so.
alicia: yeah, because this time we've hadto have practicode open, but it's really easy to navigate, so we'll practice this time withwhat they look like, and the next time we'll actually go into practicode. i'll show youhow to go in and pick that case out. so, these are actual cases, and just realquickly 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 patientis having sharp abdominal pains and fainting. then you get into the hpi. now this was setup a little differently, i separated it because the other thing that should be practiced asa coder is being able to find the information in the case, and this is what practicode givesyou. this is real world experience, not experience
learning how to take a test; this is how youcan read a report and pull out the information you need. what does our patient have? they talked abouta left lower quadrant and right lower quadrant pain, and then these are all the questionsthat the doctor asked the patient about the quality of the paid, the severity, what arethe modifying factors. so nothing gives this person relief. and then you scroll down, yousee associative symptoms: none. then, this patient has an addiction to alcohol for 10years 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 highlightingin my head the stuff that i feel is pertinent that i probably can get a code out of. i scrolldown... and alleviating factors, this has to do with the alcohol, so i notated thatby 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 ofthese other problems. the patient reported that they're having dizziness,the quality, and it talks about that. remember, outpatient setting, we're only coding thediagnosis, not the signs and symptoms. it talks a little bit more about what makes themfeel like they're going to faint, and then i noted again -- the patient has been drinkingtoday, 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 poppingup at me because i'm thinking, "ok, i'll get a code out of this." and normally this iskind of clumped together but i divided it up on the individual lines because it's easierfor you to see. past medical history -- you can pull codesout of this. the alcohol abuse, yes. she is diabetic. she hashypertension. there was nofamily medical history. another thing that they've got here is a bmi. people don't liketo be called "obese" even in their medical record, so a lot of times doctors are gettingaround that by coding the bmi because a bmi of 33 - - you're obese, but it's much nicerto say that you have a diagnosis of a bmi
of 33 versus morbid obesity. that's somethingi notated. the patient's physician exam - this is where,before it was all asking the patient questions. now, the doctors actually, physically, examiningthe patient. general appearance: healthy-appearing and obese. we can code that the person isobese, but it would be nicer to do the bmi. they can get around normally, and then thepsychiatric, if the patient has problems down there in the bottom you can sometimes pullsome codes for psychiatric especially for geriatric patients - scrolling down just alittle bit more. mental status and orientation to time andplace -- those are not things that we're going to be able to pull codes out of, but whenyou're doing cpt and the e/m this stuff is
all pertinent because they're going to beclicking off, you get little checks for the stuff. go ahead and scroll down and -- let'ssee vision, neck, and lymphs. see how they're doing all these body systems: thyroid, theydo the lungs, cardiovascular, heart, pulses, abdomen; and again, they're having, there'sno 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 pullingdiagnoses off of this per say, we're actually getting stuff to do the e/m. assessment and plan means diagnosis and howhe's going to treat it what's his plan. he's giving the patient a diagnosis of hypertensionand he states its benign hypertension. in
icd-9 that makes a difference. in icd-10 itdoes not. obesity unspecified. he didn't say morbid obesity, he just said obesity. andthen 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 uncontrolledor not? we have diabetes type 2, uncontrolled and ithas 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 uncontrolledhere, but states it up in the body of the report that it's uncontrolled then you canuse that. what are they going to do? they're going to go over the diet and the guidelinesagain. abdominal pain, unspecified site. they're
going to do a ct scan. and when you're doing like hcc coding andstuff, you have to have that doctor's signature in a certain way. in icd-10, essential primaryhypertension... 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 painand you can code left lower quadrant and right lower quadrant in icd-10 but you can't codeboth. there's not a code for right and left lower quadrant so you're going to use r10.30which is unspecified but it actually means that when you read the small print that it'smultiple sites. e11.65 is type 2 diabetes that's uncontrolledmeaning 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 tohave that. now, obesity unspecified e66.9, but actually i would code the bmi which wouldbe 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 takeout. 99214 for the e/m and then the explanation; the practicode actually you go in, you codeit. these are the codes that they came up with and i wouldn't check them and i saidi 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 answersare correct. you get a rationale with practicode.
in icd-9, i went ahead and down below didall in icd-9 so that you could see the difference, and again it does not matter per se what orderyou code these in. most of the time people would code them in the order that the physicianwrites them, where he did a hypertension first, but it's okay to code them in a differentorder. if, as long as you follow the guidelines for order of code in addition and stuff likethat; but all of these diagnoses would be interchangeable. the patient actually came in for abdominalpain, that was the chief complaint, so that might go first. the fact that they're diabeticis a pretty severe thing, then hypertension, then obesity is probably the most ideal wayto code it.
the 99214, i put the code for the bmi in icd-9there for you so that you could use that. now, it depends why you're coding. codingfor hcc is done a certain way. coding for the physician's office is done in a certainway. coding for reviews and audits and stuff like that, it could be done in different waysfor certain needs or for billing or something. but this is the great thing that practicodedoes, 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 theygave.
laureen: i did pull up just a sample. it'snot the same exact one but just so they could visualizewhat it looks like. alicia: oh, yes. there's your case and youcan 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 youwant to put a practicode -- laureen: let me cheat and show the answers[laughs]. alicia: yeah. let's say you look at it andyou 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 itgraded as a "poor." alicia: correct. you can go and do these morethan once and there's like 150 in family practice, internal medicine icd-10 practicum, 150; soyou 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 tosee if you know a guideline. second, you get immediate rationale. third, this is actually the format that ifyou're coding for a facility or a doctor's office and you're using a program becauseyou're not going to be doing this stuff by hand. that's exactly the way they do it. itbrings up the real life case, and then you
literally plug in the information and it looksjust like that on the right, and then you submit it. and most programs will immediatelysend 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 thedifferent categories that they have and they're adding more all the time. and if you enrollin practicode through cco we have unlimited access to all the exercises where on theircommercial site they limit it to like a set number of cases because this is a studentprogram through cco, even if you're a member not like an official student you still getthe access to all of the modules and the new ones to come for as long as you have yourpracticode membership. it is on a year-to-year
basis. it's pretty amazing; we're very excitedabout it. alicia: it gets to show your improvement andthen you can walk into an employer and he says, "you just got certified, why shouldi hire you?" "well, because i love coding and i love it so much that i invested in mycareer by doing practice codes," tell him who practicode is and say, "look what they'vedone 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 somegreat things that you can do with practicode and on top of that practicode is owned byaviacode? laureen: aviacode.
alicia: aviacode and they hire new coders.if you do this and this comes to their attention
Icd-10 Code For Diabetes Type 2,andyou're really good, you bet they'll hire you. they need more coders and they don't carethat you've only been a coder for --you've been certified for three months. it's qualitythat they're looking for. laureen: yup, alright. thank you for thatvery much.
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