Medical Coding Training

30/12/2021

The Importance and Power of Language
By Lee Fifield In Facility December 29, 2021

The words and narratives we use in healthcare have a significant impact on our patients and our work culture.
When you hear the term “health equity” what do you think of? It may sound like just another buzzword, but the concept is one whose time has come. For decades the words we’ve drawn on in healthcare have been centered on more privileged socioeconomic groups (think white, heterosexual, wealthy men). In addition, we tend to use adjectives that can unintentionally dehumanize an individual or their situation. And though the majority of healthcare providers operate under the best of intentions, it is important to recognize that inequitable language can have a very real impact on the patient experience and patient care.

To address inequities in the healthcare system, teams from the American Medical Association and the Association of American Medical Colleges (AAMC) Center for Health Justice came together to produce the document, “Advancing Health Equity: A Guide to Language, Narrative and Concepts.” The guide provides physicians and other healthcare workers with a foundational toolkit for health equity. Its basic tenet is that “Words reflect our thinking and shape our thinking; it is to our benefit to pause to consider and reconsider their meanings.” Let us do so now.

The Importance of Health Equity Language
The first section of the guide focuses on language that promotes health equity. It is intended to raise questions about language and commonly used phrases and terms, with the goal of cultivating awareness about dominant narratives (deeply held values that have been repeated and reproduced over time) and offering equity-based, person-first alternatives.

It is important to remember that there is no right or wrong when it comes to language. Language is constantly changing and context matters. Also, what is appropriate or even preferred in one place might not be in another part of the country. But there are a few common principles you can follow:

1. Choose your adjectives with care: Avoid words like “vulnerable” and “high-risk” that can negatively affect the way you think about a patient.

2. Avoid dehumanizing language: Don’t reduce an individual to their diagnosis or situation in life. Use person-first language instead. For example, don’t refer to a patient as a diabetic; refer to them as a person with diabetes. Instead of calling someone homeless, refer to them as someone who is experiencing homelessness.

3. Remember that there are many types of subpopulations: Avoid referring to someone as a “minority.” Be specific to their background.

4. Avoid terms with violent connotations when referring to people, groups, or communities: Instead of “tackle” or “combat” use positive words like “engage” or “serve.”

5. Avoid unintentional blaming: For example, when you refer to people who “do not seek healthcare” you ignore their reasons for doing so and make a judgement. Perhaps a patient does not have access to transportation or does not think they can afford medicine. Instead, refer to them as a patient with limited access to a specific resource or service.

These principles may seem nitpicky or even unimportant at first glance, but they can really change how you think about a patient and subsequently how you formulate a care plan for them. Build on these principles by considering and discussing problematic words you may commonly use with colleagues — words that have the potential to create and perpetuate harm. For example, calling someone an illegal immigrant brings to mind a much different feeling than calling them an undocumented immigrant. Refer to the guide for a list of problematic words and phrases, their equity-focused alternatives, and the reasons for making a change. And remember: All of this may be uncomfortable to think or talk about, but it will help you provide a better environment for both your patients and your facility.

Why Narratives Matter
The second section of the guide focuses on narratives. Narratives are embedded in the structure of the healthcare system and in the ways in which we think about patients, families, communities, and the neighborhoods we serve — even ourselves. Narratives are so deeply rooted that they shape what questions we ask ourselves and what solutions we might develop when a patient walks through the door. Our approach with a patient may depend on many things, including, for example, the way they look, their age, their chronic conditions, their reluctance to seek or comply with healthcare, previous incarcerations, and much more, whether we realize it or not. Dominant narratives serve to uphold social and economic relations that privilege some and marginalize others. They determine who we “see” and whose needs are and aren’t prioritized. “Importantly, dominant narratives shape our understanding of what we deem possible and not possible,” suggests the guide.

So, what does this mean? First of all, it does not mean that healthcare workers are inherently racist, agist, sexist, or anything of the kind. It means that as caregivers we must dig deep to think about dominant narratives and discuss how they affect the care we provide for our patients. For example, are we operating under a narrative that blames a person for their own condition without even realizing it? What other narratives may be affecting our approach to care without us realizing it? In short, we must change the questions we ask ourselves when treating a patient to provide the best care. We must examine and change the narrative to one based on health equity.

To learn to see and think critically through dialogue, aim for the following approach:

Think keenly
Listen deeply
Act intentionally
Reflect frequently

Where to Start?
The topic of health equity may seem daunting. Making a change is always challenging, but by establishing a meaningful dialogue with colleagues and practicing change, your healthcare organization will reap the rewards of greater understanding, better patient care, and better health outcomes.

Source:

The words and narratives we use in healthcare have a significant impact on our patients and our work culture. When you hear the term “health equity” what The words and narratives we use in healthcare have a significant impact on our patients' health equity.

30/12/2021

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04/07/2019

ICD-10-CM Codes for Independence Day Follies

The Fourth of July is right around the corner, and United States friends will gather to celebrate our independence. With the celebration comes a slew of accidents and injuries. Here are some ICD-10 codes you may see during this holiday.

Food and Outdoor Fun
Nothing says “Independence Day” like picnics and barbeques. Here are some food hazards to keep an eye out for when cooking and eating outdoors:

Grilling and chilling (Y93.G2 Activity, grilling and smoking food) is a great way to spend the holiday but be careful not to pick up the burgers and hot dogs with your hands: X10.1XXA Contact with hot food, initial encounter.
When you leave the potato salad sitting in the sun for too long and are so hungry that you want to eat it anyway, you may land yourself in the hospital due to A05.9 Bacterial foodborne intoxication, unspecified.
Outdoor sports are also a popular way to enjoy the Fourth of July. If you are feeling sporty, here are some tips to keep you safe and the corresponding ICD-10-CM codes to avoid:

Make sure you know how deep a pool is before you dive into it: W16.52 Jumping or diving into swimming pool striking bottom.
If your idea of sporty fun is fishing with Uncle Cletus, be careful when he catches the big one, gets excited, and yanks the fishing pole out of the water too hard: W56.52XA Struck by other fish, initial encounter.
When a friendly game of volleyball on the beach turns ugly, look to this code: W21.06XA Struck by volleyball, initial encounter.
Even an “All-American” sport like football can be dangerous when you aren’t paying attention to your surroundings: W21.01XA Struck by football, initial encounter.
Avoid Too Much Sun

Many people aren’t used to being in the sun all day long, especially those of us in the Northern states. If you find yourself outside picnicking and baking in the sun longer than most days, be sure to use sunscreen and stay hydrated to avoid these problems:

L55.1 Sunburn of second degree
T67.0XXA Heatstroke and sunstroke, initial encounter
T67.5XXA Heat exhaustion, unspecified, initial encounter
E86.0 Dehydration
Get Back to Nature

Some Americans make the celebration a holiday weekend by getting back to nature through camping. If you are one of those people, a couple of things you’ll want to watch out for in the woods are poison ivy (L23.7 Allergic contact dermatitis due to plants, except food) and angry wildlife (W53.21XA Bitten by squirrel, initial encounter). When injuries occur in the forest, look to this code: Y92.821 Forest as the place of occurrence of the external cause.

Flares, Explosions, and Booms! Oh My!

It’s not Independence Day without fireworks. The beautiful light show and resounding booms are awe-inspiring, but when they are lit by partygoers who have had too much to drink (F10.129 Alcohol abuse with intoxication, unspecified) or when in the hands of those who are overly jubilant to be putting on the fireworks display (F63.1 Pyromania), they are dangerous. When not handled responsibly, someone may land in the emergency room for:

W39.###A Discharge of firework, initial encounter
H91.90 Unspecified hearing loss, unspecified ear
X97.###A Assault by smoke, fire and flames, initial encounter
T25.32 Burn of third degree of foot
Sparklers may seem harmless, but when not held by the end of the stick, their flares can cause injuries, too: T23.031A Burn of unspecified degree of multiple right fingers (nail), not including thumb, initial encounter.

Enjoy the holiday and remember to celebrate our country’s independence safely!

Source: https://www.aapc.com/blog/47391-icd-10-cm-codes-for-independence-day-follies/

27/06/2019

June 27th is National HIV Testing Day: Coding Fundamentals for HIV Screening

Medicare covers annual HIV screening. It is important for providers to recommend HIV screening because early detection will help their patients live longer, healthier lives. Claims reimbursement for this preventative service is dependent on proper coding and a clear understanding of benefit limitations and requirements. Here’s what you need to know, especially in honor of National HIV testing day, June 27.

HIV Background
HIV is a virus that weakens a person’s immune system by destroying cells that are important in fighting disease and infections. Currently, no effective cure exists for HIV, but timely diagnosis and proper medical care help to control it.

HIV screening involves taking a blood sample and examining it for the presence of HIV antibodies. These disease-fighting proteins react to HIV specifically and when present, indicate active infection. Early treatment, such as antiretroviral therapy, significantly reduces the risk of developing acquired immunodeficiency syndrome (AIDS), the final stage of HIV infection, contracting AIDS-related conditions, and dying of AIDS.

Note: “Increased risk for HIV infection” is defined in the Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 210.7.

Who is Covered?
Medicare covers annual screenings for certain Medicare beneficiaries without regard to perceived risk or who are at increased risk for HIV infection, including anyone who asks for the test, or pregnant women.

Frequency of testing:

Annually, for Medicare beneficiaries between the ages of 15 and 65 without regard to perceived risk
Annually, for Medicare beneficiaries younger than 15 and adults older than 65 who are at increased risk for HIV infection
For Medicare beneficiaries who are pregnant, three times per pregnancy:
First, when a woman is diagnosed with pregnancy
Second, during the third trimester
Third, at labor, if ordered by the woman’s clinician
Coding HIV Screening
HCPCS Level II and CPT Codes
HCPCS/CPT Code
Descriptor

G0432

Infectious agent antibody detection by enzyme Immune assay (EIA) technique, qualitative or Semi-quantitative, multiple-step method, HIV-1 or HIV-2, screening
G0433

Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, antibody, HIV-1 or HIV- 2, screening
G0435

Infectious agent antibody detection by rapid antibody test of oral mucosal transudate, HIV-1 or HIV-2, screening
G0475

Hiv antigen/antibody, combination assay, screening
80081

Obstetric panel (includes HIV testing)
ICD-10-CM Codes
Increased risk factors not reported – Z11.4

Increased risk factors reported – Z11.4 & Z72.51, Z72.52, Z72.53, or Z72.89

Pregnant Medicare beneficiaries – Z11.4 & Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, O09.90, O09.91, O09.92, or O09.93

HIV screening HCPCS Level II codes G0475, G0432, G0433, and G0435 must be submitted with the required HIV primary diagnosis code Z11.4.

Early diagnosis and treatment of HIV can help improve the health of these patients and decrease transmission of the virus. Help spread awareness of the importance of HIV screening as we approach HIV awareness day.

Source:

Medicare covers annual HIV screening. Claims reimbursement is dependent on proper coding and a clear understanding of benefit limitations and requirements. Here’s what you need to know.

30/05/2019

30/04/2019

5 Tips to Successfully Navigate Diabetes Coding

With the implementation of the Patient-Driven Payment Model (PDPM) fast approaching, now’s the time to prioritize your ICD-10 training, as proper diagnostic coding will become crucial to keeping your skilled nursing facility (SNF) revenue on target.

If you’re still getting comfortable with the idiosyncrasies of ICD-10, chronic and complicated conditions like diabetes can prove challenging, particularly when different presentations of the disease affect the codes you choose.

Today, we simplify diabetes reporting with five coding tips to streamline the way you code this condition that affects an estimated 9.4 percent of Americans, according to the CDC’s National Diabetes Statistics Report, 2017. Not surprisingly, the percentage jumps significantly in your long-term care population, with numerous studies putting the prevalence of diabetes in the range of 25 to 34 percent.

Again, it’s important to grasp PDPM’s heavy reliance on ICD-10 coding, which will be used to determine the principal reason for the Skilled Nursing Facility Prospective Payment System (SNF PPS) stay — so let’s begin our diabetes coding tutorial!

Tip 1: Narrow Your Code Choice
Figuring out which diabetes code to choose can seem daunting, but you can quickly narrow your code selection by bypassing three of the five diabetes categories that rarely apply in the long-term care setting:

Category E08 (Diabetes mellitus due to underlying condition)
Category E09 (Drug or chemical induced diabetes mellitus)
Category E13 (Other specified diabetes mellitus).
This leaves you with two main ICD-10 categories for the two main types of diabetes:

E10 (Type 1 diabetes mellitus)
E11 (Type 2 diabetes mellitus).
Caution: Type 1 and Type 2 diabetes differ significantly, with Type 1 requiring a greater complexity of care. Type 2, though, is far more common, which may lead you to erroneously default to E11 out of habit. This error can undermine vital treatment of your residents with Type 1 diabetes.

Tip 2: Look at Control
Joy Dugan and Jay Shubrook, authors of International Classification of Diseases-10 Coding for Diabetes, suggest looking at the level or degree of diabetes control.

ICD-10 does not include explicit references to controlled or uncontrolled diabetes. However, the level of control is indicated as a complication in the fourth and fifth characters: EXX.64X in the case of hypoglycemia (blood sugar levels below 70 mg/dl), and EXX.65 for hyperglycemia (blood sugar levels above 130 mg/dl).

Another fourth character, 9, indicates that the condition is controlled (e.g. E10.9 (Type 1 diabetes mellitus without complications)). But using 9 “should be the exception rather than the rule,” according to Dugan and Shubrook, “given that most people with diabetes have either suboptimal control, complications, or both.”

Tip 3: Note Insulin Use
Type 1 diabetes is understood to be insulin-dependent, and some of your residents with Type 2 diabetes may also require insulin to manage their condition. Neither E10 nor E11 include corresponding drug use instructions. You’ll want to choose from two codes:

Z79.4 (Long term (current) use of insulin) or
Z79.84 (Long term (current) use of oral hypoglycemic drugs) when coding diabetic residents.
Note: In the above code descriptions, “long term” refers to drug therapy intended for an extended period. You can report the appropriate code as soon as drug treatment begins.

Tip 4: Consider Complications
The complications associated with diabetes are seemingly endless, which makes capturing them tricky. Look through your provider’s documentation for all manifestations directly caused by the diabetes (e.g., retinopathy, hearing loss, neuropathy, feet ulceration, hypertension, etc.).

Many of these conditions can be coded with the following fourth-digit E10 and E11 subdivisions:

EXX.1- – … with ketoacidosis
EXX.2- – … with kidney complications
EXX.3- – … with ophthalmic complications
EXX.4- – … with neurological complications
EXX.5- – … with circulatory complications
EXX.6- – … with other specified complications (includes musculoskeletal, oral, and skin complications; hypoglycemia; and hyperglycemia)
EXX.8- – … with unspecified complications.
The only exception to this sequence is E11.0- (Type 2 diabetes mellitus with hyperosmolarity), as this complication, where extremely high blood sugar levels occur without the presence of ketones, is unique to Type 2 diabetes.

Tip 5: Remember Comorbidities
To clarify the distinction between complications and comorbidities, complications of a disease are adverse events occurring after a diagnosis of the disease — and for which the disease is the underlying cause of the subsequent conditions. Comorbidities describe medical conditions that exist at the time of diagnosis or later develop in conjunction with the disease but without a direct, causal relationship.

Reporting the comorbidities that accompany the diagnosis of diabetes is important, as these add heightened risks to your residents’ health and will require more intensive care. In terms of reimbursement, with payments increasingly risk-adjusted, improved specificity of diagnosis documentation and coding will help you collect the revenue you deserve.

Common comorbidities include:

E66.- – Overweight and obesity
E78.- – Disorders of lipoprotein metabolism and other lipidemias
I10 – Essential (primary) hypertension
L97.- – Non-pressure chronic ulcer of lower limb, not elsewhere classified.
Note: Don’t overlook obesity, which goes hand in hand with Type 2 diabetes. Be sure to code BMI (body mass index), as well.

Bottom line: Report as many codes as necessary to describe all complications and associated conditions. Sequence these codes based on the reason for the encounter.

Source:

Benefit from our diabetes coding tutorial before PDPM implementation when ICD-10 coding becomes critical to your SNF's financial future.

19/04/2019

Coding of Diseases Being Reported in the Main Street News

Diseases and procedures are hitting the news.

Last week, the Food and Drug Administration (FDA) announced that 35 people had reported seizures (R56.9) after using electronic ci******es (F17.290). The seizures were considered adverse events and involved children and young adults. Seizures are possible side effects of ni****ne poisoning (T65.221-). The agency is requesting consumers to report any issues with e-ci******es. Seizures have been reported by people who vaped for the first time and regular users.

In reviewing the coding, it was interesting that there is no adverse reaction code for ni****ne. The code above is for accidental poisoning.

The United States declared the elimination of measles in 2000, but almost 400 cases have been reported from Jan. 1-March 28, across 15 states. There are currently six outbreaks happening in the United States, which include Rockland County, N.Y.; New York City, Washington state, Santa Cruz County, Calif.,; the state of New Jersey, and Butte County, Calif.. These outbreaks have been attributed to travelers bringing the disease from foreign countries. The people who contracted measles were unvaccinated.

A story from Sacramento, Calif. was published regarding 200 people who were exposed to measles, as a child in the emergency room of a local hospital was diagnosed with the disease. The patient was initially thought to have the flu, but was later diagnosed with measles. The ICD-10-CM code for encounter for vaccination is Z23.

The Centers for Disease Control and Prevention (CDC) has announced the makeup of the 2019-2020 flu tri-valent vaccine, which will cover:

A/Brisbane/02/2018 (H1N1)pdm09-like virus (J10.1)
A/Kansas/14/2017 (H3N2)-like (J09.X2)
B/Colorado/06/2017-like Victoria lineage (J11.1)

The quad-valent will add coverage for B/Phuket/3073/2013-like (Yamagata lineage).

The CDC had a delay in selecting the H3N3 vaccine component. It is not known if the delay will impact the timing or availability.

When coding this condition, it is important to remember that associated manifestations such as pneumonia, other respiratory conditions, and gastrointestinal issues will change the code.

For the past five years, public health researchers have been trying to identify the responsible virus that causes acute flaccid myelitis (AFM). The researchers need to understand the triggers and how it works in order to develop a vaccine. Currently, it is believed that non-polio enteroviruses (EV-D68) are the culprits. It is particularly troubling that this virus occurs every other year – 2014, 2016, 2018 – and the rate of occurrence is rising. The researchers are now looking at spinal fluid for the virus antibodies rather than the virus. They are also reviewing AFM patients’ genetic histories to understand why some children are susceptible. The goal is to be prepared to diagnose and treat the disease in case it returns in 2020.

There was not a proposed code for AFM in March, but perhaps in September, a proposed code will be submitted.

Mick Jagger underwent transcatheter aortic valve replacement, TAVR, on April 4. The femoral artery was used to access his aortic valve. His tour will now begin in July rather than this month, as initially planned. Due to the minimally invasive procedure, he’ll be dancing in the streets after a short recovery time.

The ICD-10-PCS code is dependent on the type of material used to replace the valve. PCS includes autologous material, zooplastic, synthetic material, and nonautologous material.

Source:

Diseases and procedures are hitting the news. Last week, the Food and Drug Administration (FDA) announced that 35 people had reported seizures (R56.9) after using electronic ci******es (F17.290). The seizures were considered adverse events and involved children and young adults. Seizures are possibl...

08/04/2019

15 things to know about medical coding

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Medical coding is a key component of revenue cycle management. When done efficiently and accurately, it helps ensure hospitals are properly reimbursed for the services they provide.

Here are 15 things to know about medical coding:

1. AAPC, formerly known as the American Academy of Professional Coders, describes medical coding as “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.” The codes are from transcription of physician’s notes, laboratory and radiologic results or other medical record documentation.

2. Medical coding professionals take information from the medical record documentation and assign appropriate diagnoses and procedure codes, according to AAPC. They then develop an insurance claim, which indicates how much the insurer owes for the care and helps determine how much the patient will be billed.

3. The AAPC notes that medical coders are not the same as medical billers. Medical coders use classification systems to assign codes, including the International Statistical Classification of Diseases and Related Health Problems. Medical coders may also audit and re-file appeals of insurance claim denials. Medical billers process and follow up on claims.

4. Accurate coding of claims requires correct clinical documentation. Coders are unable to assign proper codes when documentation is incorrect or lacking, which could result in a claim being denied by an insurer.

5. In 2018, the most common medical coding errors identified by the American Medical Association were unbundling codes, or using multiple current procedural terminology codes for parts of a procedure, and upcoding.

6. The first medical coding system, introduced by French physician and statistician Jacques Bertillon in the late 1800s, was known as Bertillon Classification of Causes of Death, reports The New York Times. The system was used to classify and track mortality.

7. Dr. Bertillon’s system was renamed the International Statistical Classification of Diseases, Injuries and Causes of Death in the 1940s, reports The New York Times. It is now known officially as the International Statistical Classification of Diseases and Related Health Problems, or ICD, and has continuously been updated.

8. The U.S. currently uses ICD-10, which launched nearly two decades ago but has only been used in this country since October 2015. In June 2018, WHO released a version of ICD-11. The organization said on its website that it expects to present ICD-11 to the World Health Assembly this year for adoption by countries.

9. The number of medical records and health information technicians, which includes medical coders, is projected to grow 13 percent between 2016 and 2026, according to the U.S. Bureau of Labor and Statistics. There were 206,300 such jobs in 2016, and 234,100 are projected for 2026.

10. The average annual salary for medical coders is based on the person’s credentials, as well as where they work and their job responsibility, according to AAPC. The association estimates the average annual salary is $52,441. According to AAPC, the average medical coder with no certification earns about $45,035 annually compared to about $51,477 for those with one certification.

11. Certified coder/medical coding technician is among the most sought-after healthcare jobs this year, according to a salary guide from staffing firm Randstad US.

12. Medical coders don’t have to have bachelor’s or master’s degrees, but they must be well-versed when it comes to anatomy, physiology and medical terminology education, according to AAPC.

13. Patty Buttner, director of health information management practice excellence for the American Health Information Management Association, told Becker’s coding professionals also need to be involved in the revenue cycle, need to know the impact of their job on the organization, and must work in collaboration with colleagues such as clinical documentation improvement professionals and quality staff.

14. Ms. Buttner’s advice for hospital revenue cycle leaders is to ensure their organization has an internal auditing process in place.

“That’s so vital to identify and correct any issues that may be related to coding [and] make sure the most quality and accurate work is going out the door,” she said. “You really want those codes to represent the whole story of that patient.”

15. Additionally, Ms. Buttner stressed the importance of continuing education for medical coders. She said healthcare organizations must support these professionals in their education endeavors so they can be informed and grow in their job.

Source: http://medicalcodingnews.org/15-things-to-know-about-medical-coding-2/

28/03/2019

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25/01/2019

Core2Code is grateful for all the Alumni's who rated us as Best Medical Coding Academy (4.9/5).

Cheers to Trainers, Placement Coordinators and HR's..