Hi everyone, how are you today? Welcome back and if you are new here, welcome to my channel where you can learn the real world coding experience and this is Hong, the coding expert. If you want to pass any coding exam to start your coding career or if you are already holding a coding credential, working in the field and want to learn more in order to advance your coding profession then you are in the right place.
Practice is one of the keys to success. No matter how smart or talented you are, you are likely to forget the basic things if no practice is done. It is an important tool to being successful and it sure will help you to pass the coding exam. When you practice more often, you will make fewer mistakes and as a result, you will feel more confident about taking the exam. Have you noticed that in each and every single video lesson that I make, I always present coding questions or case studies and I want you to open your book and practice.
Slowly but surely you get there. I believe who heartedly you all will pass the CBC exam and all you need is a little inspiration, determination, And last but not least is your consistent practice. With all that being said, today's video is about the case studies for the new 2022 CPC exam. I use these case studies to help you focus more on the RC10CM official coding guidelines which is the area that 10 questions will focus on. Alright without further ado, let's get started.
This is the homework from the previous video that I wanted you to try and the purpose of this homework is to test your knowledge of IC10CM official coding guidelines. If you already watched my video titled Adverse Effect vs. Bolsening, then you should be able to answer this question in less than one minute without opening your book to look up any single code. Assuming you already watched that video and took notes, then your first step is to find out whether this case is about the echo effect of drugs or a poisoning.
Patient admitted with syncope due to taking valium in combination with an over-the-counter antihistamine taken as directed on the packet but without consulting a doctor. Based on what I just read and highlighted, syncope caused by taking Valium, a prescription medication, in combination with over-the-counter medication without consulting the prescribing physician is coded as abortion. And here is the IC10-CM official coding guideline. Examples of poisoning include First, error was made in drug prescription. Errors made in drug prescription or in the administration of the drug by providers, nurse, patient, or other person.
Second, overdose of a drug intentionally taken. If an overdose of a drug was intentionally taken or administered and resulted in drug toxicity, it would be coded as a poisoning. Third, non-prescribed drug taken was correctly prescribed and properly administered drug.
If a non-prescribed drug or medicinal agent was taken in combination with a correctly prescribed and properly administer the drug, any drug toxicity or other reaction resulting from the interaction of the two drugs would be classified as a poisoning. And this was exactly what happened in our case. On-prescribed medication interact with other non-prescribed over-the-counter medication and cause the syncope.
Four. Interaction of drugs and alcohol When a reaction results from the interaction of a drug or drugs and alcohol, this would be classified as poisoning. It's almost always that you will be dealing with this coding guidelines in any coding exam whether inpatient or outpatient and either from AAPC or AHIMA.
So you got to know this coding guidelines. Now let's go back to our case. Based on the IC10CM official coding guidelines, this is classified as a poisoning, so we must follow their coding rules in which the first code or codes must be the poisoning codes or T-codes followed by additional codes for all manifestations of poisoning.
In other words, the signs and symptoms are codes and in this case it is the syncope. If you look at this four possible answers, only C had two T-codes for portioning of two septic rocks sequence first and followed by an R-code for a manifestation and in this case it's the syncope so it is the right choice. That said the correct answer to this case is C.
T42.x1a, T45.0x1a, and R55. Now, you understand why I want you to know the IC10CM official coding guidelines. Apparently in this case, if you already know this coding guideline, then you don't even have to open your book, and yet you're able to narrow down the correct answer.
I am carefully selecting my case study so that I can introduce the assistant official coding guidelines and help refresh your memory. I hope you like it. Alright, let's move on to the next case.
Case number one. If you have been watching my videos, then you should know my reverse analysis. In other words, my backward approach by now. Once you master this technique, then the process of elimination will be much more manageable.
Running out of time is one of the most frustrating things about taking the exam and it's also the main reason why many people fail the coding exam. For example in this case, you have to read a long operative report. In addition, there are many goals in the answer that you have to look up in your IC10 and CBT books. But you only have about 5 minutes to tackle this case if you follow my advice and not spending too much time on the medical terminology, ANP, compliance and regulatory questions.
Otherwise, you will only have about 2 minutes and 40 seconds for each question based on my calculation as you already know. So what will be your approach to tackle this case? Do you start reading the op report first? By the time you finish reading the op report and trying to understand what they are doing, your five minutes have gone.
You don't even have a chance to look up a single code, let alone find the correct answer. Not to mention, you probably don't have a clue what you are reading if you are not a coder or never coded. this time of surgery before.
My reverse analysis, in other words, my backward approach, will help solve this problem. You analyze the answer first and then read the op report after. And I am the one who developed this technique when I was in school. Many of you who use my backward approach have already passed the exam successfully. Follow my tips and strategy.
A and C have the same code, K40.90, so they are in the same group. B and D also have the same code, K40.91, so they are in the separate group. Now you know, there are two groups, so there are two codes for you to look up in Yashiten's same book, K40.90.
and pay 40.91 Please pause the video and do it now. Assuming you already looked them up in your IC10CM book and here's what you find. K40.90 unilateral in junior hernia without obstruction organ green not specified as recurrent.
K40.91 unilateral in junior hernia without obstruction organ green recurrent. Follow my tips and strategy, you highlight the main difference between each diagnosis code and when you're done you can tell both codes are for unilateral, inguinal hernia without obstruction or gangrene. And the only difference is K40.90 is not specified as recurrent versus K40.91 is specified as recurrent. After you're done highlighting, you should have an idea what your focus is and now is the time for you to read the op report and find out.
Let's read it. Preoperative diagnosis, right direct inguinal hernia. Postoperative diagnosis, right direct inguinal hernia. Based on the post-op diagnosis, in other words, the diagnosis discovered or confirmed during the surgery, this patient has a right direct inguinal hernia and not specified as recurrent.
Therefore, K40.90 unilateral in unihonior without obstruction of gangrene not specified as recurrent is the right code to use for this diagnosis. That said, we can eliminate B and D from here. A and C still remain and they both have D17.6 and CBT.
49505 so we cannot use these two codes for our process of elimination. The only difference now is C has CPT 55520 with modifier 59 which H doesn't have. So please pause the video, open your CPT book and look it up now. I wait for you. Assuming you already looked it up in your CBT book and here's what you find.
55020 excision of lesion of spermatic core separate procedure. Now your job is to find out if an excision of spermatic core is performed. For your own knowledge, when you dissect an operative report, whatever you see in the specimen It means that tissue or lesion is already excite or being cut.
And in this case, lipoma of core is listed in the specimen. So it already gives you a clue that this procedure excision of spermatic core is actually performed. However, we still want to go one step further to confirm.
So let's go back to the op report. Operation right in junior herniography. Well, they want to trick you by not listing the excision of spermatus cor in the operation title.
But because you are coning with harm, so you know it better by checking the body of the operative report. Your focus now is the key term lipoma excision or excision. So you don't have to read every single word, just scan the report real quick and bam here it is. Lee Poma off the call, what a 63 and claim at its pace and excite. Based on what I just read and highlighted.
The lipoma of the core was dissected so 55020, excision of lesion of spermatic core is the right code to use for this surgical procedure and because it is distinct from the hernia repair so it can be report with modified fitness attached. Therefore the correct answer to this case is C, K40.90 D17.6, CPT49505RT and CPT55520 with modified 59 attached. Case number 2, follow my tips and strategy. A and C have the same code C44.1191 so they are in the same group.
B and D also have the same code. C44.1121 so they are in a separate group. Now you know there are two groups so there are two codes for you to look up in Yashiten's same book C44.1191 and C44.1121.
Please pause the video and do it now. Assuming you already looked them up in your IC10 CM book and here's what you find. C44.1121 Basal Cell Carcinoma of Right Upper Eyelid including Cantus and C44.1191 Basal Cell Carcinoma of Left Upper Eyelid including Cantus. Follow my tips and strategy.
You highlight the main difference between each diagnosis code and when you're done, you can tell both codes are for the basal cell carcinoma. However, C44.1121 is for the right upper lid versus C44.1191 is for the left upper eyelid. Now you should have an idea what your focus is.
When you read the op report, let's read it. 60 year old man with a diagnosis of basal cell carcinoma of the eye on a session of basal cell carcinoma of the right upper eyelid was performed. Based on what I just read and highlighted, this patient presented with a basal cell carcinoma of the right upper eyelid So C44.1121 basal cell carcinoma of the right upper eyelid is the right code to use for this diagnosis. That said, we can eliminate A and C from here. B and D still remain.
And the only difference between them is B has CBT11643 and D has CBT11643. 11443. So please pause the video, open your cpt book and look them up now. Assuming you already looked them up in your cpt book and because 11443 is an identical so I'll show you each parenchal. 11440 excision, other benign lesion including margins, face, ears, eyelids, nose, lips, excise diameter 0.5 cm or less. 11443 this is an identical so it includes all the information from the curve above 11440 would ease the parent curve except 11443 issue when the excise diameter of a benign lesion between 211 to 230 centimeters.
Similarly 11640 excision malignant lesion including matching phase is I list no slip, excise diameter 0.5cm or less. 11643 this is also an identical so it includes all the information from the curve above. 11640 what is the parent curve? except 11643 is used when the excise diameter of a malignant lesion between 2.1 to 30 centimeters.
Follow my tips and strategies, you highlight the main difference between each diagnosis code and when you're done you can tell 11443 is you if the lesion is benign lesion versus 11643 can be used only if the lesion is malignant. Now you know what your focus is. When you read the report, what is to find out whether the lesion is benign or malignant?
An excision of basal cell carcinoma of the right upper eyelid was performed with an excise diameter of 2.5 cm and single layer closure. Based on what I just read and highlighted, it is a malignant lesion. basal cell carcinoma and an excise diameter measured 2.5cm, so 11643 is the right code to use for this procedure. Having said that, the correct answer to this case is B C44.1121 and CBT 11643 with modified E3 attached for the right upper eyelid. Case number three.
This case is related to chemotherapy and cancer treatment and if you have been watching my videos and taking notes then you should be able to nail this case in one or two minutes. For those of you who are new to my channel you should watch my video titled Neoplasm confusion with cause E first and learn how to call neoplasm to deal with these cases. Instead of analyzing the answer first as you normally do following my strategy, the better approach is to read the report and find out what is the main reason to bring them into the hospital.
In this case, the patient is a 75 year old male who arrives today for his scheduled chemotherapy treatment. Based on what I just read and highlighted, this is his plan and schedule chemotherapy treatment and based on the IC10-CM official coding guidelines. If a patient admission or encounter is solely for the administration of chemotherapy, then G51.11 encounter for anti-neoplastic chemotherapy is listed first.
and also the principal diagnosis. As a coder, you got to remember this IC10-CM official coding guideline. So I'll say it again. If a patient admission or encounter is solely for the administration of chemotherapy, then G51.11 encounter for antineoplastic chemotherapy is listed first. and also the principal diagnosis.
That being said, if you look at these four possible answers A, B, C, D, only B and D have G51.11 and count for chemotherapy enlisted first, so one of them will be the correct answer. C also has G51.11 but it's not listed first and A doesn't have C51.11 so they are not the correct answer. That said, we can eliminate A and C from here. B and D still remain. Now if you are coding with Hong and getting smarter and smarter every day, then based on just this sentence, he's being treated for metastatic prostate cancer to liver and lung.
The prostate cancer has spread to the liver and lung. So you need to have three additional codes right behind G51.11. One code for his primary prostate cancer, one code for the secondary liver cancer, and one code for the secondary lung cancer.
And because there is no documentation to indicate that the prostate cancer has been excised or no longer receive any treatment, so we cannot use any code. in the category G85 for personal history of malignant neoplasm. I did mention G85 in case number 4 in my last video.
Now if you look at these two possible answers B and D, D has G85.46 for personal history of malignant neoplasm so it is not the right choice. Therefore, The correct answer to this case is B. However, for the purpose of learning and just in case you are new to my channel, I will approach using my routine strategy to illustrate that you are still be able to narrow down the correct answer. B and D still remain and they both have C 78.00 and C 78.7. So we cannot use these two codes for our process of elimination.
The only difference now is B has C61 and this has G85.46. So please pause the video, open Yashitenshin book and look them up now. I wait for you.
Assuming you already looked them up in Yashiten's same book and here's what you find. C61 malignant neoplasm of prostate, G85.46 personal history of malignant neoplasm of prostate. Follow my tips and strategy, you highlight the main difference between each diagnosis code and when you're done you can tell C61 is for an active prostate cancer versus G85.46 is for a personal history of prostate cancer and this code can only be used if the prostate has been previously excised or eradicated and there is no occurrence of further treatment.
Now based on the report he is still being treated for metastatic prostate cancer so C61 is the right code to use for his diagnosis. Therefore the correct answer to this case is B. G51.11, C61, C78.00 and C78.7.
By the way, for your own knowledge, if you are coding with harm, then you should know any RC10 CM code starting with the letter R. A for sign symptom, letter S is for injuries, letter T is for burns and poisoning, and letter C is for cancer. You should take note because someday this will come in handy.
Just a friendly reminder that if you enjoy what you have learned so far and appreciate my time spent for this video, then you could please pause the video, click the like, Subscribe and share buttons below now to support my channel and that would be great. I really want you to do well on the new exam this year and also to have more confidence at work. Thank you so much for your support and we should move on to the next question.
Case number four. Follow my tips and strategy. B and C have the same code. j96.00 so they are in the same group.
A and D have different codes j96.20 and i50.9 so they are in the separate group. Now you know there are three groups so there are three codes for you to look up in your IC10 CM book j96.20 j96.00 and i50.9 Please pause the video and do it now. Assuming you already looked them up in the IC10-SAM book and here's what you find.
I50.9 have failure unspecified. Conjective heart failure J96.00 acute respiratory failure unspecified whether with hypoxia or hypercapnia. J96.20 acute and chronic respiratory failure unspecified whether with hypoxia or hypercapnia.
Follow my tips and strategy to highlight the main difference. between each diagnosis score and when you're done you can tell the only difference between J96.00 and J96.20 is J96.00 is for acute respiratory failure versus J96.20 is for acute and chronic respiratory failure and I50.9 is for congestive heart failure unspecified. Now you should have an idea what your focus is when you read the report. Let's read it. A patient with acute respiratory failure, hypertension and congestive heart failure is admitted for intubation and ventilation.
Based on what I just read and highlighted, this patient presents with acute respiratory failure. and being admitted for intubation and ventilation. This is a very serious medical condition when the lungs cannot get enough oxygen into the blood. Buildup of carbon dioxide can also damage the tissues and organs and as a result it can be fatal.
Having said that in this case acute respiratory failure is the principal diagnosis because it was the condition that's called the admission. So J96.00 is the right code to use for this condition. That said we can eliminate A and D from here. B and C still remain and they both have I50.9 so we cannot use this code for our process of elimination. The only difference now is B has i10 and C has i11.0.
So please pause the video, open Yashitenshin book and look them up now. I wait for you. Assuming you already looked them up in Yai Shi Teng Shi book and here's what you find. I10 essential primary hypertension and I11.0 hypertensive heart disease with heart failure.
Based on the question, this patient also presents with hypertension and congestive heart failure. So the question is Can we use the combination code or combo code I11.0 for both hypertension and congestive heart failure? Based on the IC10-CM official coding guideline under Chapter 9, disease of the circulatory system I00 to I99, hypertension, the classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement. As the two conditions are linked by the term worth in the alphabetic index, these conditions should be coded as related even in the absence of provider documentation explicitly linking them unless the documentation clearly states the conditions are unrelated. In other words, they allow you to use the combination curve To link these two conditions, hypertension with heart failure and also hypertension with kidney failure, you don't have to query the physician for the causal relationship.
If you are an inpatient or DIG coder, then you got to know this coding guideline. They also go one step further, hypertension with heart disease. Hypertension with heart disease classified to I50 or I51.4 to I51.7, I51.89, I51.9 are assigned to a call from category I11. Hypertensive heart disease use additional calls or calls from category I50 heart failure to identify the types of heart failure in those patients. with heart failure.
In other words, they advise us to use code in category I50 as an additional code. Now let's go back to our case. Based on the IC10-CM official coding guideline, you have to use both the combination code I11.0 for hypertensive heart disease with heart failure and I50.9 For conjecture half field, having said that, the correct answer to this case is C, J96.00, I11.0 and I50.9. If you are currently taking my free basic coding class, then inside my course, you find the link to download the new 2022 IC10CM official coding guidelines PDF file. On a different note, for inpatient or DIG coder and also for your knowledge if this patient presents with both acute respiratory failure and acute congestive heart failure and both conditions are equally treated and responsible for the patient admission to the hospital then either condition can be designated as principal diagnosis and as a result it will change the DIG assignment.
But it's not in this case. The patient's heart failure is stable on current medication. I hope you get my point. Let's move on to the last case. Case number 5. Follow my tips and strategy.
B and D have the same code. K21.9. So they are in the same group. A and C have different codes. K20.90 and K21.00.
So they are in two separate groups. Now you know there are three groups. So there are three goals for you to look up in your IC10CM book. K20.90, K21.9 and K21.00. Please pause the video and do it now.
Assuming you already looked them up in your Accident Science book and here's what you find. K20.90 esophagitis unspecified without bleeding. K21.00 gastroesophageal reflect disease with esophagitis without bleeding.
And K21.9 gastroesophageal reflect disease without esophagitis. Follow my tips and strategy, you highlight the key difference between each diagnosis code and when you're done, you can tell the only difference between K21.00 and K21.9 is with or without esophagitis and K20.90 is for an unspecified esophagitis. Now you should have an idea what your focus is when you read the question.
our report. Let's read it. A patient with GERD present to a facility for upper endoscopy submucosal injection of flexiglass into the lower esophageal lining.
Based on what I just read and highlighted, this patient presented with GERD and it stands for gastroesophageal reflex disease and there is no documentation of esophagitis so we have to use K21.9 gastroesophageal reflex disease without esophagitis for the patient condition. That said we can eliminate A and C from here. B and D still remain and they both have CBT 43236 so we cannot use this code for our process of elimination. However this has 43235 which B doesn't have.
So please pause the video, open your CBT book and look it up now. I wait for you. Assuming you already looked it up in your CBT book and because 4-3-2-3-6 is an identical, so I'll show you its parent code. 4-3-2-3-5 iso-phasio-gastro-diuretoscopy, flexible, trans-oral, diagnostic, including collection of specimen by brushing or washing when perform subject procedure.
4-3-2-3-6 This is an identical so it includes all the information from the cover ball 43235 which is the parent code except 43236 is performed with directed submucosa injection any substance and based on the report our patient Whitgert presents to a facility for upper endoscopy submucosa injection of plexiglass into the lower isofascial lining. So 43236 is the right code to use for this procedure. EZD with directed submucosa injection of plexiglass into the lower isofascial lining. That said the correct answer to this case is BK21.9 and CBT 43236. Now you understand.
With my reverse analysis, in other words, my backwork approach, you will minimize the number of calls that you have to look up in your RC10CM and CBT books and as a result, it will save you a lot of time during the exam. This is your homework, I really want you to try and the purpose of this homework is to test your knowledge of RC10CM official coding guidelines. Remember, practice makes perfect. This patient was admitted for chemotherapy due to a primary casinoma of the right transplanted kidney. What cause should be reported?
I will go over it in the next video. That is all for today. Thank you so much for watching, for liking, and sharing this video.
If you find this video is helpful, informative, and easy to learn with this format or if you have any suggestion then please leave me a comment below just to let me know. I really appreciate. Until next time, have a great day.