I’ll Tell You What I Really Thought

Featured Coffee – Simple Maple Latte

Have you ever reviewed an attendees (or presenter) list, recognized a particular name, and your energy level dropped?

Or, you have an upcoming training session, and you know one person who always disrupts your meetings will be there?

Well, as professionals, we know how to behave in unpleasant situations; however, this blogger shares what’s “Inside the mind of a medical coding auditor.”

What was I really thinking and feeling when I had to interact with an unreasonable coder?  Relax with a cup of Simple Maple Latte, and I’ll tell you what I really thought.

I had a training session scheduled with a group and a week before the meeting, they included another coder to the meeting list.

I experienced a challenging interaction previously with this coder, and I absolutely did not want her in my session.  She was so disruptive and disrespectful I had to end the session early because it was not productive.

I enjoy interactive sessions.  The more questions asked, the better the meeting is to me.  This coder, however, will interrupt me mid syllable and say things like, ‘that’s not true’ or ‘I disagree.’   When asked what is not valid or why she disagrees, she won’t respond.  It’s incredibly frustrating to me.

As a professional, I have to place my mask on and maintain my professionalism.  Over coffee with you, I can share what’s going on behind the mask. I have to resist the urge to stop the session and press this coder until she put into words what’s not true or why she disagrees. I know she doesn’t have answers.  She’s just a cynical and insecure person.  She feeds off of negativity, and her mission seems to be to spread her negative energy throughout the room.  I don’t like her attitude, and if given a choice, I would not allow her to attend my sessions.

My professional side prohibits me from showing or expressing how I really feel.  Here, I can remove the mask.

Thanks for joining me for coffee and allowing me to share what I really thought.

 

 

 

Read the Instructional Notes

Featured Coffee – Healthy Coffee Smoothie

I just have to talk about this smoothie before we get into ICD® instructional notes.  It is awesome!  I’m getting the healthy benefits from the ingredients in the smoothie while satisfying my coffee craving.

I experienced one of my most frustrating interactions with a coder recently.  The coder was arguing an ICD-10-CM® guideline, but his argument was only based on his opinion, not a guideline or instructional note.

According to the coder, the ICD code for a pre-procedural exam should be coded according to the planned surgical procedure, not the type of pre-procedure exam performed.  His example was a patient who has a pre-operative chest X-Ray for a scheduled cardiac procedure.  His position was the chest X-Ray should be coded with diagnosis code Z01.810® – Preoperative cardiovascular exam, because the surgical procedure was planned for the cardiovascular system.

I reminded him that the preoperative exam is performed to assess or identify any conditions or abnormal findings that may place the patient at risk for the surgery or anesthesia.  The Z-code is the primary diagnosis, and the condition that requires surgery may be reported as an additional diagnosis.   Of course, any clinically relevant findings should also be coded.

Then I asked, “What if the patient has a pulmonary function test before a scheduled hysterectomy?  According to your logic, what pre-operative diagnosis would be appropriate?” Indeed, it went downhill quickly.

I asked him if he read the instructional notes, and he didn’t respond.  I advised him to refer to the notes, and then we could have a discussion.  He actually told me there was no need for him to read the instructions because what he stated made perfect sense.

I opened my ICD-10-CM®, and we had storytime.  “Long ago, in a faraway town, some knowledgeable people…”  I absolutely did do storytime, but long story short, by the time I was done, he shifted his “opinion.”

So, in case you want to know the “instructional notes,” and how I helped him understand, here goes.

Z01 in ICD® has a note, “Codes from category Z01 represent the reason for the encounter”, and we know the reason for the encounter is the preoperative exam.  As a result, that takes us to Z01.81®_, which includes codes for the types of pre-procedural examinations performed – cardiovascular, respiratory, laboratory, and other.

Therefore, the bottom line is, assign the appropriate Z-code for pre-procedural examination based upon the type of exam performed for surgical clearance, not the planned surgical procedure.

I discovered a valuable tool on the WHO site.  They have ICD 10 online training available.  Check it out, it’s well worth the time!

 

 

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10_CM®)

ICD-10® is copyrighted by the World Health Organization (WHO)

You Again?

Featured Coffee – Jamocha Almond Fudge

Years (at least ten) after I was escorted off of the premises, I was contracted as a coding consultant for another company.  Remember the coding manager from Incident-To?

Well, she walked into my office!

She was a new hire as a coder for this company.  She told me she had been out of the industry for quite a few years (big surprise there, huh?), and neither of us mentioned the Incident-To incident.  She actually said that she was looking forward to working with me, and she knew she would learn a lot from me.

Hmmph.

So, the moral of this story is to treat everyone with respect.  You never know who may end up on top.