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I am a student at Penn Foster Career School, taking Medical Billing and Coding. I also just became a new member to AAPC. I am in the middle of my studies with Medical Coding 1 Section and in one of the exercises there is an review question that states there is an E code but I don't understand how?

Review Question: "A patient is admitted with uncontrolled nausea and vomiting after chemotherapy treatment for lung cancer?

There is nothing specific about drugs per say but the there is an E
code of 933.1? The only thing mentioned was "chemotherapy treatment";
so what determines the E code?

As I am doing my exercises per each section of my studies, I am finding the correct codes (when there is more than one diagnosis); but I place the codes in wrong the sequence. Is there an easier way to remember a word or something to make the right determination in coding; from first or secondary diagnosis' or when to use the V or E codes when you don't receive any clues such as given in some of the exercises?

I am determine to get this right and make it as a coder. Thanking you in advance.
 
yllek521@gmail.com said:
I am a student at Penn Foster Career School, taking Medical Billing and Coding. I also just became a new member to AAPC. I am in the middle of my studies with Medical Coding 1 Section and in one of the exercises there is an review question that states there is an E code but I don't understand how?

Review Question: "A patient is admitted with uncontrolled nausea and vomiting after chemotherapy treatment for lung cancer?

There is nothing specific about drugs per say but the there is an E
code of 933.1? The only thing mentioned was "chemotherapy treatment";
so what determines the E code?

As I am doing my exercises per each section of my studies, I am finding the correct codes (when there is more than one diagnosis); but I place the codes in wrong the sequence. Is there an easier way to remember a word or something to make the right determination in coding; from first or secondary diagnosis' or when to use the V or E codes when you don't receive any clues such as given in some of the exercises?

I am determine to get this right and make it as a coder. Thanking you in advance.
Click to expand...

An E code will NEVER be the primary diagnosis code-these codes supply the what/where/how information, usually for accidents or poisonings. The symptom or condition (i.e nausea, fracture) would be coded first. I would suggest really reading the first section of your ICD-9 book and going through with a highlighter-this section provides the how to assign codes and tells why. Sometimes when coding, you won't be able to code a V or E code if the information is not documented-remember the Golden Rule of coding: "not documented, not done!". Good luck. :)
 
The patient is having an adverse reaction to the chemo, so yes you need the E code. Anytime a patient has a reaction to a therapeutic substance you need an E code listed secondary. You find them in the table of drugs and chemicals in your code book. For this case look under chemotherapy and follow then over to the column for adverse effect. When coding adverse effects you always code the problem first followed by the E code for the adverse effect by drug.
When coding poisoning which is taking a therapeutic substance incorrectly you follow over to the column for poisoning and then to whether the patient intentionally meant to do harm (suicide) or whether the outcome was unintentional. The the poisoning is first listed followed by the problem followed by the E code.
V codes are often misunderstood. V codes mostly, though not always, indicates a asymptomatic patient accessing health services, such as screenings, follow up encounters, aftercare, etc. I tell my students that when they look at a note and can say to themselves, " there is nothing wrong with this patient" then it usually means a V code will be first listed.
 
Ms. Mitchell, thank you so much for the information, I will work harder on developing a more understanding of the problems per case and research the proper code on the information you provided.

If you can clarify on what I am doing wrong when I have two or more diagnosis but I seem to reverse the sequence on how they should be listed, I follow the rule on "with" or "due to" but still list the codes in the incorrect order. What can I do to understand the description of the case? Thanking you in advance.
 
when coding something such as diabetes with manifestation , you always code the underlying causal condition first, in this case the diabetes.
sometimes this is not the case and chapter specific guidelines will have priority, such as pain (338.xx)
even though the pain is due to an underlying condition, when coding an encounter for pain management you list the 338.xx code first followed by the condition that caused the pain or the site specific code such as 715.xx or 719.xx.
The coding guidelines are in the front of the code book and are also on the CDC website
http://www.cdc.gov/nchs/icd.htm
look under the ICD-9 CM tab and click on the choice for guidelines
you need to read these and know what is in them it will assist you greatly, especially with dx code order.
 
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