Please let me know what I did wrong...

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I recently applied for a coding position and was given a test to judge my coding abilities. After taking the test, I was told that while the codes I assigned were correct, I left off several CPT/ICD-9 codes and modifiers. Can you please help me where I went wrong? Here's 3 examples from the test:

1. A 14 yr old boy came in with a painful right wrist after falling due to being tackled during a football game at school. X-rays were performed which were negative for a fracture. The physician applied an immobilization splint and documents wrist sprain. Assign all appropriate diagnostic and procedure codes, excluding E/M.
I coded: 959.3, 842.00, E886.0, E849.6, 29125-RT

2. A 56-year-old man with a history of coronary artery disease with angina presents to the ED with chest pain. The patient is not currently on any medications. The physician does tropinans and an EKG that reveals the patient is not having a myocardial infarction. The physician documents chest pain and refers the patient to his cardiologist.
I coded: 786.50, 414.00, 413.9, 93000

3. A 6-year-old male presents with left arm pain after falling off the trampoline in his yard. X- rays reveal a fracture of the shaft of the ulna and radius. The physician documents the fracture and performs a closed reduction, applies a cast, and refers the patient to an orthopedic service for follow up.
I coded: 959.3, 813.23, E884.0, E849.0, 25560-LT
 

mmorningstarcpc

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I quickly glanced at this and noticed you didn't add in any ICD-9 procedure codes

I am unsure why you are remarking on the ICD-9 procedure codes. These most likely were done in the office or an OP setting. ICD-9 procedure codes are for IP only services.

Also, not sure what may have been indicated for coding, but did you miss the E/M coding? As I don't have the actual test or instructions, E/M is my first thought for missing codes. Also, radiology coding depending on where xrays were performed and/or interpretted. (Appropriate modifiers for E/M and xray also).
 
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The instructions stated: "Assign all appropriate ICD-9-CM diagnostic codes (including all applicable E codes) and both ICD-9-CM and CPT procedure codes including applicable modifiers (excluding E/M) to the following Emergency Department encounters"

After seeing your post regarding missing the ICD-9 procedure codes, I realize this is what I did wrong. The directions state to utilize this coding. I do have experience with ER coding and these codes were never required of me and so I didn't realize to code them.

My fault I suppose for not being completely thorough in reading the directions.

Thank you both so much for the help.
 

GaPeach77

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I am unsure why you are remarking on the ICD-9 procedure codes. These most likely were done in the office or an OP setting. ICD-9 procedure codes are for IP only services.

Also, not sure what may have been indicated for coding, but did you miss the E/M coding? As I don't have the actual test or instructions, E/M is my first thought for missing codes. Also, radiology coding depending on where xrays were performed and/or interpretted. (Appropriate modifiers for E/M and xray also).

I just had to reply. No insurance carrier is going to pay for a procedure if they do not know what the patient is having the procedure for. ICD-9 codes are mandatory for outpatient billing or you have a denied claim. That is Coding 101.
 

LTibbetts

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I think where dangill may be confused is the ICD-9 procedure codes. These are for inpatient only, and therefore, not requried for your ER examples. This is not where you went wrong. I believe that it is simply the modifiers for the EKG's, etc. Also, for the Ecodes, it is now required (by most at least for reporting requirements) to add the place of occurance ecodes, and if possible, the activities ecode. Maybe that is what they were looking for. And in an earlier reply to your post someone said something about modifiers for your x-rays (-26 or TC), which are also necessary.

You may not think that all of these add up to much for errors, but people who outsource coding often don't have time to train their coders and want someone who is extremely capable the first time around. They have to have perfection in order to please their clients as there is major competition out there for outsourcing and consultant firms, so it is impairative that they look good for their clients. -Not too add insult to injury or say anything negative towards you at all!! I'm sure that you are an excellent coder! This is only my experience with testing for these types of companies and I have managed to get some feedback from some of them and this is what I am told by them. Some are looking for something specific and they are not always very forthcoming about what that may be. Also, I don't think that coding directions are always clear to the person testing, as some want the professional side, some want the facility side, and some want both, and I don't think that that always comes across loud and clear.
 
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vj_tiwari

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Hey,

I observed your coding & marked some points, here are they...

1> Your ICD 9CM & CPT Knowledge is good (means you know how to reach for a correct code).
2> You also use modifiers & all that what needed.
3>But you're doing some minor mistakes viz., when you coded 959.3, 842.00, E886.0, E849.6, 29125-RT & 959.3, 813.23, E884.0, E849.0, 25560-LT then you need not to code Injury of same site with Sprain or Fracture. Even when most severe type of injury is present (Laceration, Wound, cotusion, Fx, Dislocation, Superficial injuries,Foreign body) then don't code for Injury code of same site again. And don't forgot to code new Activity codes with regular E codes.
4>Also when you've coded this 786.50, 414.00, 413.9, 93000 then, just observe the current coditions for encounter. Pt. comes with history of coronary artery disease with angina presents to the ED with chest pain. So Hx code for CAD & Angina with Chest pain (786.50).

I Appreciate you for coding the Place of occurance & all that ... be'coz when I started to coding I always made mistakes on that. That is just clear the basic of coding again & Fly.... :)

If you want any help please let me know...!

Hope this helps! :)

VJ.
 
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mmorningstarcpc

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I just had to reply. No insurance carrier is going to pay for a procedure if they do not know what the patient is having the procedure for. ICD-9 codes are mandatory for outpatient billing or you have a denied claim. That is Coding 101.

If you notice, I was referencing ICD-9 PROCEDURE codes, which are for IP only. As I stated above, it seemed that one responder thought they needed ICD-9 PROCEDURE codes, which you would not use as you are coding for OP procedures/services. You certainly would need to bill the ICD-9 DIAGNOSIS codes.
 
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