Wiki Practicode is so confusing

Wichita, KS
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I am brand new to medical coding. I just got certified but am yet to actually be employed in a coding position. I purchased Practicode to help me get some real-world experience because I didn't feel quite ready to start work. I feel like it is just confusing me more. I have lots of questions. I think it is partly that the Practicode is just set up REALLY poorly, but maybe you guys can help me out. Some of these questions may seem dumb, but keep in mind that I have ZERO real world experience and also am getting increasingly confused by Practicode.

1- First off, what do the forms look like when you are submitting codes? Are the they same as what Practicode is like for those who have done it?

2- Coding in Practicode is set up so that you only have room for up to 4 Dx codes, and it does not count them incorrectly if that is all you have despite the answer key (and instructions) stating that others are required. When you are coding IRL, you do use ALL the codes whenever they are applicable, correct?

3- When coding for more than one procedure, do you only apply the dx codes where they are relevant. IE- you have an emergency room visit for a dislocated shoulder and dehydration. On the E/M line you would code for both conditions, but on the procedure code for the shoulder, you wouldn't code for dehydration, correct? Practicode goes back and forth on what it requires for a "correct" answer on this.

4. Will it always say that you do or do not need to code external causes or is this just something you come to learn with different payers?

I am sure I will have more questions as I go. Thanks for your help!!!
Yes, I agree Practicode is poorly implemented. It could have been so much better. All your preparation for the exam has been about choosing the best of the multiple-choice codes provided. So, in that sense, this is more "real life" in that there are no hints or prompting. You are expected to abstract the info you need from the chart and find the codes on your own. The burden is on YOU to learn from it. When you code something incorrectly, you will need to look at your answer and theirs and try to figure out the difference and why they chose the code they did. I've learned a lot with that approach but am a little disappointed in the "rationale" provided in the answer key. It is often a copy-and-paste generic answer that doesn't provide any real insight.

As for your questions:
1) Whether you are completing an actual paper CMS-1500 form, entering the data into encoder software, or using an in-house form ... I'd say the format is more-or-less accurate. If you strip away all the billing details (insurance, patient, location, bla bla bla) what the "coder" needs to provide is the CPT, modifier, units, and dx. If you have separate billers, they can take it from there. They've just boiled the process down to its essence.

2) It depends. Our software only supports 4 dx per line ... there may be many more in the chart, but only 4 per line go out on the claim. The answer key is a little confusing at first because they are trying to give you some wiggle room. Suppose the chart has 7 dx (we'll just call them just A, B, C, D, E, F, Z) ... they have to able to accommodate users putting them in different orders. As you look at each row of the answer key and see several dx listed, those are all the accepted answers for that box. Some can't be first, so the "answer" for the first dx might list "A, B, C, D, E, F" but the second through fourth will include "Z" ... your answer would be correct as long as you have any of the 4 in an acceptable order (A,B,C,D or D,F,A,Z or B,Z,F,C) etc.

3) I hope someone else with more coding mileage chimes in here. I agree. At work we code what's "relevant" ... everything (or the top 4) on the E/M and what's relevant on everything else (if a patient has a sore throat and conjunctivitis you wouldn't code the conjunctivitis on the line with the Strep test)! Nevertheless, they do often want every dx on every line in Practicode. I've seen it require sleep apnea, back pain, or renal failure as a dx for an EKG. Really?

4) Yes and no. Practicode always tells you if it wants external cause codes. Other than that, they not required ... just "encouraged." Our office doesn't have any payers requiring them (yet)... but we fully code them if we can (if the provider collected the necessary info).

I'm chewing through the third module now. It can be a useful learning tool ... but had potential to be so much more.