Medical Coding Help
What to do When You're Stuck?

Where can you go for medical coding help when you're stuck with a coding problem? Find out here...

Medical coding is so complex and intricate, it's easy for even the most experienced medical coder to get stuck every once in a while.

To help you understand the complexities of medical coding, consider this: The three major medical coding manuals, CPT, HCPCS, and ICD-9, each contain thousands and thousands of codes.

Your job as a medical coder is to find the exact codes from each book, match them up with what happened at the office visit, and put them together correctly on a medical claim.

This means that you go through thousands of codes and find the right ones, code to the highest level of specificity, as well as represent all of the procedures that were performed on the date of service accurately.

You have to do this while following all necessary coding conventions and medical coding guidelines.

This has to be done for each and every single patient who is seen in your office or clinic, and can amount to hundreds of different claims each day...

But don't worry!!

This sounds like a lot of work, but it's not usually as difficult as it seems. Most of the time, your office will have a set of commonly billed codes, which you can refer to when you're coding your claims.

The more experience you get with medical coding, the easier it will become for you to simply look at a code and know exactly what it is, how to bill it with other codes, and how to send it to insurance.

But there'll also be times when you're stumped and could desperately use some medical coding help...

How do you get stuck?

The problem will inevitably arise: your doctor will code for something you've never seen before, or perform a procedure that you've never billed for before.

Perhaps your office will begin giving a new medication injection, which hasn't been fully approved by the FDA. Or there'll be complications during a surgery and have to bill for multiple procedures.

In these rare (but very real) cases you may have difficulty finding the exact codes. You're very likely to get stuck.

Getting stuck on a diagnosis code

One of the biggest rules when coding a diagnosis is to code to the highest level of specificity. This means that you have to keep going until you can't go any further.

For instance, if your doctor codes for a strange or unheard-of diagnosis, you have to look for it in the ICD-9 manual.

Let's say that you look for the diagnosis in the index, find a possible code, and then look up the details. These details may be wrong, or they may specifically exclude your diagnosis.

What do you do? Keep looking!

Think of every possible word that you can come up with, and check the index again. For example, you can code injury as wound, open, laceration, abrasion, or contusion. Then pick a code, and check the details.

You may also want to ask the doctor, ask the nurses, and look up the diagnosis in a medical dictionary. If you're still stuck, use the internet and search a credible medical search engine (like WebMD or Mayoclinic), to see if you can gain any insights.

If worse comes to worse and you can't find the correct code, choose the diagnosis that's the closest to it.

For example, if the diagnosis code you're looking for is pain, back, left side only, but the closest code you can find is pain, back, then you code for the more general diagnosis.

This is an accepted medical coding practice, although it will hopefully be improved with the implementation of the new ICD-10 codes, which includes thousands more codes than the ICD-9 code set.

Getting stuck on a procedure code

Because medical procedures are constantly changing and medical technology is continuously improving, medical procedure and supply codes are always changing as well.

Just as in diagnosis coding, your provider will almost surely perform some new procedure which you won't know how to code, or your office will give a new medication.

Furthermore, procedure code descriptions and guidelines change according to outside influences, like CMS. CMS is a federal agency that sets the rules for how to code a Medicare claim.

Because of CMS's vast influence and authority, most commercial insurance companies use their guidelines as a basis for setting their own guidelines. When CMS changes their rules (which they do constantly) many commercial insurance companies follow suit.

When determining the correct CPT or HCPCS codes, make sure you have the most current set of coding manuals. These should be updated each and every year, just like ICD-9 codes.

Your most current manual will reflect any changes in procedure coding that are in effect for your date of service.

Use your coding knowledge to get as far as you can when you're looking for the right CPT or HCPCS code. Even if you can't get it exactly correct, just getting closer to the right one will provide you will the medical coding help you need.

Sometimes, understanding all the medical terminology helps you find the right code (see basic medical terminology for a primer).

Example: a code is for the removal of an organ, and you've narrowed the list of possible procedure codes down to two. One of the codes is for a procedure ending in -ectomy, and the other is for one ending in -otomy. Knowing what these suffixes mean will help you find the correct code.

Probably some of the best sources for CPT or HCPCS medical coding help are your professional online resources.

There are many medical organization email listservs. You can send an open email, asking for medical coding help. Chances are that your problem has already been encountered by someone else, and they can help you find the answer.

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