ICD-10-CM PCS Inpatient Coding

Navigating the Trickiest Medical Coding Guidelines – A 15-Year Veteran’s Perspective Introduction So, here's the thing: I've been coding for over 15 years , and trust me, I’ve seen it all. Coding guidelines are fantastic when you're reading them in theory, but when it comes to applying them in real-life scenarios, things can get… messy. Some of these rules are straight-up tricky, especially when they don’t quite align with what the provider documents. Let's break down some of the most frustrating guidelines and how I’ve learned to navigate them. 1. The "With" or "In" Convention – When Assumptions Go Wrong One of the first things we coders are drilled on is the "with" or "in" convention. These terms usually imply a causal relationship between two conditions. Sounds straightforward, right? Well, not always. Where It Gets Tricky Here’s where the gray area creeps in: Providers don't always write with coding conventions in mind....

Success in Medical Coding Is Never a Solo Journey – The Power of Teamwork Introduction: The Myth of "Self-Made" Coders As a newly joined medical coder, you might feel pressure to prove yourself by doing everything perfectly and independently. It’s easy to think, “If I just focus and work hard, I’ll succeed on my own.” But here’s the truth: no one succeeds in medical coding—or any profession—alone. I’ve been in this field for years, and every step forward in my career was made possible not just by my own effort, but by senior coders, trainers, team leads, and peers who guided, corrected, and supported me. Teamwork is not just helpful—it’s essential. The Story of Nelson Mandela – A Movement, Not Just a Man Nelson Mandela didn’t bring down apartheid by himself. He had a movement behind him. Likewise, in medical coding, even though you sit alone at your desk, you’re part of a team that includes auditors, billers, physicians, QA specialists, and trainers. You rely on tr...

Question: A patient was admitted for abdominal pain but left against medical advice (AMA) before being examined. The emergency department (ED) notes documented a suspected small bowel obstruction (SBO) as the working diagnosis. A CT scan of the abdomen showed: 1. Nonobstructive gastric and small bowel distention/gastroenteritis 2. Constipated fecal retention and advanced diverticulosis coli Given the CT findings and incomplete evaluation, should a query be raised to clarify the etiology of abdominal pain, or is SBO the appropriate principal diagnosis (PDX)? Answer: 1. Principal Diagnosis (PDX) Selection The patient was admitted for abdominal pain, and SBO was documented in the ED as a working diagnosis. The CT scan findings suggest gastroenteritis, fecal retention, and diverticulosis, but it does not definitively confirm SBO. Since the patient left AMA before further evaluation, SBO remains the most appropriate PDX based on the available documentation unless further clarification is pr...

 Question: The OE orders for this inpatient account include pulmonary edema and pleural effusion. The patient is also COVID-19 positive. According to the progress notes, the patient was admitted for altered mental status (AMS), with the etiology documented as dementia and delirium. The patient actually had heart failure with reduced ejection fraction (HFREF) exacerbation. Since pleural effusion has a higher DRG, it was assigned as the principal diagnosis (PDX). However, the patient was also actively treated for COVID-19 and CHF exacerbation. Considering ICD-10-CM coding guidelines, what should be the appropriate PDX selection, and are there any potential query opportunities? Answer: 1. CHF, Pulmonary Edema & Pleural Effusion The auto-suggested CHF code was not validated, which led to coding CHF unspecified, while the patient actually had HFREF exacerbation. Pulmonary edema and pleural effusion are symptoms of CHF and should not be coded separately unless specifically treated. 2...

IPDRG Coding: Principal Diagnosis (PDx) for HIV, Pancytopenia & Suicidal Ideation Published on:   February 13th  Introduction: Understanding PDx in IPDRG Coding Medical coding for IPDRG (Inpatient Diagnosis-Related Grouping) can be challenging, especially in complex cases involving HIV, Pancytopenia, and Suicidal Ideation (SI) . Choosing the correct Principal Diagnosis (PDx) is crucial for accurate billing, reimbursement, and patient record documentation. In this blog post, we will explore a real-life coding scenario , address common queries , and provide expert insights on determining the PDx in such cases. Case Study: HIV, Pancytopenia & Suicidal Ideation  Case Details: Patient admitted to the ED with suicidal ideation and self-inflicted right wrist injury . Diagnosed with Pancytopenia and HIV (CD4 count: 24, 3.4%). Currently on oral antibiotics (Leeflex and Doxycycline) for treatment. Admitted under BA (Behavioral Admission) for depression an...