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Clarification - procedure codes - New Coder

Posted: Sep 18, 2011

Can anyone clariify a procedure code for me. What is the difference between

99.10 - infusion/injection of thrombolytic agent and

36.04 - intracoronary artery thrombolytic infusion

I have researched this all day and cannot find an answer. Does 36.04 which states direct injection mean open surgery (CABG)? I cannot find anything that tells me the difference. Thanks in advance. CathyCoder

Answer - Redpen

[ In Reply To ..]
I can tell you the difference, but I'd rather show you how to figure this out for yourself--if you can do that, you don't have to "remember" the difference and next time something similar comes up you can figure that out, as well.

The codes themselves tell you, but you have to look at more than the code itself. Let's try it . . .

Look up 99.10 in the Tabular List of procedure codes. It's Injection or infusion of thrombolytic agent, as you noted. Glance around at the other 99.1x codes there--do you see something that might be a clue? What kind of things are those?

Now look backward until you find 99.1. What is that? Injection or infusion of . . . And what does that includes note tell you?

Now look backward a bit more until you find 99. What does that say? Other . . . what?

So, given that 99 is "Other _______ procedures," what is 99.10 going to be? How are we going to do it?

[Everyone is freaking out now because I'm not giving the crucial bits . . . so you'll have to supply them . . . ]

Now look up 36.04, which you already said was Intracoronary artery thrombolytic infusion. What's that written right under it? What's the rest of the line beginning with "That by"? That by ____________________. That's a clue.

Now go back up to 36.0. What is that? Removal of ___________.

And 36 is what? ______ on ____________. What is written right under it in that includes note? That bit applies to all the codes that begin with 36.

So, how is 36.04 being done?

And how is 99.10 being done?

The answer to your question is in all of that. You should see it now. Yes? No?

Clarification - NewCoder

[ In Reply To ..]
Redpen,

Thanks so much for your great explanation. It is clear as can be NOW! My confusion stems from an incorrect answer key that seems to consistently give answers that I cannot explain. I have no way of knowing if they are right and spend a lot of time trying to figure out why things are not what they seem. Are you a teacher?

Thanks so much for your help.

New Coder

She teaches at The Andrews School - See message

[ In Reply To ..]
What I like about learning at The Andrews School is they help you when you mess up on a test. If you don't understand it and mess up, the instructors send it back, with hints like the above, and you try it again. You don't just fail a test. You get to learn what you didn't understand that made you fail the test, so tests are actually instructional instead of punitive. It reminds me of that old "teaching them to fish instead of handing them a fish" saying.

Clarification - New Coder

[ In Reply To ..]
If only I had known this when I was choosing a school. I am completely on my own. When I do have a question, I have to try to figure it out with others who are in the same boat as I am, and I am not confident that they really know any more than I do, so it is not much help. By the time I receive an answer, I have forgotten my question. Live and learn I guess. Thanks.

Clarification - New Coder

[ In Reply To ..]
I would like to add, keep this in mind if you are pondering which school to go to. Email me and I will tell you which one I choose. If I had it to do over, I might rethink things. I thought I was choosing the right school because they are the credentialing agency, but they might not have the best method to teach the course, or the best interest of the students in mind. If they really wanted you to do well, wouldn't they have instructors to "teach" you. I liked the idea of being able to work at my own pace, but now I wonder why I paid all of that money to teach myself.

I've heard that before - nm

[ In Reply To ..]
nm

Clarification - Laney

[ In Reply To ..]
I'm looking for suggestions on the best 'study at your own pace' course for coding. I currently work FT in another field but would like to devote approximately 10-15 hours weekly to study. Any and all suggestions welcome, thanks

Clarification - Student of Coding

[ In Reply To ..]
Does the key lie in the fact that the 99.1x codes are administered intramuscularly or intravenously or subcutaneously, and the 36.0x codes describe intra-arterial administration?

Umm, almost . . . let's think some more . . . - Redpen

[ In Reply To ..]
You're almost there, but you still haven't grasped the real difference.

First, did you go through the questions we asked above? Actually looked this up in your code book, read each thing I pointed out, and noted what it said? Or did you kind of think about it from afar? If you didn't go through the steps, do that because you'll see something important. It's going to tell you exactly what the difference is.

I asked that because your question tells me that you might not have looked "up" far enough. It appears that you're still "at" the code itself.

Think about this, too. If you went to the doctor and had an intramuscular injection of penicillin, say, or a subcutaneous injection of something, or even an intravenous injection or infusion, how would that happen? Would you be sitting there with maybe your arm out of your sleeve in front of a nurse with a needle? And she's going to poke you with it? It doesn't take a doctor to do that, does it? No, it's just a needle going through the skin.

Can an intraarterial injection be done the same way? Yes. So is that the difference? Not really, no. There is something else. Something "bigger."

In coding, a big part of success lies in being able to figure things out as you go. There is a lot of stuff to remember, but there is new stuff coming around all the time. New codes, changed codes, new policies, and so forth. It is very helpful to be able to sort this out on your own.

Look back up above both of those codes and tell us what you see. Yes, you're correct about what kind of injections they are, but that isn't the whole story. There is something else. It's written right there . . . you just have to look far enough to see it.

It might help if you write down what you are seeing. Sometimes if we just "look" we don't really "see" what we need, especially when we are students. If we write it down, though, it connects.

Write out the code number and the text associated with it. Look back up and write out the three-digit category. Look back up and write out . . . and so forth. When you do that, you will see yourself writing out the reason. If you don't, you didn't go far enough back.

This is really easy . . . no big thinking required. You just have to look far enough. (And it's not that far!)

Thanks for the clarification - Student of Coding

[ In Reply To ..]
Ms. Redpen

You are one great teacher! I discovered the answer that you so socratically led us to...and...I have another reminder to read all the notes, review the subsection headings...and "think". Operative versus nonoperative procedures! Thanks. I wish my teacher could do this that you do so well.

Yaaay! You found it! - Redpen

[ In Reply To ..]
Excellent! You found it! And now you know WHY to read all the notes and headings, so you won't need to be reminded! You'll just start doing it on your own because you've learned that the information you need is there for the finding!

Yes, exactly, one of those codes is for an operative procedure and the other isn't. Look around the one that isn't and you'll see that everything there is much the same.

Almost everything you need to know is in the code book. A huge problem among coders is the tendency to try to memorize the purpose and use of each code. "Oh, remember that this code is used for . . . " I think coding textbooks encourage that thinking by presenting information as "Use xxx.x for this, use xxx.y for that, use xxx.z for the other." It makes it appear that the information can't be gotten to any other way . . . you just have to memorize it. In most cases, if you look it up correctly and think about what you see, you'll end up there yourself and see that there is no need to memorize anything.

In most cases, at least. For the others, we need Coding Clinic. :)

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