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Question for coder & coder 2 - Student

Posted: Sep 28, 2013

When asked to code pulmonary nodule, with no other information, how can you tell the correct code? Under nodule I see pulmonary, solitary 793.11, I see lung, solitary 793.11 & solitary, lung 518.89. I already know that the 518 one is correct but I have no idea why.

Where are you seeing this??? - Coder 1

[ In Reply To ..]
I don't see that in my Ingenix 2011 code book. That is the only one I have here. Shouldn't be a problem, though. Maybe it is...I recall issues with this code from years gone by. My book might also have a printing error or something.

In the alpha, I see:
Nodule(s),nodular
lung, solitary 518.89
solitary, lung 518.89

I don't see pulmonary, solitary 793.11 at all. So, I am wondering where you are seeing that, and if your code book really says "lung, solitary 793.11" because mine doesn't.

The only way I could get 793.11 was to use an online code lookup, which you would not be using because there is no need for it and because it would lead you down the path to certain ruin.

Could you check what you see in the alpha index again, please?

Wait! Wait! Nevermind! - Coder 1

[ In Reply To ..]
I googled it. The codes changed a bit. Looks like they added the code for radiographic findings in October of 2011 (for 2012).

I still don't know what you see there, though. Is it exactly like in your post? The answer to that is the choice depends on what you are coding. Rad or not? Why does your book say the 518.xx answer is correct? Might be the way the question was asked or the age of the book.

One thing I saw online was from someone who said the codes in his book were crossed out, but he didn't say by whom.

Isn't this awful? You ask some people for help and they just make you do all the work.

Yes, it's just like that. - Both 2013 editions by Buck

[ In Reply To ..]
The directions just say "Using the ICD-9CM, code the following" Lung nodule. It does not tell me why in the back, just gives the answer. I wish it did. I've got about 6 like this. I'm wrong but I don't know why.

Let me ask you this . . . - Student

[ In Reply To ..]
Postoperative diagnoses:
1. Ptosis, right upper lid,
2. Loss of superior visual field secondary to #1.
3. Superior hemisnopia secondary to #1, right eye.

So I coded the ptosis correctly & I coded the hemianopia correctly. Why don't I code the vision loss?

Hint: Look up what hemianopsia is. - Coder 1. (nm)

[ In Reply To ..]
NM

No problem, then - Coder 1

[ In Reply To ..]
OK, look this up again. There are 2 codes given for the same wording. That is unusual, but there it is.

Look them both up in the tabular. What do they turn out to be?

Which of those are you coding? Really, you can't tell. In real life could you tell? Sure...you'd know if it was talking about a radiologic test or not.

You aren't wrong. The book should have used that in the answer key without providing more explanation.

That book likes to do things like that to inspire classroom discussion. It just frustrates everyone and makes students think coding is random craziness.

When you come up with things like this, assume that the book is wrong and try to show why it is wrong. You will actually learn from that.

Thank you both so much! - Student

[ In Reply To ..]
I don't know my eye terms like I should. That makes perfect sense to me. Right now it does feel like random craziness. I'm understanding the V codes better & I'm more comfortable with some of the guidelines. Is there anything else you guys would recommend I do to help me learn?

update on pulmonary nodule - Coder2

[ In Reply To ..]
I checked my 2013 code book today:
Nodules
Lung solitary 793.11
Pulmonary, solitary 793.11
Solitary, lung 793.11
No 518.89 under there now. So if you were to look it up today, you would be led to 793.11. But if you are in a 2011 or 2012 book, that 518.89 is still there.

Are you in a course or are you doing this on your own? The thing that really helped me when I was learning was a book called Clinical Coding Workout with answers. You code the cases from beginner to advanced. It has explanations in the back of why answers are wrong and why they are right, and cites guidelines also.

Good to know! - Coder 1

[ In Reply To ..]
You'll never forget about pulmonary nodules! Or why it's so important to use a current code book!

Now you can share your findings with your teacher and with the publisher of those books, too. It's the responsible thing to do.

That IS confusing. - Coder2

[ In Reply To ..]
They brought in 793.11 as a new code in 2011 to code pulmonary nodule found on x-ray. When I am coding it depends on the documentation and they usually say something like known pulmonary nodule, unchanged. So I choose 793.11. It is not actually a disease of the lung, but an abnormality and they really don't know what it is, (they haven't done a biopsy to diagnose it). The 518.89 I have to use on rare occasions when they document something nonspecific like restrictive lung disease instead of saying asthma, or they just say lung disease. So, you will know when you have the chart and the documentation, but as for just a phrase in a coding class, I don't know. Like you say, the book is confusing, and I don't know how you would choose and how one could be wrong with a one liner and the book the way it is.

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