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coding student, freaking out - Just started V codes

Posted: Sep 12, 2013

I am a new coding student -- having taken three classes so far. I was understanding everything, I thought, pretty well, and while I was not always able to get the right code, I always knew what I had done wrong. But now V codes. I can't find anything. I don't even know what words to look up. I feel like I'm lost. Will this get easier? I'm getting so discouraged.

Chill -- nothing is wrong - Coder

[ In Reply To ..]
You are upset because V codes don't seem to work like other codes. (They don't.) You are doing pretty good, though, to notice that ... you don't know what to look up. See? You discovered what the problem is all by yourself! That tells me you were doing things right in those first three classes.

As it happens, the V codes are not as nicely done as the rest of them. They are quite annoying to look up. Nobody knows what to look up.

There is an easy way around this. Yes, it does NOT follow the rules, but it cannot be helped. Instead of looking them up in the Alphabetic Index first, go straight to the Tabular List V codes and read all the way through it from beginning to end. The section isn't that long. Make a note of anything that looks likely, then decide which it is.

This will show you what-all is in there. You will get much better at it very quickly.

Then, once you are sure of the code, use the wording in it to find it in the Alpha. In that way, you will eventually learn what to look up in the alpha.

I know this sounds heretical, but in this case, it is really the only way to survive. Never, ever do this with the other codes, but you pretty much have to for the V codes and, to a lesser degree, the E codes.

As an example, you are coding a patient who needed a flu shot. Go to the beginning of the Tabular V codes and start skimming. You will find the code very quickly. When you do, figure out how you could have looked it up in the Alpha.

Let us know how you fare. Don't be discouraged by this, either. Most everything follows the rules, so you will be buzzing along nicely in no time. :-)

If the Vs are so horrible, why do we put them first??? It s because we think they are such a no-brainer. Really, they aren't difficult. They just work differently.

Also........ - Coder

[ In Reply To ..]
I forgot to mention that it can be a challenge to figure out what some V codes are for. You'll read them and wonder what on earth they are. This confuses everyone, so that V codes are always getting "explained" in publications like Coding Clinic.

If that weren't bad enough, sometimes there are 2 or 3 codes that look very similar.

A classic example are the history of and family history codes. History of means the patient has it. Family history means the patient's family has it. To make matters even more annoying than they already are, "History of, family" gets alphabetized into the middle of the "History of" list (in the Alpha Index). It is almost impossible to notice this when you start out.

And there they are, several columns plopped right into the middle of History of. Just waiting to trick you. Look them up! You can see for yourself.

Thanks to all of you! - OP

[ In Reply To ..]
You are right, I am starting to feel a little more comfortable with them. Still confusing -- there is just SO MUCH to learn. I wonder how it is possible to learn it all. I hate how you can get a code, and think it is right, only to find out you weren't even close.

Lets talk about that - Coder

[ In Reply To ..]
That should not be happening. If you are following the rules for looking up codes, you should not be coming up with things that aren't off at all, nevermind not even close. Unless they are V codes.

Let's talk about these incorrect codes and put you on the path to success.

I WOULD LOVE THAT! - I have a few things in my homework

[ In Reply To ..]
That I can't figure out what I need to code. That is my biggest problem right now -- pulling what I need to code out of a small paragraph. I hate that when I get a code, I just don't feel certain that it is right. I hate it when I look something up in the alphabetical and it gives me a code but when I look in the numerical I can't be sure it is right. I wish everything felt exact and I could be confident of what I'm doing.

OK! Let's have those questions! - Here, not by email

[ In Reply To ..]
We want others to benefit from this, too.

Give me an example and I'll show you what to do.
You can change it so that it isn't exactly like the question in your course.

Remember that those little paragraphs are not real coding. They are just course examples. What you look for will depend on what you are studying.

Also remember that you should be finding the correct code in the Alphabetic Index. You check the numeric to be sure and to see any additional information, but you already made your decision.

A lot of people act like they think the Alpha is an index like the kind in a textbook ... just a place to find what page number to start with, so they can look around there and find something better.

Coding textbooks never tell you this straight out. They think that telling you how TO do it (step 1, step 2, step 3 ...) will get the point across. Hah! So, I'm telling you.

FIND THE CODE IN THE ALPHA. CHECK THE TABULAR, BUT DO NOT CHANGE YOUR MIND.

Just to be sure you are hearing this, let's say it again. Find it IN THE ALPHA.

If you see something in the Tabular that you think is better, start over in the Alpha and try to get to that other choice.

There really isn't a big decision required here. No ponderous thinking. It is just a matter of looking it up alphabetically. (At least it is for diseases, not V codes.)

That's exactly what I was doing . . . - Using the alpha as a starting point

[ In Reply To ..]
That's information they didn't tell us -- I figured that would probably just put me in the general area.

Well, knowing this will make it easier - Coder

[ In Reply To ..]
I should ask... what did the first 3 classes consist of? Were they 3 college-type courses, or 3 lessons in your code book?

And, if you wouldn't mind, the name of the book you are using would help. I might have it.

It is 3 college-type courses - We started at chapter 8

[ In Reply To ..]
In Step by Step Medical Coding, by Carol Buck.

My coding question just got deleted - I guess we must not be able to ask those here

[ In Reply To ..]
:(

No, you CAN ask coding questions here. - And are you the OP?

[ In Reply To ..]
We never had a problem with asking coding questions before.

If your post was deleted, you would have gotten an email from the moderator. If you did not get an email, perhaps it was a glitch.

Just be sure not to post test questions, questions that contain (or appear to contain) patient names, etc. The same rules that apply to the rest of the board.

I did get a message - It says I can not ask for homework help

[ In Reply To ..]
It said I have to ask my instructor. Which is fine, I will ask her Monday, when I have to turn my homework in. I only have access to her once a week :( Which kind of stinks, because people are allowed to say all kinds of nasty stuff to each other and that's fine, but I can't ask legitimate coding questions. It isn't like I was asking anyone to do them for me -- I was just asking for guidance into what to code first. But anyway, thank you for your help! The advice you have given me is invaluable.

OK, here is a suggestion - Coder

[ In Reply To ..]
General questions are not "homework help."

"How do I know which goes first" is a general question, not homework help.

Here is the difference..."The question says the patient has blah, blah, and blah, and was treated withblah. Which should I code first." That would sound like a homework question, and even I would be reluctant to answer it. Answering it is for you to do, not me.

If you don't know what should go first, I have more questions for you ... what did your instructor say, what did the book say, and what do the coding guidelines say?

The first code depends on what you are coding ... inpatient, outpatient, or a diagnostic test, for example.

Maybe you can't tell because there isn't one that goes first. Or because you don't have enough information.

"Susan was seen today for hypertension. She received a flu shot, as well." Outpatient, so the main focus of the care goes first. Makes sense. HTN, then needing a flu shot.

"Susan was seen for HTN, hyperlipidemia, and hypothyroid. All stable. Renewed her prescriptions." I think it would be difficult to say which was the focus, so take your pick.

"Susan was seen for acute upper respiratory illness with fever and cough. We gave her a prescription for zpak, and renewed her prescriptions for htn, hyperlipidemia, and hypothyroidism. Dx: Acute bronchitis, htn, hyperlipidemia, and hypothyroidism." What's the main focus? The uri, which was diagnosed to be acute bronchitis. You would code acute bronchitis first, followed by htn, hyperlipidemia, and hypothyroidism in no particular order.

Now take that same example and add something. "Susan was seen for upper respiratory. She has a history of htn, hyperlipidemia, hypothyroidism, and djd of the left ankle. The htn, hyperlipidemia, and hypothyroidism are stable. We renewed her meds for those. Dx: acute bronchitis." Code acute bronchitis first, htn, hyperlipidemia, and hypothryroidism after it in no particular order, and ignore the djd because it received no treatment. It ws mentioned, but has no effect on anything else and no treatment was provided for it.

Something else worth mentioning. Coding textbooks can make it seem as though there is a particular order to the codes when there is not. This is because answer keys show only one possible answer. Online materials, like those you are probably suffering through, have one correct choice, which may make you think there is something hugely significant about it when there isn't. Most college coding instructors are not coders, either, so they don't know this and may themselves think there is one correct answer when there may be several combinations.

I was already a certified coder when I had to take a course that used that very textbook. It was unbelievably frustrating. So, don't let that book discourage you.

The instructor said nothing - We read the material first

[ In Reply To ..]
And then she asks us if we have any questions or need to go over anything. Believe me, I do -- but that doesn't help me currently. The examples you gave me make perfect sense, which actually makes me feel better. I'm stuck on something different. We are focusing on outpatient right now. Here is what I understand, and feel free to correct me if I'm wrong -- you code the definitive diagnosis if there is one, first. If there is no definitive diagnosis you can code symptoms. If you do have a definitive diagnosis, you do not code symptoms that are related to the definitive diagnosis. Next, you code any other conditions that could have a bearing on the first-listed diagnosis.

So how about this scenario: (This is similar but not my homework question)

"The patient was admitted for pain management following biopsy of the lung for stage IV lung cancer".

Stage IV lung cancer would be a definitive diagnosis, except that the patient is presenting for pain from the biopsy. Pain management is a therapeutic procedure, so what it said earlier in the book for that is that I'm to sequence first the reason for the outpatient encounter, at which case I can't figure if that would be the cancer, the biopsy or the pain. I have no idea what to code.

Yes, this book is driving me crazy. It seems like it is trying to teach me by letting me do stuff wrong and then saying, "No, that's not right", instead of just telling me how to do it in the first place.

Suggestions - Coder

[ In Reply To ..]
That is a confusing scenario, so don't feel too badly. That pain management bit has been addressed in Coding Clinic, a good sign that it confuses everyone.

This is also not outpatient. It is an inpatient admission. The rules are different. Let's not worry about that yet, though.

Let's break it down into 3 scenarios. First, if the patient was there for the lung cancer, no other complicating factors, what would you code?

Second, if there for the biopsy for the lung cancer, what would you code? Hint: Is a biopsy a diagnosis or a procedure? Have you studied procedures yet? No? Well, can you find some diagnosis like "needs biopsy"? Or encounter for biopsy?

I see encounter for chemo, for PT, for some other stuff. So, if there for chemo for lung cancer, what would you code? Easier, hmm?

But wait! Is he even having a biopsy during this encounter? No, he already had it.

I should mention that there are guidelines for this. They are in the front of your code book. If not, you can find them online at the CDC. Google ICD-9 guidelines 2013. Should take you right to them.

The trick to learning this is to look up what you want to do in the Guidelines. There is a section on V codes and one on malignancies. There might be something to help you with that pain thing.

Now let's try a third scenario. The patient had a biopsy, and now they have pain, and they have lung cancer. So, they are being admitted for pain management.. After a biopsy. And you've been looking at those Guidelines ...

I don't know - I am still not sure what to do

[ In Reply To ..]
In your first scenario, I would code the cancer. In the next scenario, I have done procedure codes but like you said, this is a history of procedure, so would probably do a history of biopsy code. If he was there for chemo, then the book says that for patients receiving chemo, you code the primary reason for the admission encounter with the appropriate V code and then you list the diagnosis or problem for which the service is being performed second. Except that it isn't chemo, it's pain management, and chemo is an exception. For other therapies, the book says that for patients receiving therapeutic services only, sequence first the diagnosis, condition or other reason for the encounter. It doesn't mention a V code at all. As far as I can tell, the reason for the encounter is pain. But the pain is from the biopsy. Which is from the cancer. The definitive diagnosis is cancer. I feel like I should code the pain, code the history of biopsy and code the cancer but I don't know for sure. The only thing I can really find in the front that might pertain is the section on "late effects", and we've done nothing or read anything about those yet, so I actually don't even know how to do that yet.

Read the guidelines on pain - Coder 2

[ In Reply To ..]
Do you have access to the icd-9 coding guidelines? They will give you guidance on coding pain. Questions you must ask, reason for admission? If it is pain, what kind of pain? Is it neoplasm related, postoperative or postprocedural, or a specific cause documented. I think you always need to check the guidelines and since we want to keep this help going, we don't want to give you answer right out, but point you in the right direction. It seems like a lot of things going on with this patient, but if you follow the guidelines, you will know what to go with, maybe shaky at first, but you will know as you do more.

Thank you for pointing me in the right direction - This book is starting to aggravate me

[ In Reply To ..]
They are asking me questions on information they it hasn't even covered yet. It is asking me inpatient questions when we are just starting on outpatient :( If I did not have you guys to point me in the right direction, I would have no idea. The guidelines for pain management clearly state how to code pain management. Thank you! I don't know why this has to be such a struggle.

Be glad it is a struggle - Coder

[ In Reply To ..]
If anyone could do this, anyone would, and our work would be valued less. Our good incomes are the result of this being such a challenge.

You may find that the source documentation, i.e., the Coding Guidelines, make more sense than most textbooks. The exception is Faye Brown. You might want to get a copy of that.

You should also be sure you find and use the instructions in the front of your code book that tell you how to use the code book. Very helpful.

Thank you so much! - I will do that.

[ In Reply To ..]
I don't mind the struggle -- It just seems like the author should teach you what you need to know BEFORE evaluating you on it. The guidelines were just mentioned as an aside to us in class -- but I'm going to focus a lot on those. It seems like that will tell me what I need to know, and I'll look into Faye Brown's book took. Thanks all! :)

what? - we have done

[ In Reply To ..]
coding scenarios before on here. If it is a coding board, that is what it should be for. No, we wouldn't be answering questions on tests, and Coder always gives guidance not direct answers. AAPC and AHIMA boards do it too. Guidance, coders working out problems together, and students asking for advice, and other coders telling what they know to help. Yes?

yes, it will get easier - V codes

[ In Reply To ..]
are history of codes, status codes, reason for encounter codes, screening, need for vaccination, types of birth, etc. Give us an example of what you're stuck on. Read the guidelines on V codes and that might help you with what to start with when looking up.

From one student to another - Yes, it will!

[ In Reply To ..]
I so remember how you are feeling! I felt like I would never learn how to master the V codes and also the dreaded E codes. Slowly but surely, I have gotten better with them. I am now at the end of my coding course and, yes, it definitely gets easier! As usual, Coder's advice is spot on.

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