A community of 30,000 US Transcriptionist serving Medical Transcription Industry

for some reason, I am not grasping ICD-10 flags... - Alias

Posted: Jun 11, 2013

I am going into the 3rd chapter of Step-by-Step Coding 2013, but the flags are a bit confusing. Also, the first-listed Dx can be a bit hard to grasp. Will this get easier? Guess I just need some encouragement... I find that I understand it to a point, but if I take my mind off it for only a moment, then I am not getting it. Wish I could have afforded Andrews, but I have to make the best of what I have - which is a lot really - complete access to tons of information - just trying to retain it and make sure I can 'apply' what I am learning.

Of course, learning MT years ago, I remember lots of tears in the beginning...

Just feel so intimidated right now.

I have a question for you Alias - Current coding student

[ In Reply To ..]
Are you just learning to code ICD-9-CM? At my school, they told us not to even worry about ICD-10 until we get ICD-9 down. Maybe I'm not reading your post correctly though. I obviously don't have much advice for you because I'm still learning (and I agree it's very difficult), but good luck in your studies!

ty for replying... - Alias

[ In Reply To ..]
this course begins with ICD-10 (in the beginning anyway) and we have to convert ICD-9 to ICD-10 and ICD-10 to ICD-9 in the exercises. It is really awesome how they made the changes and how much more detailed the codes are. I was just wondering if anyone has a way to remember the flags and what they mean, that is where it gets a bit confusing, being that I have not coded yet.

I just am not sure, should I have that information really down pat before I proceed to the next module (because there are testing exercises after each chapter), or will it come together as I keep going? I would think I should understand what I am reading currently before I proceed...

Does that make sense?

Good luck to you as well, and I appreciate that you responded.

I agree, probably learning 9 first would make more sense...but I love 10 because they are like puzzles you have to solve... :)

Umm, are you trying to teach yourself? - Suggestion

[ In Reply To ..]
Well, if you think sobbing is normal in education, that book will put you on the right track. I think more students drop out of coding because of that book than all other reasons combined. That book would drive ME out even today.

First of all, you do not NEED to grasp the ICD-10 flags. I looked at the book on Amazon. It appears to be trying to show you the General Equivalency Mapping from ICD-9 to ICD-10 codes. I don't know what you think you need to grasp about them, but the GEMs are not "coding." That is a conversion tool. Period. You aren't going to use it in coding. If you do need to convert anything, you can look it up. Nobody is going to ask you what those numbers tell you. The GEMs come with a key that tells you. And you aren't going to understand it now at all!

To code, you are going to use one book for ICD-9. You will then use another book for ICD-10. You are not going to do any converting. (I will likely be doing some, but you, as a front-line coder, will be unlikely to ever do that.)

In any event, just the fact that you describe "access to tons of information" which you are trying to "retain" and make sure you can "apply," tells me that you are probably beating the subject into the ground. That's why I suspect you have no teacher.

Having a lot of information is not helpful if you think you need to memorize all of it. I don't memorize . . . I look it up. It's too much to memorize. It's also silly to memorize things you can just look up.

Will it get easier? Well, that book is a known nightmare. It's blitheringly confusing. Sorting out the wheat from the volumes of chaff in it is a pain.

It's also organized in a backward manner. That entire first section with the stupid flags should be an appendix. You do that AFTER you finish everything else.

You should also do the coding guidelines AFTER you at least learn how to look up codes. And, you should do the guidelines for one set of codes while you are learning about those codes--not in one giant chapter when you have no idea why you need to know that.

If you are not taking a class, my suggestion is to skip all that ICD-10 stuff and go straight for the ICD-9. Skip the guidelines chapters for a bit, too. Once you have done a little ICD-9, then start incorporating the guidelines.

Now, about the first-listed diagnosis. This is not a complex concept. On an outpatient basis -- which is what I saw the book talking about when I looked at it on Amazon -- it's the main reason the patient was there.

Just figure out why the patient was there. What's the main reason? What got treated?

It's different for inpatient, and that's a little confusing, but I think you're doing outpatient there.

Were you an MT? If so, don't you instinctively know why that patient was there? It's not rocket science, even if that book makes it so.

Also, on an outpatient basis, sequencing isn't as critical as it is for inpatient.

If you would like to ask more questions, feel free. Just quote from your book, if you would, so we can tell what it's telling you and why you are confused.

perhaps you do not mean to be rude, but you really come off that way... - Alias

[ In Reply To ..]
firstly, what? if you have a code, for example, flag 1, approximate, 2 no map, 3 combination, 4 scenario, 5 choice list.

if you are coding R6521 with a flag of 10112, I am not understanding all the flags 10112 as they each mean something.

also, first-listed diagnosis: "Initial office visit, male with persistent abdominal pain and bloody diarrhea. Patient was scheduled for small-bowel x-rays and colonoscopy etc.

first-listed diagnosis, persistent abdominal pain and bloody diarrhea?

however, when I look up persistent abdominal pain and bloody diarrhea, there (to me) do not appear to be clear codes because they have flags added and I do not see 'bloody diarrhea' in either ICD-9 or 10. I have 789.0 (ICD-9) but can't get the second one.

your responses do not make me feel good, they only make me more frustrated and to feel you are somehow berating me and putting me down for some reason, not sure why. I don't think you mean to be that way, but it comes off like that.

no, I don't really have a teacher, and I am basically on my own with books and internet sites - but that doesn't mean I can't learn this.

and I like the ICD-10 and the GEM, and files. it makes sense how they are mapping.

this book is written by Carol J Buck MS, CPC, CPC-H, CCS-P. ? no good?

chapters 1-7 are ICD-10, but I will skip on to chapter 8 to ICD-9 per your advice. I do appreciate that.

also, I cannot see the right side of the page of what I am typing, so not sure everything is coming out with correct spelling.

thank you,

Answer - sm

[ In Reply To ..]
The GEM is a crosswalk that tells you what the equivalent code is in the other system. If you have a code in ICD-10, and want to know what it is in ICD-9, or vice versa, you can use that list to find it. There is not a one to one correlation. For some codes, there may be an exact match. For others, there may be only an approximate match. That is what the flags are telling you.

You do not need that to code in either set. When I use 10, I do not look up a code and say the flag says such and such. I am using the code book for each set, not the GEM. You will not code using the GEM.

To find a code in 9, look it up first in the Alphabetic Index. Find the code. Then look up that code in the Tabular List. I am not sure what you are doing, but I don't think it is that.

When you look up diarrhea in the Alphabetic Index, the word (bloody) is listed there in parentheses.

There are instructions and rules for using the code book. They are written in the front pages. You should find and follow them.

ty, this is a big help... - Alias

[ In Reply To ..]
I wasn't sure even for the certification testing if I would need to know this or not, not so much the actual coding.

Appreciate your help!

~ Alias

If you do not know, ask before jumping in - Save time and effort

[ In Reply To ..]
I live on the water. Someone almost drowned outside my home, about 30 yards out, because he didn't know the water was so shallow that he could stand up. It looks deep when you are in it, but from high above, you can see how shallow it is.

It is a lot like that when you are learning something. Experienced people know more than you do, so ask before jumping in to drown.

No, that is not on certification tests now. ICD-10 is not on them now, either. That is why you don't want to make the water 10 feet deeper by tossing it in.

You need to learn to use ICD-9 now. And fast, too, so that you can test in 9. Once you have done that you can pick up 10 in a few hours.

I can assure you that mixing them together is not going to help at all.

People write books to sell books. Someone asked for book advice and was told to get an AHIMA book and Faye Brown 2012. They were told to avoid the one you have and why.

That is what I suggest you do. All that excess information is great for the book seller, but utterly useless if youcannot figure out how to do what you most need to do ... and the most simple and fundamental thing in coding ... look up a darned code.

If it helps convince you . . . - GEM

[ In Reply To ..]
I think if a textbook had an entire section, like 7 chapters or something, and it's FIRST, of ICD-10 GEM, it would seem as though this was something you really, really needed.

So, above when I checked my copy of that AHIMA ICD-10 book to see if it had answers, I also looked to see what it had about GEM.

It fit on one page. In fact, it fit on about 1/3 of the page.

In teaching ICD-10, they don't seem to think GEMs have much of a place, except to mention that they have a purpose in, say, converting entire databases from 9 to 10. Which coders don't do.

It also sounded as though they were warning against trying to actually code by converting codes from 9 to 10. Or 10 to 9, or whatever it is that book has you doing.

When you code in ICD-9, you get the book out and look up the codes. When you code in ICD-10, you don't look up your 9 code in the GEMS to see what it converts to. You code in 10 exactly the way you do in 9 . . . by looking up the code.

I think your book is just blowing things all out of proportion, much to the detriment of students.

I must add, however, that this is not only a book - Alias

[ In Reply To ..]
but a course online to go along with the book, so to clarify I am not only using the book. There are numerous references one is also expected to search - and that is why I mentioned it is a bit overwhelming sometimes because there are SO many places to research from. I have the books, the online course, and the Evolve...

However, since I just also took a Health Informatics course, it has added another dimension to coding...especially when it comes to EHR/EMR and how it will all connect in the future. I like it...

Not sure why this book starts out with 10, but I am going to skip through the first 7 chapters and jump to the ICD-9. Since I do not have actual samples of documentation, to just look up codes I thought was not giving me the entire picture...

My thoughts are that coming from medical records/transcription, I know how complicated the charts and documentation can be, so that is why I was confused about first-listed diagnosis (outpatient) because I have only experience with hospital documentation (principal diagnosis). Inpatient, I remember there are patients with sometimes 15+ diagnoses, many of which are multiple codes - this is what I was worrying about, if I can learn how to break those down and code correctly. I remember coders in the office at times struggling also with trying to figure out codes, and they had extensive knowledge of anatomy and physiology. I thought it sounded very interesting and challenging, as compared to my job as a MR clerk, which also could be interesting going through the charts, etc.

The next module coming up is getting into infections, diseases, "specific guidelines" so hopefully that will help put it more together.

Also, this book comes with complete access to Evolve Student Resources, and online, and it offers so much more than the book itself. The only complaint I have is not having 'structure' as one would have in a physical class, but it is what I have to deal with. That is why I appreciate these boards so much -

Hey, my first choice was, you guessed it - Andrews, but I had to work within certain guidelines and constraints so I am trying to make the best of what I have.

Thank you,

Learning to code - Suggestion

[ In Reply To ..]
You have to learn to add and subtract before you can learn division. Likewise, in coding you have to learn how to find codes before you can code an entire hospital stay.

If you don't do that first, none of this will make sense. You will become one of those coders who struggles to find codes and to "break down" codes, as you put it.

Teachers don't just add structure to a course. Their real value lies in the explanations they provide to correct student misunderstandings.

Here is my explanation.

Coding is basically a process in which you read medical documentation to identify the conditions and services of the episode of care, after which you look up the codes.

No matter what they have, you end up finding individual codes.

If the patient is admitted for fever and respiratory symptoms, and is later diagnosed with pneumonia, pneumonia is the PDx. If they were also treated for their hypertension and diabetes, you are also going to code hypertension and diabetes.

In other words, everything comes down to finding three codes . . . pneumonia, hypertension, and diabetes.

Finding individual codes is the addition and subtraction, so to speak. It is the fundamental skill you need to learn. The instructions are in the front of the code book.

If you think a lot of struggle is involved in this, that is a misperception. It is not that difficult. The code set was not designed for rocket scientists, but for normal people. If code-finding is hard for you, you are doing it wrong. There are steps to follow and almost all the information you need is in the code book.

Coders learn by finding one code at a time because that is a necessary skill. It is all we end up doing, anyway. That's what it all boils down to in the end. One code at a time.

The fact that you could not find a code for "bloody diarrhea" is an indication that you do not understand how to find a code. You need to look up the instructions for that and memorize the process, practicing it until you can do it successfully. You need to do that before doing anything else.

ty (No message) - Alias

[ In Reply To ..]
xx

Alias/Learning to code - Anonymous

[ In Reply To ..]
Alias, I read your original post and could not help but respond. I am a new coder (I am certified but working in another area of health information) but unfortunately I can only reiterate what others have said. I would completely ditch the book you are using and concentrate on learning ICD-9 and doing some heads down coding of actual patient records. You can take the ICD-9-CM book (invest in one if you do not already own one) and go through it section by section, you need the basics before you even think about ICD-10. There are guidelines and rules for coding certain disease processes (diabetes, hypertension, infectious disease/HIV, etc.). Find a companion textbook to help you, one that teaches basic, no-nonsense coding. You need to know more than just how to look things up in an index; that is the first step but you also need to confirm the code in a tabular index and there will be guidelines to follow in regard to using additional codes in some instances or adding modifiers. Sequencing does become important in some situations. When coding, remember (someone else said it as well) to ask yourself why the patient was admitted or the reason for their visit. When looking things up, forget adjectives such as "bloody" and focus on the main disease process. Create some theoretical scenarios and practice coding those, code your own health history. If you can code from the ICD-9 code set, you will be able to code in ICD-10. Please forget about trying to convert diagnoses from 9 to 10. If you try to learn everything all at once you are going to get overwhelmed; think baby steps.

You mentioned working as an MR clerk. Can one of the coders in your department give you some help? Can you do some abstracting - that is where I started - and for me it is helpful because I am learning more in regard to record review and how things need to be sequenced. It is also a great way to learn how to navigate the EHR at your facility and maybe gain some exposure to any coding software they might be using. Working in MR in any capacity can open other doors.

My opinion is that coding is too complex to be self taught, but I understand that a person does what they have to do. Sorry to be so long winded, good luck to you.

tyvm for your response, Anon - Alias

[ In Reply To ..]
this helps put things into perspective. I do have the ICD-9, and obviously can look up codes for clear-cut diagnoses. Will start with that -

I appreciate everyone's help...

Similar Messages:

Jul 27, 2013

Please be careful when searching for jobs! This one is full of red flags. hello, I am replying back to your message concerning the job posted on Craigslist in which you're interested in medical office assistant. Your application was received, unfortunately the position has already been filled, but there's another position to be filled, if you will be interested. I have gone through your Resume/email and am quite impressed, i think you are the right ...

Oct 03, 2012

I have read countless articles today that state that the reason that so much MT work is being outsourced is b/c there are lack of MTs on the US side working in the industry. I love when the uneducated write these articles. They are totally missing the entire reason work is outsourced, MONEY. There would be plenty US based MTs to do the work provided we were paid what we are worth. The reason the work even went over to India and other countries is b/c it is cheaper for the ...

Dec 25, 2010

x ...

Apr 03, 2012

How's this for arrogance: "In the past she had been given this medication, which she had declined due to reading the package insert, so I advised her not to read package inserts and just use the medication as prescribed." ...

Jun 08, 2012

Last year my relatives started getting calls from a collection agency saying I owed a Payday loan and would go to jail, etc. if I did not pay up. Needless to say this was quite disturbing as I had no idea what was going on and these people had all my info. I talked to a lawyer who said it was a scam from India. A link is below. Of course Americans can rip you off too but sending confidential info overseas is just asking for trouble. This is probably just the tip of the iceberg http://w ...

Aug 15, 2013

when terminating employees. I have seen employees with more experience than me terminated. I have no work and only have 1 account, surprised I am not out the door. I think I will just continue to work when I can, an hour or less a day, until they say no more. ...

Sep 11, 2013

I haven't been to MTStars much lately and noticed some are talking about being terminated. Are you given a reason for the termination? I scraped by my last evaluation (this percentage you have to keep is scary no matter how they tell you the scoring is changed). Scared silly I'll be terminated because don't want retire until I'm 65 (getting close) and too old to start looking for a home job again because I can't work outside the home anymore. Wha ...

Nov 25, 2013

FIRST report out of the box, no name, but there IS an ACCOUNT NUMBER! So, let's see, how many ways can we spell this name to see if we can find it. Should I try? Well, I decide to write a pend note and then try a few spellings afterwards. I get to MEDICATIONS section. He invented a new medication! He says TOPEPENEX. Huh? It printed TOPAMAX. Okay, since I don't have a degree in pharmacology, do I look up what Topamax is for? Does he mean XOPENEX? WELL, I CAN'T look it up o ...

Mar 18, 2014

I found this VERY INTERESTING, and since nobody has brought this up on the boards, thought I'd "share"...I saw a job posting on a job seeker's board that had the audacity to offer .... 0.02 cents per TEMPLATED RPT....WELL, JUST FRIGGIN FANTASTIC...another way to SCREW w/our pay...REALLY????????? ...

Jun 10, 2014

regions is because they brought some work back here to make it look good in bankruptcy court -- like see, we're providing jobs in the U.S. ...

Jun 24, 2014

their workers only once a month? Does it benefit them financially or something. Just offered a job but they pay only once a month and by the time I start, I wouldn't get a paycheck until mid August. ...

Aug 14, 2014

Found this on MT Forum India 06-03-2014, 11:44 AM (This post was last modified: 06-03-2014 11:45 AM by idrissuhail.) Post: #1 idrissuhail Trainee Posts: 1Joined: May 2014 HUge Openings with Nuance with Excellent Package Greetings from Nuance Communications IncHiring Season Started with Nuance.MT, Sr MT, QC, MLS candidates can apply. Candidates can work as HBE, OBE and Temporary Basis (4 hours/day)Best Salary with ...

May 12, 2010

According to the Escript, I'm doing an average of 300 lph on VR but usually at the end of 8 hours, I don't top 1100 liines most days. On Dictaphone's ExSpeech, i used to consistently do 1800-2400 a day on a combination. I have noticed with EScript that 1 day a week, my lines will hit 1200-1300, and I even hit 1500 one day, yet the lph were still 300. It doesn't make sense. No, I do not take breaks. Half the time I don't stop ...

Aug 03, 2010

In our speech machines in DocQmanage Enterprise Platform, we can either go to member longin or "About DocQment Enterprise Platform". In DocQment Enterprise Platform it actually states "Solutions include interactive speech recognition for clinician SELF-EDITING" and shows a picture of 2 doctors looking at a computer screen editing. Then go to upper right and open up Duke Primary Care and the case study. Duke Primary Care improves their process with SpeechQ. Rea ...

Jul 13, 2011

Look at what just happened in Mumbai today. Three terrorist bombs in the busiest business sectors, killing 20 people and injuring scores of others. Something that seems to happen from time to time, currently being blamed on their rival, Pakistan. (Another favorite U.S. offshoring destination). Those blasts could have just as easily hit one of our MTSOs' main offices, servers, IT techs, QA, etc. over there. There just isn't the same level of security ...

Sep 28, 2012

We've been talking here about how we put in applications for non-MT jobs and never hear anything? Well, Career Builder has a tool now that shows how many applications a position has received. Every one that I applied for had over 200 applications, which is the highest level they have, 200+. Might explain a little bit. ...

Oct 16, 2012

was just to let you know not to go anywhere because eventually they will swallow that company, too. ...

Jul 31, 2013

just heard that we will no longer be able to use nja as a reason for not getting the minimum required hours in per week. if you fail to meet min. requirements for 3 weeks in a row, performance assessment will start. you will have to switch hours or make up hours, but you will no longer be able to use nja as a reason why you do not get all your hours in. That ain't my problem. If I am scheduled to work 9-5 m-f and there isn't any work, they shouldn't expect me to change my ho ...

Aug 08, 2013

My employer, who has several VA contracts, was audited by the DOL last year. The findings of the audit were that the employer should have been paying us the prevailing hourly wage because the contracts were federal government contracts. Many people got back pay for the period of time for which the books were audited, but not everyone did because the DOL only audited one of our accounts. Even though all the rest of the MTs were paid exactly the same way (on a production basis), ...

Sep 06, 2013

happy new year! Slapped in the face again. *blech* ...

Sep 12, 2013

nm ...

Mar 30, 2014

Ask anyone what's happened to earnings in this field over the last 10 years. If you have a penchant for the macabre, try the last 20 years. I won't bother with the details because you already know them. Well, you put up with it, didn't you? While the population of ESL dictators exploded and VR came on the scene, while the sheer number of medical devices, instruments, procedures, tests and other terminology we deal with doubled and then tripled, while benefits were hac ...

Jun 04, 2014

MM was laying off a lot of PT MTs. I accepted that since I have always passed their ridiculous 98% (and higher) audits and always worked my shift, etc. So no reason to fire me. However, I've been wondering if the real reason (since I see there are still PT MTs here) is that they don't want any employees from California (or any other state where the minimum wage is too high in their eyes). What do you all think? Are there any FT or PT CA MTs from MModal still working for MModal? ...

Jul 19, 2013

This woman underwent 7 months of chemo for breast cancer and didn't even have it!! The dr. misread the PET CT scan - and what, no one else caught it in 7 months? I think this is just the tip of the iceberg as far as medical malpractice goes, and I don't think her settlement was near enough!! ...

Jul 21, 2014

I normally work nights and get the worst dictators and horrid ASR. Of course, the worst dictators are usually the low man on the totem pole and get the worst coverage. At least, that is my experience from everywhere I have worked. Plus you get the sleepy doctors that can barely move their mouths in between yawns. I also only rarely get operative reports. On the few occasions I have needed to work a day shift, in addition to much better dictation, I get a lot of operative reports (I am tie ...

Dec 10, 2014

Let's say Nuance acquires a hospital account and 9 or 10 MTs fall for their line of crap and come on board with Nuance. These MTs are kept busy for awhile, usually only as long as it takes to get the VR adequately trained because entire workypes are now being completed in, like, half the time than it took to complete them with straight typing. Some worktypes, like many associated with ERs, are converted to front-end EHR and avoid arriving in anyone's queues at all, in any ...

Dec 29, 2009

Don't you get it...these cannot be done by ILPs or by machine alone. In 3-4 yrs these so-called crap jobs will be the ONLY reason a few MTs will even be needed; all else will be totally automated, and even ILPs will not be required, unless they learn to do crap jobs. Learn to live with it or train for something else. It's just the writing on the wall. Don't bash me, I don't love it, I'm just being realistic. I'll do them because I'm n ...

Apr 02, 2010

I just received a letter from Medquist saying they will no longer be offering Kaiser Insurance which I have had for years. That means starting all over finding a doctor and having insurance that doesn't cover anything. I was with Blue Cross before Kaiser and nothing was covered. It's a scam. ...

Jul 10, 2011

I've been an MME for about a year. I have seen some doozies come to me, usually from our beloved ILPs. Recently that's starting to change. First of all, there are a lot of really good MTs, but I'm talking about the bad apples. Unfortunately, over the past few months, this tree has been producing many more bad apples. I've been getting a lot of US MTs that are awful. Granted they may be new, but they are taken off of 100% too quickly. The ...

Mar 10, 2012

Are they saying its because of technology reasons? ...