How To Pass Your Certification Exam - Amazon Web Services · Chapter 17 Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99) Chapter 18 Symptoms, Signs,

How To Pass Your Certification Exam

Alicia ScottCPC, CPC-I, CRCCCO Education Director

© Copyright Certification Coaching Organization • https://www.cco.usProprietary Information • Do Not Share or Copy Without Written Consent

What We Will Cover● Anatomy● Disease Process● Overview of ICD-10-CM● Basic Code Selection● “Official” Coding Conventions and Symbols● General Coding Guidelines● Practice● E/M● Areas Overlooked● Testing Tips


Anatomy● All Body Systems● Heart● Lungs● Skeletal

Almost every exam you take will have 8 to 10 questions on Anatomy and Terminology

Longest Words. (45) PNEUMONOULTRAMICROSCOPICSILICOVOLCANOCONIOSIS (also spelled PNEUMONOULTRAMICROSCOPICSILICOVOLCANOKONIOSIS) = a lung disease caused by breathing in particles of siliceous volcanic dust. This is the longest word in any English dictionary.

https://www.quora.com/What-is-the-longest-medical-term


Anatomy

© Copyright Certification Coaching Organization • https://www.cco.us

Proprietary Information • Do Not Share or Copy Without Written Consent

Betts, J. Gordon (2013). Anatomy & physiology. pp. 787–846. ISBN 1-938168-13-5. Retrieved 4.10.2018.

http://cnx.org/content/m46676/latest/?collection=col11496/latest

https://en.wikipedia.org/wiki/International_Standard_Book_Number

https://en.wikipedia.org/wiki/Special:BookSources/1-938168-13-5

Disease ProcessWHAT IS TAVR?

• TAVR is a procedure used to treat aortic stenosis for patients who are high-risk or too sick for open-heart surgery.

• This less invasive procedure allows a new valve to be inserted within the native, diseased aortic valve.

• The TAVR procedure can be performed through two different approaches -• transfemoral (through an incision in the leg) or transapical (through an

incision in the chest between the ribs).

• TAVR is performed on a beating heart and does not require cardio-pulmonary bypass.


Disease ProcessWhat is Aortic Valve Stenosis?

• Aortic Valve Stenosis is a narrowing of the aortic valve.

• The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body.



• Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve.

• This causes pressure to build up in the left ventricle and thickens the heart muscle.

• The heart can make up for aortic valve stenosis and the extra pressure for a long time.

• But at some point, it won't be able to keep up the extra effort of pumping blood through the narrowed valve resulting in heart failure.




Disease Process What is Aortic Valve Stenosis?


Disease Process What is Balloon Valvuloplasty for Aortic Valve Stenosis?

• Balloon Valvuloplasty (also called valvulotomy or valvotomy) is a procedure that widens a heart valve that is narrowed.

• During this procedure, a thin flexible tube called a catheter is inserted through an artery in the groin or arm and threaded into the heart.

• When the tube reaches the narrowed heart valve, a balloon at the end of the tube is inflated. The balloon widens the valve opening.

During the procedure, the patient will be awake but he or she will receive local anesthesia where the catheter is inserted as well as intravenous (IV) pain medicine along with a sedative to help the patient relax.


Disease Process What is Balloon Valvuloplasty for Aortic Valve

Stenosis in Older Patients?

• Valvuloplasty is not appropriate for most older people who have stenosis. These people typically need an aortic valve replacement procedure.

If a person is too sick to have the aortic valve replaced right away, valvuloplasty may be used as a "bridge" until he or she can have the replacement procedure.


Disease Process Risks with Balloon Valvuloplasty for Aortic Valve Stenosis in

Older Patients

• Serious complications happen in 1 or 2 out of 10 people who have this procedure.

These problems include stroke, heart attack, and aortic valve regurgitation.


Overview Of ICD-10-CM


1893 First Edition (Origins back to 1850s)● International List of Causes of Death● International Statistical Institute

1948 Sixth Revision, WHO took over● Included causes of morbidity for first time

1967 World Health Assembly adopted WHO Nomenclature Regulations● All Member States must use current version for morbidity and

mortality statistics

1990 - 43rd World Health Assembly● ICD-10 was endorsed

1994 Some WHO Member States began utilizing ICD-10

Overview of ICD-10-CMGuidelines are approved by:● American Hospital Association (AHA)● American Health Information Management

Association (AHIMA)● Centers for Medicare and Medicaid Services (CMS)● National Center for Health Statistics (NCHS)


Overview of ICD-10-CMRequired under the Health Insurance Portability and

Accountability Act (HIPAA)

On December 7, 2011, CMS released a final rule updating payers' medical loss ratio to account for ICD-10 conversion costs.

Effective January 3, 2012, the rule allows payers to switch some ICD-10 transition costs from the category of administrative costs to clinical costs, which will help payers cover transition costs.

https://www.cms.gov/Medicare/Coding/ICD10/Statute_Regulations.html


http://www.gpo.gov/fdsys/pkg/FR-2011-12-07/pdf/2011-31289.pdf

Overview of ICD-10-CMEntire record should be reviewed for each

encounter:● Inpatient facility = entire admission● Outpatient facility/Professional services = single date

of service


Basic Code Selection

• Formerly Volume 2• Index to Diseases and Injuries• Neoplasm Table• Table of Drugs and Chemicals• External Cause Index




Index of Diseases and Injuries● Alphabetic Index

○ Main Term■ Dx (do not start with body part)

● Subterms add specificity, such as:○ Site○ Etiology○ Clinical Type



●Chapter 1 Certain Infectious and Parasitic Diseases (A00–B99)

●Chapter 2 Neoplasms (C00–D49)●Chapter 3 Disease of the Blood and

Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50–D89)

●Chapter 4 Endocrine, Nutritional, and Metabolic Diseases (E00–E90)

●Chapter 5 Mental and Behavioral Disorders (F01–F99)

●Chapter 6 Diseases of the Nervous System (G00–G99)

●Chapter 7 Diseases of the Eye and Adnexa (H00-H59)

●Chapter 8 Diseases of the Ear and Mastoid Process (H60–H95)

●Chapter 9 Diseases of the Circulatory System (I00–I99)

●Chapter 10 Diseases of the Respiratory System (J00–J99)

●Chapter 11 Diseases of the Digestive System (K00–K94)

●Chapter 12 Diseases of the Skin and Subcutaneous Tissue (L00–L99)

●Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)

●Chapter 14 Diseases of the Genitourinary System (N00–N99)

●Chapter 15 Pregnancy, Childbirth, and the Puerperium (O00–O99)

●Chapter 16 Certain Conditions Originating in the Perinatal Period (P00–P96)

●Chapter 17 Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99)

●Chapter 18 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00–R99)

●Chapter 19 Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88)

●Chapter 20 External Causes of Morbidity (V01–Y99)

●Chapter 21 Factors Influencing Health Status and Contact with Health Services (Z00–Z99 )





www.ICD10codesearch.com



Pay attention to the:● Includes● Excludes● Use additional Code● Code specific guidelines

○ Notes before the chapter

Coding Conventions and SymbolsAlphabetic Index and Tabular List (Section I.A.1)• Alphabetical list

• Index of Disease and Injury• Index of External Causes of Injury• Table of Neoplasms• Table of Drugs and Chemicals

• Always code from Tabular List (I.C.19.e.1)

• Tabular list: structured list of codes divided into chapters based on body system or condition


Coding Conventions and SymbolsAbbreviations (Section I.A.6.a-b)

● NEC “Not elsewhere classifiable”○ aka other specified○ Provider documented more information than the

code set includes

● NOS “Not otherwise specified”○ aka unspecified○ Provider did not document enough to select a more

specified code than the “unspecified” option (or default code)


Coding Conventions and SymbolsPunctuation (Section I.A.7)

[ ] Brackets• Tabular list enclose synonyms, alternate wording,

explanatory phrases• Alphabetic index identifies manifestations codes in

which multiple coding and sequencing rules will apply

(-) Dash• Indicates the code is incomplete (needs more

characters)


Coding Conventions and SymbolsPunctuation (Section I.A.7)

( ) Parentheses• Enclose supplementary words that do not affect code

assignment (aka nonessential modifiers)

: Colon• Tabular list after an incomplete term that needs one or

more of the modifiers that follow to make it assignable to a given category


Coding Conventions and SymbolsExcludes 1S60.371A - Other superficial bite of right thumb, initial encounter

S60.3Excludes1:open bite of thumb (S61.05-, S61.15-)


http://www.findacode.com/code-set.php?set=ICD10CM&i=26805



Coding Conventions and SymbolsWhat is up with 2 Excludes?

Excludes 2

When you need to code additional codes to give a more detailed description. S60.221A - Contusion of right hand, initial encounter

S60.2Excludes2:contusion of fingers (S60.0-, S60.1-)





Coding Conventions and Symbols

● Code first● Use additional code● Code also


Coding Conventions and SymbolsObstetric diagnosis

Relation to trimester O00.1 - Tubal pregnancy

Use additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy



Coding Conventions and SymbolsSequencing CodesTHE ORDER OF THINGS Code also

A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.

F80.4 - Speech and language development delay due to hearing lossCode Alsotype of hearing loss (H90.-, H91.-)

H90.0 - Conductive hearing loss, bilateral © Copyright Certification Coaching Organization • https://www.cco.us

Proprietary Information • Do Not Share or Copy Without Written Consent



Coding Conventions and Symbols“And” (Section I.A.14 and Section I.A.8)• Read it as “and or or”

“With” (Section I.A.15)• Means “associated with” or “due to”• Presumes a causal relationship between two conditions

linked by these terms in the Alpha index or Tabular list-Unless the documentation clearly states the conditions are unrelated

“See” and “See Also” (Section I.A.16)• See = Go to• See Also = Look over there if what you need isn’t listed

here


Coding Conventions and SymbolsDefault codes (Section I.A.18)• Code listed next to the main term in the Alpha index

Code Assignment and Clinical Criteria (Section I.A.19)• Assignment of a dx code is based on the provider’s

documentation that the condition exists• If documentation does not support diagnostic statement,

query the provider• Payers may interpret documentation differently


Coding Conventions and SymbolsAdditional Symbols and Conventions• Specific to each publisher• List of the conventions and symbols used in each book

are usually listed in the front of the code book just before the “ICD-10-CM Official Guidelines for Coding and Reporting”

• Legend/key usually appears in the footer of each page in the Tabular list


Coding Conventions and Symbols7th Character for Fracture coding

A - initial encounter for closed fractureB - initial encounter for open fractureD - subsequent encounter for fracture with routine healingG - subsequent encounter for fracture with delayed healingK - subsequent encounter for fracture with nonunionP - subsequent encounter for fracture with malunionS - sequela


Coding Conventions and Symbols


S42.023A Displaced fracture of shaft of unspecified clavicle, initial encounter for closed fracture

S42.026A Nondisplaced fracture of shaft of unspecified clavicle, initial encounter for closed fracture

http://www.findacode.com/code.php?set=ICD10CM&c=S42.023A

http://www.findacode.com/code.php?set=ICD10CM&c=S42.026A

Coding Conventions and SymbolsS42.024A - Nondisplaced fracture of shaft of right clavicle, initial encounter for closed fracture

S42.025A - Nondisplaced fracture of shaft of left clavicle, initial encounter for closed fracture

S42.026A - Nondisplaced fracture of shaft of unspecified clavicle, initial encounter for closed fracture


General Coding GuidelinesAlways use current year guidelines https://www.cdc.gov/nchs/icd/icd10cm.htm

Four Sections:- I: Conventions, general coding guidelines and chapter specific guidelines• A: Conventions for the ICD-10-CM• B: General Coding Guidelines• C: Chapter Specific Coding Guideline

-II: Selection of Principal Diagnosis-III: Reporting Additional Diagnosis-IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services


General Coding GuidelinesHow to read the guidelines

See section I.C.4.a.2• Section I. Conventions, General Coding Guidelines

and Chapter-Specific Guidelines • Section I.C. Chapter-Specific Coding Guidelines• Section I.C.4. Chapter 4: Endocrine, Nutritional,

and Metabolic Diseases (E00-E89)• Section I.C.4.a. Diabetes Mellitus• Section I.C.4.a.2 Type of diabetes mellitus not

documented


General Coding GuidelinesLevel of Detail in Coding (Section I.B.2)

• Code to the highest degree of specificity

• Without all the required characters a code is not considered complete and will not be accepted


General Coding GuidelinesWhat is used to identify a code:

• Diagnosis• Symptoms• Conditions• Problems• Complaints• Other reason(s) for the encounter/visit


General Coding GuidelinesOutpatient Setting

• Only code definitive dx

• If no definitive diagnosis has been determined, code the signs, symptoms and abnormal test results or other reasons for the visit


General Coding GuidelinesInpatient Facility Setting

May Code:• Probable• Suspected • Questionable• Rule out• Differential• Working

• Except for HIV


General Coding GuidelinesAcute and Chronic Condition • Acute: Abrupt set; short duration; rapidly progressive• Chronic: Lasting a long time

Note:• When both are documented and there is a separate code for

each, report both codes with the acute code sequenced first

• Chronic conditions treated on an ongoing basis may be coded as many times as required for treatment and care of the patient, or when applicable to the patient’s care plan.

• Do not code conditions that no longer exist


General Coding GuidelinesCombination Code (Section I.B.9)• A single code is used to classify:

• Two diagnoses • A dx with an associated secondary processes• A dx with an associated complication

E11.22 - Type 2 diabetes mellitus with diabetic chronic

kidney disease

Use additionalcode to identify stage of chronic kidney disease

(N18.1-N18.6)


https://www.findacode.com/code.php?set=ICD10CM&c=N18.1

https://www.findacode.com/code.php?set=ICD10CM&c=N18.6

General Coding GuidelinesSequelae (Late Effects) Section I.B.10● The residual effect (condition produced) after the

acute portion of an illness or injury has terminated○ May be apparent early after an acute phase or

illness○ May occur much later, as with a previous injury or

illness

E64.2 - Sequelae of vitamin C deficiency


General Coding GuidelinesSequelae (Late Effects) Section I.B.10

Documentation to look for:• Due to an old injury• Due to previous illness• Due to an illness or injury that occurred one year or

more before the current encounter Arthritis in the left hip due to previous fx


General Coding GuidelinesSequelae (Late Effects) Section I.B.10

Two codes are usually required when coding sequela1. The residual condition (arthritis)2. The cause of the sequela (hip fx)

Note: The code for the acute phase of an illness or injury that leads to the sequela is never used with a code for the cause of the equela.


General Coding GuidelinesImpending or Threatened Condition (Section I.B.11) Impending

coronary syndrome I20.0delirium tremens F10.239myocardial infarction I20.0

Threatened abortion O20.0job loss, anxiety concerning Z56.2labor (without delivery) O47.9loss of job, anxiety concerning Z56.2miscarriage O20.0unemployment, anxiety concerning Z56.2


General Coding GuidelinesBorderline Diagnosis (Section I.B.17) Borderline

diabetes mellitus R73.03hypertension R03.0osteopenia M85.8-pelvis, with obstruction during labor O65.1personality F60.3


General Coding GuidelinesLaterality

• Right is usually 1• Left is usually 2• Bilateral is usually 3

Note: If one side is corrected/repaired and the

condition no longer exists on that side, code the unilateral coe for the side on which the condition still exists


General Coding Guidelines Documentation by a Dietitian, Nurse or EMT of:

● BMI ● Depth of Non-pressure ulcers,● Pressure Ulcer Stages ● Coma Scale● NIH Stroke Scale The associated dx must be documented by the

provider.


Chapter-Specific Coding GuidelinesCase 1

This patient was referred to me by Dr. Feelgood. The patient was admitted from the ER.She is 65 year old and has a hx of a previous MI 4 years old and has not had any previous bypass surgery. She has coronary artery disease and today she is experiencing unstable angina. I discussed with her the need to have a cardiac catheterization. She says she would like to have her husband and daughter come in to speak with me prior to scheduling the cath.

A. I25.111, I25.2 I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm

B. I25.110, I25.2 I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

C. I25.118D. I25.110


http://www.findacode.com/code.php?set=ICD10CM&c=I25.111

http://www.findacode.com/code.php?set=ICD10CM&c=I25.110

Chapter-Specific Coding GuidelinesCase 2This 59-year old male previously had knee surgery in his left knee with a prosthesis inserted. He comes to the office today complaining of pain. Imaging of the knee and blood work confirm an infection surrounding the prosthesis. He is being referred to orthopedics to discuss treatment and I have prescribed an antibiotic.

A. T84.59XS - Other joint-SequelaB. T84.54XA - Left knee d/t prosthesis C. S81.002S, M01.X62 - Not even closeD. T84.50XD - Unspecified knee


Chapter-Specific Coding GuidelinesCase 3This 20 year old female was using her cell phone to send a text message while driving on Interstate 44 to a family activity. Her car hit another car.

A. V43.52XA, Y92.411, Y93.C2, Y99.8B. V43.62XA, Y92.411, Y93.C2, Y99.8C. V43.52XA, Y92.410, Y93.C2, Y99.8D. V43.22XS, Y92.410, Y93.C2, Y99.8


Chapter-Specific Coding GuidelinesCase 3This 20 year old female was using her cell phone to send a text message while driving on Interstate 44 to a family activity. Her car hit another car.

A. V43.52XA, Y92.411, Y93.C2, Y99.8 (Gold Star)B. V43.62XA, Y92.411, Y93.C2, Y99.8C. V43.52XA, Y92.410, Y93.C2, Y99.8D. V43.22XS, Y92.410, Y93.C2, Y99.8

1. Accident, car, transport, driver, collision V43.52XA2. Place of occurrence, hwy, interstate Y92.4113. Activity, cellular, telephone4. External cause status, leisure activity


Chapter-Specific Coding GuidelinesCase 4Bobby is a 10-year-old patient who had been playing with his new pet. He decided to feed the dog and was bitten while feeding the dog in the backyard of his parents single-family home and sustained an open bite wound on his upper left arm.

A. S41.152A, W54.0XXS, Y92.015, Y93.K9B. S41.149A, W54.0XXS, Y92.019, Y93.K9, Y99.8C. S41.139A, W54.0XXA, Y92.018, Y93.K9D. S41.152A, W54.0XXA, Y92.017, Y93.K9, Y99.8


Chapter-Specific Coding GuidelinesCase 4Bobby is a 10-year-old patient who had been playing with his new pet. He decided to feed the dog and was bitten while feeding the dog in the backyard of his parents single-family home and sustained an open bite wound on his upper left arm.

A. S41.152A, W54.0XXS, Y92.015, Y93.K9B. S41.149A, W54.0XXS, Y92.019, Y93.K9, Y99.8C. S41.139A, W54.0XXA, Y92.018, Y93.K9D. S41.152A, W54.0XXA, Y92.017, Y93.K9, Y99.8 (Gold Star)

1. Bite, arm, upper2. Bite, bitten by, dog3. POC yard, private, single family 4. Activity, animal care5. External cause status, specified NEC


Chapter-Specific Coding GuidelinesCase 5 This 59-year old male previously had knee surgery in his left knee with a prosthesis inserted. He comes to his PCP office today complaining of pain. Imaging of the knee and blood work confirm an infection surrounding the prosthesis. He is being referred to orthopedics to discuss treatment and I have prescribed an antibiotic.

A. T84.59XSB. T84.54XAC. S81.002S, M01.X62D. T84.50XD


Chapter-Specific Coding GuidelinesCase 5 This 59-year old male previously had knee surgery in his left knee with a prosthesis inserted. He comes to his PCP office today complaining of pain. Imaging of the knee and blood work confirm an infection surrounding the prosthesis. He is being referred to orthopedics to discuss treatment and I have prescribed an antibiotic.

A. T84.59XS - Infection and inflammatory reaction due to other internal joint prosthesis, sequela

B. T84.54XA - Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter

C. S81.002S - Unspecified open wound, left knee, sequela, M01.X62 - Direct infection of left knee in infectious and parasitic diseases classified elsewhere

D. T84.50XD - Infection and inflammatory reaction due to unspecified internal joint prosthesis, subsequent encounter


E/M


Areas Overlooked

Information not found in your manuels General knowledge● CMS.gov

How to research on a website● Keyword: Site:cco.us

○ NCCI site:cco.us○ HIPAA site:cco.us

■ You can do this with any website like CMS.gov or AAPC.com etc.


Areas Overlooked

Compliance and Regulatory5 questionsServices covered under Medicare Parts A, B, C and DApply coding to payment policyPlace of service reportingFraud and AbuseNCCI editsNCD/LCDHIPAAABNsRVUs


Areas Overlooked

References/Resources5 questionsFederal regulations/citations/referencesOffice of Inspector GeneralCenters for Medicare & Medicaid ServicesMedicaid & Workers Compensation


Testing Tips

● Look at exam layout● Exam Tips● Time management● One Hour Per Column Timing● Learn to skip - one dot, two dot


Questions


Thank You

Happy Learning

Alicia’s Contact Information:[email protected]

[email protected] Text me


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http://www.cco.us

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Documents

How To Pass Your Certification Exam - Amazon Web Services · Chapter 17 Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99) Chapter 18 Symptoms, Signs,