Okay. Now I want to spend some time on exercises not in the coding handbook.
This particular exercise is an introduction to pregnancy coding, or OB coding.
I think that chapter 15 OB codes are among the hardest in the code book to code.
There's just more steps that have to do with that.
I have quoted here three guidelines that are applicable to this particular scenario.
And I wanted you to notice this first one: assume the pregnancy is affected unless the
provider says otherwise.
No matter what a young woman comes in with, if she's pregnant, it's going to be more than
likely a pregnancy complication code.
So in this particular case we're coding the pregnancy complicated by the cholecystitis.
What I have done in this diagnosis section, I have in purple and bolded the terms that you
will need to code.
For example, 32 weeks will be coded; the pregnancy complicated by cholecystitis will be coded;
the gestational diabetes will be coded; and that fact that it is managed with changes
to the diet only with no insulin is important in the selection of the code.
And as you can see here, I have the pathways.
This guideline reminds you that you need that final character indicating which trimester
it is.
And this is the gestational diabetes.
The only path not on this slide is the very last one, the weeks of gestation.
That's on the next slide.
And here's the pathway.
So I recognize we have not done chapter 15 yet, but I want you as always to read a little
bit ahead to understand what's coming down the road and how important it is that we always,
always go back to the guidelines.
Here's another exercise not in the coding handbook.
The patient was admitted to the hospital with choledocholithiasis.
Let's look that one up with our pronouncements.
See if we can get a better pronunciation than what I just did.
Oht, oh. [Laughs].
It didn't go to one.
Nope.
>>COMPUTER: "Choledocholithiasis".
"Choledocholithiasis".
>>SPEAKER: Choledocholithiasis.
This word I have to look up several times to remember how to say it,
but it is choledocholithiasis.
Choledocholithiasis is how you say this word and it is stones of the bile duct.
So this patient has surgery three days ago for the choledocholithiasis.
He has recovered well.
Chemotherapy will be ordered to begin next week to address his primary right kidney pelvis cancer.
He also has diagnosis of an old MI three years ago and hyperlipidemia.
And I have your reminder that the choledo- [laughs].
There, I lost it again. [Laughs]
Choledo- choledo... choledo-cholelithiasis.
Woo.
An old MI is called a "healed" MI.
Here are the paths to get to these codes.
The next exercise I want to go over is a clinic note.
This unfortunate gentleman is seen in the office today to follow up on complications
related to the trecheostomy and J tube, both of which were placed during hospitalization
for a spinal cord injury with cervical fracture at C1, incomplete lesion three months ago
due to a motorcycle accident.
The infection in both the trach and the J tube is staphylococcus.
He continues to gain use of his extremities.
He continues to be seen in outpatient PT.
I have in the purple font here bolded those main terms that are going to be coded.
I have purposefully not highlighted motorcycle accident, but in many times that's an external
cause code that you would be coding if you're working in the hospital.
I have here the path for the complication of the trach with an instructional note.
Use additional code to identify the type of infection, then I have the neck abscess and
additional code to identify the infectious agent.
And here is the staphylcoccal code.
So those three, first three codes have to do with the complication of the trach.
The complication of the J tube, K94.2.
I'm going to just put this here.
Use additional code to identify the type of infection.
Also an instruction note below the complication for the J tube.
So that takes us through the first four codes.
The only one left is the code for the spinal cord injury and I have that on the following slide.
And here it is with the seventh character D for subsequent encounter.
This is considered a subsequent encounter, and not a sequela because the patient is still
receiving treatment for complications related to a surgery.
So my understanding is that falls under a subsequent encounter.
Here's another one that I'll let you go through on your own, but I purposefully wrote an emergency
department diagnosis that had to do with dental, dental diagnosis.
That's something that the book doesn't cover very much and you never know where you're
going to be working.
So I wanted you at least to be aware that there are codes for dental diagnosis.
This person's alcoholism and intellectual disabilities also coded in this case.
Here's another long one.
The patient is admitted to the hospital for surgery to take down the peritoneal adhesions
causing the patient continued abdominal pain.
She has post-inflectional peritoneal adhesions and chronic peritoneal effusion, both complications
of a gastric band surgery and post-infection she had last year.
The offending organism was streptococcus.
At that time, her BMI was 42.
It is now 29 and her nutrition is adequate.
Even though she has lost almost 100 pounds, she continues to be medicated for hypertension
and diabetes type 2 on insulin.
And I have here the path where you have a complication of the procedure, which again,
it is a K tube.
K tube- a K code, not a T code for complication of a bariatric procedure.
Here's the strep as cause of infection, peritoneal adhesion, peritoneal effusion, hypertension,
and type 2 diabetes, additional code to identify the insulin use, and I make a note here.
I would not code the BMI because it does not meet the UHDDS criteria for a secondary diagnosis.
Remember that it's in section three I believe of your guidelines and you can see the six
criteria that must be met in order for a diagnosis to be considered secondary.
Once again, be mindful the exercises in this PowerPoint do not address all of the guidelines.
Exam questions can relate to all of the guidelines.
Follow the assignments schedule with regard to specific assignments.
Post any questions you have in discussion board along with the path that you attempted to
find this code, and I'll be glad to help you.
Thank you for your attention and have a good day.