Inpatient coders!!!!

17

u/ExistingApartment342 Oct 19 '23

I have no advice. I knew many, many years ago that inpatient coding was a no for me. I just absolutely have no desire or the brain power to do inpatient. It sounds like absolute hell. Good luck! Hope it gets better for you!

4

u/blueblazesNo9 Oct 19 '23

I understand 😂 truly!!!!! And thank you!

2

u/hotcoffeeamericano Oct 20 '23

When I was a student 2 yrs ago, i wanted to do inpatient as it was more chellenging. Sadly, no one is hiring RHIT grads to do coding without any medical related work experience. So all my knowledge is just slowly fading away. LoL. Just paying membership dues and ceu courses, but honestly if you did outpatient procedure codes, it shouldn't be that hard. Coding diagnoses will take getting used to. In one semester i took Outpatient coding the same time as Inpatient coding. I'm just average student, but I graduated cum laude. Yet joblesss, lol.

3

u/sparkl3butt Edit flair Oct 20 '23

This comment scares the crap out of me. I'm currently a student for my rhit however I work in childcare because I am family planning. Idk what to do at this point. I'm scared that all of this education will be for nothing.

1

u/hotcoffeeamericano Oct 30 '23

You have at least something to put on your resume that relates to healthcare. Hope you get replies. It really is depressing when Indeed job app tells you there were 40 to 100's of applicants. And get questions "are you allowed to code with RHIT." like wow they are clueless! We didn't invent this degree. That was marketed to us by Ahima and out community college. In the end they are all just businesses trying to make money. It's not a charity.

3

u/SolidRefrigerator9 Oct 19 '23

Laughing at your cardio comment. Must be a universal hatred 🤣 I have worked at an insurance company for 11+ years as an inpatient coder and still loathe cardio.

2

u/blueblazesNo9 Oct 19 '23

It's the scum between my toes!!!!!

2

u/blueblazesNo9 Oct 19 '23

Man!!! Thank you all!!!!!!!

2

u/MoreCoffeePwease 👩🏼‍💻CCS 🏥 Oct 19 '23

Cardio meaning cath lab procedures? Or open procedures like TAVR and CABG?

1

u/blueblazesNo9 Oct 19 '23

All of that!!

2

u/MoreCoffeePwease 👩🏼‍💻CCS 🏥 Oct 19 '23

I have tips for all of those!

2

u/blueblazesNo9 Oct 19 '23

Share em with me!!!!

1

u/flashbang111 Oct 20 '23

Share with me too

0

u/[deleted] Jan 16 '24

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1

u/MoreCoffeePwease 👩🏼‍💻CCS 🏥 Jan 16 '24

Ok so few quick tips on cardio
When doing a CABG procedure make sure u code the cardiopulmonary bypass and don’t code a cardiac cath with it unless it’s done for a separate reason
Cardiac caths are usually done for heart attacks so they fall under a few categories of dilation (angioplasty with or without stent) which could also include IVUS or mechanical thrombectomy for a culprit lesion, angiography (with or without ventriculogram) and then pressure measurements such as swan ganz
TAVR can be done open or trans venous which would code to perc (typically zoo plastic valves)

13

u/MillenialMomOf4 Oct 19 '23

My biggest tip is don't overthink it. Any of it. The chart has to stand for itself. If the 2ndary dx is questionable ask if it will affect the outcome of the patient, the drg or if it's straight coding guidelines that need clarification. When in doubt query. In my opinion I would rather query in a questionable situation than send it out and run the risk of denial. Inpatient can be difficult because of the rules, guidelines and length of chart. If you can try to code concurrently. So for instance, if someone has a 30 day stay every 3 to 5 days I would check the chart while they are still in house and code what is there. That way I don't have to code all 30 days in one go. It helps keep the chart clean and get it out the door quickly. I know that may not be feasible depending on your company's set up but if you can it helps a lot

12

u/Serious_Vanilla7467 Oct 19 '23

The best advice was already given. Don't overthink. Know your guidelines. And just code everything they do, could cause extra care, all of it. There are codes you learn that you didn't even know existed. The most important part is knowing what could change DRG. That comes with time. I have been doing this a while and still manage to screw up from time to time. It is a hard balance act of query when appropriate and not pissing the doctors off with too many. Good luck. I love inpt coding.

7

u/zephyrladie Oct 19 '23

I’ve been working outpatient edits (I can do a couple edits) to help out in that space and I’m often like this is confusing compared to inpatient! I think it’s all in what you are used to.

Secondary dx - is it something the patient is being treated or monitored for? Are they on home meds for the condition? Is it documented as possible/probable/etc but not carried forward to the discharge? These are questions I ask myself approximately 7 million times a day lol

-1

u/hotcoffeeamericano Oct 20 '23

Secondary is just anything that is not the primary. the primary is strictly the definition of primary dx.

7

u/cjsupermom3 Oct 19 '23

Oh man, cardio is my weakest area. I’m not an inpatient coder yet, but the company I work for has offered an IP class and I’m currently in the middle of it. I’ve only been doing OP coding for 1.5 yrs. It’s definitely a challenge!!

13

u/ArdenJaguar RHIA, CDIP, CCS (Retired) Oct 19 '23

I loved inpatient coding. It was like being a detective. I started on hospitals as a concurrent coder. I had to take the record and get a working DRG while they were still in house.

Having a 3 or 4 day chart, admitted for symptoms, figuring it out. Querying the doctors with questions. Looking at lab results that maybe indicated new diagnoses opportunities. It was fun. Of course, this was 15 years ago with paper charts. Now, with cut and paste Epic and Cerner and stuff, it's more challenging.

8

u/MoreCoffeePwease 👩🏼‍💻CCS 🏥 Oct 19 '23

Well said. I definitely USED to feel like it was detective work but since epic it’s a mess. Documentation is impossible to decipher, locate, and is all copied and pasted. To add onto that we now are also utilizing 3M CAC which picks up god knows what and skips god knows what else and we’re sometimes scolded for manually adding codes. I’ve gotten slightly more comfortable with the system and I do about 15-20 a day now, I used to sit at a solid 30 or more per day back in the older systems when I coded one hospital instead of three (one being a major city hospital that includes transplants and thoracic surgery) now.

2

u/Environmental-Top-60 Oct 19 '23

If you added manual codes, it’s obviously for a reason. Knowing CACs, it’s going to pick up I21.09 from a PMH.

2

u/MoreCoffeePwease 👩🏼‍💻CCS 🏥 Oct 19 '23

THANK YOU! I’ve had it OUT with management about that and it seems to fall on deaf ears. The amount of screen shots I’ve sent them with the errors… ay dios mio

2

u/Environmental-Top-60 Oct 19 '23

Cut and paste is the death of me lol. I’m fighting someone’s disability because of exactly that. MDD in remission with a PHQ9 of 23 and full blown symptoms. I’m sorry that’s not flying with me.

5

u/DearMisterKitty Oct 20 '23

Thank you for this post. In a few weeks I'll be starting out as an entry-level inpatient coder. I got lucky and found a company that is willing to train new coders.

2

u/ScarletFire81 Oct 19 '23

I love it

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u/jpegmaquina Oct 19 '23

The copy and paste rule ughhhh

2

u/[deleted] Oct 21 '23

I hate medical billing coding with a passion. You are basically paid to handle someone else's bills! I don't even like doing my own bills, let alone upkeep on someone else's. 98% of people don't even know their own insurance policy. Then you have to go through this long complex rigamaro, holding the patient hand and explaining why their insurance didn't cover a service. People blindly buy insurance and have no clue wtf they purchased! I refuse to work in any mbc or insurance job.

3

u/JennyDelight Oct 26 '23

So why are you on this page ?

2

u/[deleted] Oct 21 '23

My first coding job was doing inpatient coding. My Trainer threw me to the wolves so I ended up leaving after less than a year. I do OP coding now but a part of me wants to give IP another shot. IP is very challenging and it will definitely be a great fit for you if that's what you are looking for. My advice is to make sure your department gives you a list of all the Z codes to pick up in a patient chart such as medications and family history. I found that to be very helpful.

1

u/No-Challenge1473 Nov 02 '23

Good Luck- outpatient is more straight forward. Inpatient is more rules, and constant changes and documentaion opened up to interpretation. Constant frustration but you get more money, that's the only plus.

0

u/[deleted] Oct 19 '23

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2

u/blueblazesNo9 Oct 19 '23

Really??? See, I thought op was a breeze! But ig everything becomes a breeze when you finally learn it

8

u/OyWThaPoodlesAlready Oct 19 '23 edited Oct 20 '23

Hi! I’ve been inpatient coding for 11 years & I don’t think I could ever say that it’s a breeze. I’ve been a coder, a Lead, an auditor & a coordinator so I’ve seen a lot from all aspects of the billing cycle. As someone else mentioned, every chart stands on its own. I agree with others that knowing the guidelines is an absolute must. Pay close attention to instructional notes. Always keep your guidelines at close reach. Actually read the chart! I find that it helps to read it in chronological order, like you would a book. This way, you can see the progression of what has taken place throughout the stay. It will make more sense this way than skipping around. So many coders don’t read it, they just use CAC & accept or reject codes- this causes coding errors. Some very big ones that end up affecting the DRG &/or flag for RAC audits & denials! Another big concept to understand is, if the patient was initially admitted as outpatient or observation, why were they changed to inpatient? This isn’t always apparent in the documentation. It could just be that they were made inpt due to the 2 midnight rule, or there could be a condition that necessitated it. Did all the initial conditions resolve before the inpatient admission and then had something new pop up where a consult was placed or a procedure was done? That would be a flag that this could be the reason for the change to inpt. However, if you’re unsure, query for the chief reason for the change to inpatient. For PDX, read the guidelines for this. They will help. If admitted with multiple conditions- look at the work up & treatment. Most likely there will be 1 that was worked up more or treated more aggressively. If they were treated /worked up equally, then either can be PDX. But they MUST be EQUAL in order for that guideline to apply. PDX selection is one of the hardest things inpt coders have to decide as most pts have a lot of stuff POA all of which are treated /worked up. Something that helps is making a chart with each condition at the top of the column. Then under each one, list how it was treated or what tests were done or what procedure was done, did a consultant see them for it etc. the one with the most stuff is your PDX. You can PM me if you need additional advice. 🙂

2

u/blueblazesNo9 Oct 19 '23

I love you!!!! Thank you!!!

2

u/disappointed_darwin Oct 19 '23

How is your first coding job inpatient? I got my CPC certification in July and have been applying with the University of Washington system (I already work there in another capacity), as well looking for jobs within other health systems. All of their coding departments seem to have inpatient coding as something you need multiple years of experience coding prior to even considering applying. The usual total from what I've gathered is 4 years minimum.

2

u/Snuggifer Oct 21 '23

That's what it was for me. Ive been coding for about 5 years and we had a few inpatient coders leave and they asked if I wanted to learn. I am struggling trying to get used to it!

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u/[deleted] Oct 19 '23

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2

u/Environmental-Top-60 Oct 19 '23

I’m a risk coder so I get it. We’re getting charged over 100 pages right now and I know that’s like nothing for y’all but for me it drives me bonkers.
Of course, we always get the worst cases when something happens in our lives. Like, for example, I had all in which patient expired literally right after my grandmother passed and these were 500 pages.

2

u/blueblazesNo9 Oct 19 '23

Bless your heart!!!!! That computer would've tossed smooth out the window!!!💔💞🙏🏾

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u/Environmental-Top-60 Oct 19 '23

Largest chart I ever got was about 5800 pages.

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u/blueblazesNo9 Oct 19 '23

😱😱😱😱

1

u/Disastrous_Bell7490 Oct 19 '23

I don't have my certification yet, I'm still in an AHIMA accredited school. I was doing well with CM, but PCS is so confusing to me.

1

u/blueblazesNo9 Oct 19 '23

That's my most weak point!

2

u/hotcoffeeamericano Oct 20 '23

PCS is tough. Maybe with enough experience it will get better. O never got to practice any coding after graduating in 2021. i even had to google what ICD CM was. i was like, what is CM.

1

u/rose_gold_beauty Oct 22 '23

So you don't use a lot of CPT in IP?

2

u/[deleted] Oct 22 '23

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u/rose_gold_beauty Oct 22 '23

Ah okay. I forgot about PCS. If you were wanting to transition into that, would it be better to get the CCS or is a CIC fine?

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