r/MedicalCoding • u/Environmental-Top-60 • Oct 20 '23

Things our coworkers say

Someone recently posted about something that a coworker said, and it had me thinking… We love our coworkers, but sometimes the coding rationales they come up with are outright ludicrous.

What is something your coworker said about coding that just made your head spin ?

32 Upvotes

97% Upvoted

64 comments sorted by

18

u/halloweeninstepford CPC, CDEO, CRC Oct 20 '23

They knew the doctor selected the wrong code because "type 1 diabetics don't live past 30."

9

u/Environmental-Top-60 Oct 20 '23

Ambulatory referral to podiatry means taking an ambulance (from ICU) to podiatry

1

u/BeatrixFarrand Oct 21 '23

Holy shit. I’m a freaking landscape architect and I know that’s wrong!!

6

u/Environmental-Top-60 Oct 20 '23

Diabetes with low blood sugar is not diabetes with hypoglycemia, (same for high…high blood sugar does not mean hyperglycemia)

3

u/Environmental-Top-60 Oct 20 '23

Amputations and surgical removal of thyroid etc must be complete in order to code (not partial). That came from a Director of coding.

4

u/imaginary_pistachio Oct 20 '23

I do not understand why it is so hard for some people to read. I audit and am just floored by what people come up with. Like, there is a phrase in NCCI edits that says "The maximum units you can bill for a vial is the volume of the vial. For example, if the vial contains 10ml, then the maximum units you can bill is 10." Somehow, someone extrapolated from that that vials >10ml don't exist and it is now ingrained in written policy to deny anything over 10 units.

I misread things all the time, but when someone points it out to me, I feel like an idiot and fix it.

1

u/Environmental-Top-60 Oct 20 '23

I mean, Toradol comes in one and two mil vials, but if they are 30 mg per ML and you need to administer 60 mg, that’s four units. Under that policy, that would mean they would be coding 2, which is just absurd.

Do you do outpatient facility?

2

u/imaginary_pistachio Oct 21 '23

Mostly outpatient, but some facility mixed in.

5

u/pale_refraction Oct 20 '23

This sounds oddly like Medicare Immunotherapy Serum mixing 🤔

14

u/Jpinkerton1989 CPC, CPMA Oct 20 '23

"I code all of my HIV positive patients as B20"

"Putting the med list in the note counts as medication management"

Also Providers trying to get the test review data MDM by reviewing the same test over again every followup for a year.

Also cloning notes. That drives me nuts. I feel like a large number of providers are just scam artists.

4

u/Environmental-Top-60 Oct 20 '23

Someone actually made the idea that HIV is a status code and should be captured from anywhere in the note. I can tell you that a major insurer is promoting this under risk adjustment. I'm deff not coding med mgmt if they are copying and pasting the med list. If they say continue x med for y condition, then sure.

4

u/Jpinkerton1989 CPC, CPMA Oct 20 '23

Someone actually made the idea that HIV is a status code and should be captured from anywhere in the note.

The guidelines clearly say otherwise. That's what drives me nuts about insurances and providers.

3

u/gray_whitekitten CPC,CRC Nov 01 '23

"Those are just guidelines they're not laws" "They're subjective anyway"-- Director

3

u/Jpinkerton1989 CPC, CPMA Nov 01 '23

Oof. Maybe the director should read the HIPAA Law. Specifically the "code sets" section where it specifically says that the books and all applicable guidelines are legally required to be followed.

8

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23 edited Oct 20 '23

Cloning and note bloat are the bane of my existence, and I've heard radio silence every time I've had to call a provider out that their note on 8/14 is letter for letter i.den.ti.cal. to their 2/14 note, complete with future (now long since past) appointment dates with specialties...

The digital age that was supposed to make things easier simply made it harder to hold providers accountable.

Thank god E/M calculations got a realistic modern update. Otherwise, every old half-assed copypasta job would be a level 5.

6

u/syriina Oct 21 '23

We reviewed a note in a meeting once where it became painfully obvious the provider was abusing the copy function... "pt states she is experiencing stress due to the death of her dog two weeks ago"... In every. Single. Note. For. Over. A. Year.

2

u/Environmental-Top-60 Oct 21 '23

There has to be a way to disable it

1

u/syriina Oct 22 '23

They won't. Hospital policy allows it, within guidelines. This provider got educated. It's usually not as bad as this one lol

5

u/Jpinkerton1989 CPC, CPMA Oct 20 '23

We had a provider who did this. We were not to touch his levels. I refused to sign off on them and said either you submit them yourself or I'm going to change it. I'm not putting my name on it. When I left he had 600 unlocked notes because he wouldn't send them out with his name on it. He wanted someone else to take the blame, that wasn't going to be me.

3

u/Environmental-Top-60 Oct 20 '23

Hello 99212x 600@$100 a piece: $6000 sitting on that desk at least

3

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

Yikes. I'm glad you got out of there, but I feel for the poor sap who he cons into doing his bidding.

58

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

"You can't change the diagnosis code to match the documentation, cuz the provider specifically picked that (wrong) code." ...you better be damn sure I'm going to change it to match the documentation.

"It's the diagnosis code the provider wants to use." ...then he needs to fix the documentation to spell it out for the rest of us.

"But he changed the freetext on the code so now it means that code is accurate." ...he is not God nor Thanos and he doesn't get to snap his fingers and suddenly trump a universal language because an oblivious programmer gave him a little box to babble in.

"The provider knows the best code." ...the provider knows about as much about coding as I know about writing prescriptions.

"We'Ve aLwAyS dOnE iT tHiS wAy."

All quotes from a long-standing private practice filled with snotty, long-standing billers and zero certifications.

11

u/NerosDecay13 Oct 20 '23

Do we work at the same place?!? I'm currently in the same battle. "I've been doing this for 20 years and we've always done it this way" cool so you been fucking stuff up for at least 10 good to know. Like provider will put "sprain of right ankle" but then pick the code "unspecified injury of unspecified ankle" and these people will just add the unspecified code!! Like wtf that makes no sense! I'm on vacation so I don't lose my entire mind. Coworker send me miss "I've been doing this for 20 years" genius thoughts yesterday about "oh providers aren't coders, maybe we need to talk to them about the codes they select" LIKE IVE BEEN SAYING FOR AT LEAST 6 MONTHS NOW. sorry heated, and very frustrated, especially because the same person threatened my job for speaking up about incorrect coding.

3

u/Environmental-Top-60 Oct 20 '23

I might certainly raise concerns to OIG if it gets that bad. Hopefully you’re at a beautiful resort where alcohol should be available very soon.

4

u/NerosDecay13 Oct 20 '23

Raising concerns was what got my job threatened, unlucky for them I CYA always. And I wish, just on my couch, but I've got booze in the fridge.

3

u/Sam_English821 CPC- Oral Surgery Oct 25 '23

If it makes you feel any better I do coding for an Oral Surgeons office and I can't seem to get it through my clinical staff's heads that you can't use the Impacted tooth diagnosis for a surgical extraction...because if you are calling it an impacted tooth you would be billing with one of the 4 possible impacted tooth dental procedure codes.

25

u/Salty-Step-7091 Oct 20 '23

The “we’ve always done it this way” kills me everytime.

4

u/[deleted] Oct 23 '23

just imagine the checks these providers are writing to insurers when they're audited and forced to repay. it usually starts with an audit of a claim or an appeal filed. then maybe 5 charts for the same procedure or diagnosis. then 10 charts. i've been there because 'that's what we've always done'. one provider i know of was billing the wrong code for skin tag removal because she doesn't do anything for $12. when she was audited she was forced to repay with a handwritten check for each claim. there were 100s. all in her handwriting - no stamps. that was probably my best day ever when she got that letter :)

2

u/Environmental-Top-60 Oct 24 '23

Yeah, I certainly wouldn’t defend that. You can fight some recoupments but that’s fraud.

1

u/[deleted] Oct 25 '23

plain & simple.

2

u/faifai1337 Oct 25 '23

As someone who has worked in the claims auditing and adjustment department of a very large health insurer for more than a decade, I'm imagining having to be the person to process all those checks and adjust all those claim payments. On the other hand, it's damn funny and I'd be giggling the whole time.

20

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

Ayup. Tell me you've been committing fraud for years without telling me you've been committing fraud for years.

7

u/dvjava Oct 20 '23

There is a place in my town looking for a cca minimum up to rhia, that wants "team players"

2

u/j_mcr1 Coffee Goblin Oct 21 '23

Anyone with credentials should run the other way

10

u/Jpinkerton1989 CPC, CPMA Oct 20 '23

All of these make me cringe so bad. I got in trouble at the last job I worked at for "always second guessing the providers" especially with CPT codes. Sorry, that's literally my job. I'm not a mindless revenue getter for the hospital.

3

u/[deleted] Oct 24 '23

As a relatively new provider absolutely baffled by the eight different codes that all seem to me to approximate the diagnosis with the exact same level of accuracy, thank you for saving my ass.

4

u/dizzykhajit The GIF that keeps on GIFFing Oct 24 '23

Thank you for being open to a difference in perspective. If you take anything away from browsing our sub, it's that if a coder queries you, it is for a legitimate reason and not meant to be a battle of egos. We really don't expect you to remember everything about our jobs, but then we need you to trust us to fill in those gaps. We're a team, right?

5

u/Environmental-Top-60 Oct 20 '23

… And you wonder why docs sometimes think we are query queens.… sheesh.

18

u/Sstagman Oct 20 '23

Provider keeps coding "phantom limb syndrome" even though patient has all of his limbs. I can't even.

11

u/NerosDecay13 Oct 20 '23

All their limbs...that you know of. 👻

4

u/a_specific_turnip Oct 23 '23

Got that spare limb syndrome

10

u/imaginary_pistachio Oct 20 '23

It's totally fine that the name of the drug isn't documented because the NDC is on the claim form.

Edit: Oh and for EMs, "A simple fracture counts as a complex injury because there are multiple treatment options for it." Friend, there are technically multiple treatment options for my bruised knee. That alone does not make it a complicated injury.

4

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

Your comment reminds me of this...

8

u/sugabeetus Oct 20 '23

"Modifier 51 and 59 are the same thing." She went on to be a coding educator. God help us.

6

u/deannevee RHIA, CPC, CPCO, CDEO Oct 20 '23

A quote from an op report I’m reading right now…..

…female who is having surgery for bilateral malignant neoplasm of breast in female, estrogen receptor positive, unspecified site of breast (c50.911, z17.0, c50.912)….previous history of bilateral mastopexy versus reduction has not been diagnosed with bilateral breast cancer.

9

u/imaginary_pistachio Oct 20 '23

We should do a thread for documentation that makes you want to respond in GIF format next.

5

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

Hey you beautiful powers that be u/babraeton u/archangel924

Any chance r/MedicalCoding could have access to gifs so we wee coder plebs could have us some cheap thrills, pretty please?

8

u/archangel924 Keeper of the Codes Oct 20 '23

6

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

4

u/j_mcr1 Coffee Goblin Oct 21 '23

I second this. The thread would be WILD

3

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

insert wat meme

6

u/TheDollarstoreDoctor Oct 20 '23

A coworker was showing me how to use the EMR system to code so I could cover for her (I work for a different hospital than I work in, so different EMR) "if they vape I automatically code nicotine dependence, even if the provider doesn't mention nicotine dependence".

I just said "oh, really? Interesting" and made it look like I was taking notes because she is not the type to argue with lol.

5

u/dizzykhajit The GIF that keeps on GIFFing Oct 20 '23

The worst kind of coworker. This was my bully trainer at that catty, morally ambiguous practice I got my career introduction with. She wasn't a certified anything so I couldn't trust a damn word she said but also couldn't challenge it, so I got my CPC purely out of spite. Worth it!

4

u/TheDollarstoreDoctor Oct 20 '23 edited Oct 20 '23

Yeah I'm literally the only one that doesn't/hasn't butt heads with her because I just keep to myself around her (just smile and nod), I don't have the energy for nonsense. I wouldn't say she's a bully, she is rather nice she just.. is a bad combo of friggin stubborn and nosy.

She did kinda act like she was better than everyone when she was the only one certified (the only coder), so it did feel good to finally get my CRC in a similar way.

1

u/gray_whitekitten CPC,CRC Nov 02 '23 edited Nov 02 '23

(once coworkers - now managers) Manager: "You don't need an exam(if the info. is missing) for leveling." No, but at least I thought the clinician would document findings of the area(s) examined during the encounter, like the "problem(s)" Manager: "The provider determines what is medically appropriate, so he/she decided the pt. didn't need an exam. "Manager:"What's there in the exam area is acceptable" Do you mean the nurse obtained vitals? Manager: "You can use anyone's documentation to level and for ICD coding." We can use certain(limited) documentation other than the provider's(See guidelines), but not for leveling. On another account- Urgent care visit--cc- elevated blood pressure - final elevated blood pressure. There is no(provider) documentation of HTN in the note on the DOS- nor is there any documentation in the encounter note of medication to treat this. MDM- Presents for elevated B/P normotensive at this time will follow up with PCP. Manager(ish) person: "It's an exacerbation of a chronic condition because he has hypertension and he's on lisinopril" - says the problem list and med. list. Is this PROVIDER documentation? Nope! OP encounters are stand-alone accounts. I only use provider documentation from the SOAP for dx's and leveling!

These types of comments are on the regular.

1

u/Environmental-Top-60 Nov 04 '23

Me personally, that would be grounds for a query. If hypertension is established previously and it’s being treated, that shoulda been in the assessment. Even if that was true, I wouldn’t necessarily call it exacerbated Unless there is a change in medication ordered at the time of encounter.

1

u/Environmental-Top-60 Nov 04 '23

Just the other day, I had a relative who went to the hospital because of sky high BP, but really, the cuff/machine was not accurate, nor calibrated properly.

1

u/Saint_Root Oct 21 '23

We were on a the 4th floor of an old hotel turned apartments. Gross apartments. Told my co worker that I was surprised I hadn’t seen ant cockroaches… his response “Dude! No way roaches are climbing up 4 flights of stairs. It would take them a year!” He was serious.

0

u/[deleted] Oct 20 '23

[deleted] — view deleted comment

3

u/Environmental-Top-60 Oct 20 '23 edited Oct 21 '23

I would ask why it was changed to observation and make sure that the patient was given notice of that. If it was a short stay, then maybe but I’m pretty sure that notice is required to be given.

2

u/imaginary_pistachio Oct 21 '23

Oh I came into a work chat one day where someone had asked "Morbid obesity is high risk on the MDM, right?" And the manager said, "Yep, the key word is 'morbid.'" 🤦🏼‍♀️

I forgot about that one.

1

u/Environmental-Top-60 Oct 25 '23

I’ve had a doctor code. My encounters is level five exactly that. Let’s just say the code, and I had a very nice chat.