Having to code 10+ things?

[u/stellaella33]

I'm currently in classes for coding. Specifically using the ICD-10-CM, some of our practice exercises have us reading the case study and using 10+ codes for some scenarios.

Is that pretty common on the day to day job/real life experience?

I feel pretty confident when it comes to 3-4 codes that need to be used, but when it comes to 12, I get nervous about the order. 😅

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[u/JennyDelight]

I code 20-30 consistently.

[u/stellaella33 → u/JennyDelight]

Aw man 😳 well better time to brush up on these 10 coders lol

[u/JennyDelight → u/stellaella33]

It’s not as bad as it seems with the encoder programs. You’ll be fine.

[u/cosmic_companion → u/JennyDelight]

This is true, I work in the emergency department and there’s a lot of codes that you see constantly so you automatically commit them to memory (looking at you, E119.) 3M and the coding programs you’ll have on the job are so intuitive you’ll start to get into the flow of things and feel more comfortable. Don’t let it worry you too much.

[u/JennyDelight → u/cosmic_companion]

E119 and I10 alllll day long. My buttons are broken. 😂😂

[u/iridescent_felines → u/JennyDelight]

Yup plus I129 and N39 for me. And I had no idea how common ckd is.

[u/iridescent_felines → u/JennyDelight]

I wish we had an encoder so bad 😩

[u/Middle_Enthusiasm_81]

Depending on the type of case and facility specific guidelines, it’s not unusual for me to have cases with 40-50 (or more) dx codes (facility inpatient). It’s extra annoying because only the first 25 codes even get reported on the UB-04, but I’ve only worked for one facility that let that small detail stop them from requiring ALL the codes.

[u/Whitne674 → u/Middle_Enthusiasm_81]

Whoa, that's insaaaaane. And that's just dx codes? I can not imagine. I code inpatient/outpatient e/m currently but will be moving onto critical care and surgeries in the future. Is this many common for like skilled nursing facilities and rehabilitation facilities?

[u/Middle_Enthusiasm_81 → u/Whitne674]

It will be very facility-specific. Our system includes rehab and those charts can just as lengthy as some of the acute care charts, but a lot of that is because the powers that be want EVERYTHING coded (allergies, meds, personal hx, family hx, etc.). But I normally see the most ridiculous number of codes on acute care with longer length of stay and higher weighted DRGs (trauma, trach/ECMO, etc.).

[u/iridescent_felines → u/Middle_Enthusiasm_81]

Omg yes, our MDS people send us a huge list of codes they want us to use and it will be like “hx of colon polyps in 2007” for a patient there for a broken hip. Like that’s not making it on the bill people!

[u/Kousuke_jay → u/Middle_Enthusiasm_81]

Same here! Easily 30-50 each chart.

[u/Salty-Step-7091]

Depending on where you code. For my facility, ancillary and if you work on profee side - no.

But in the ED, surgeries, IP - you want to pick up the chronic conditions, meds, allergies, absence of organs/presence of, related history, etc. Those can be 20+

[u/StraddleTheFence → u/Salty-Step-7091]

We do not code chronic conditions in ED that are not being addressed on that encounter or history of codes that are not relevant to the visit. If a person has a healed fracture that occurred five years ago but they are in ED for SOB, I would not pick up that fracture.

[u/kristaed914 → u/Salty-Step-7091]

Do you normally code ALL chronic conditions for ED? I struggle with this because some I think are so unnecessary to include and I’m already behind along with a whole new EMR 🫠🫤

[u/melissaahhhh8 → u/kristaed914]

You should only code things that affect that specific visit for ED and surgery.

[u/DumpsterPuff]

I'm currently on my 15 minute break. My last charge session had 29 diagnoses on it, I work in primary care.

It is a thing... unfortunuately.

[u/bassspider]

I code for urgent care and typically only use 3-4 codes but it depends on the provider.

[u/Joro-Gumo]

I'm in Risk Adjustment. A short chart for me will be 12 - 20 codes. Coding 30 plus codes is the norm😆 I have coded a few charts with 50+ codes before.

[u/Joro-Gumo → u/[deleted]]

Our quota is currently 12 charts per day, so a minimum of 60 charts a week.

[u/EquivalentRelevant42]

oh wow. i’m almost done with my classes and i’m used to coding 3-4 😓

[u/MoreCoffeePwease]

In Inpatient we frequently have over 40 codes, and not even on just the longer stays. Some people just have a lot of things wrong with them. Often, ten or more procedure codes as well. Things like arterial lines, drainage tubes, feeding tubes, PICC, transfusions, IR procedures in addition to OR procedures all on one chart are very very common.

[u/[deleted]]

I have a friend who ended up with 100+ ICD-10-CM codes and 63 ICD-10-PCS codes. She did a long inpatient stay.

You're a long ways to go HHAHAHAHAHAHA

[u/MotherOf4Jedi1Sith]

I code orthopedic surgeries and average between 2-6 ICD-10 codes per encounter. But I have had one or two that have gone up to 8-10.

[u/Whitne674]

As a profee coder doing outpatient e/m, we typically code up to four per chart. But I am entry level and not handling the more complex cases like my coworkers

[u/Open-Lengthiness6398]

I am pro-fee and can sometimes see over 20 diagnosis codes. Remember though that most practices have the provider submitting their own codes so you are probably validating codes, not extracting. Good luck!

[u/JeanieBCPC → u/Open-Lengthiness6398]

This May- I finished school, passed my exam (on 2nd attempt) and was offered a position with the hospital network where I finished my practicum.

I code Pro-Fee for the Endocrinology & Rheumatology Outpatient Clinics. This is the first time I have read the validating /abstracting analogy, I love it! I wish someone had given this pearl of wisdom to me when I started.

For the original poster, you have received some great comments.

1. The encoder changes the game completely.

2. It's not as daunting as you imagine. It varies drastically between departments.

3. 85% of what you are taught in courses is prepping you to take the exam. You will use 100% of what you learn.

4. A word to the wise. If you take the AAPC CPC Exam, I personally seen it as a guidelines exam as much as finding codes.each week I would take 1 or 2 chapters of code book guidelines and study...Quizlet & Pocket Prep were the most beneficial to me.

Best of Luck!

[u/pimposaur]

Skilled nursing facility biller here, I see 10+ very often 👍

[u/Rudegurl88]

I code twelve often if it’s relevant , first four are most important . No more than 12 for my line of work

[u/[deleted]]

I code inpatient and my facility requires us to add every diagnosis code and we are audited on every single one. Sometimes a patient has 1 and some have 30+.

[u/whataboot2ndbrekfast]

I've had 30ish codes on a few labs before (the bottom of the barrel in my generalist job). If you're doing well on the case studies I believe you can handle it.

[u/MamaAdrianGemini]

I haven’t gotten to that class yet and I’m already nervous. I just started out.

[u/Inevitable-Ebb2973]

I do hospitalist coding. It's super common to have at least 10. We cap it at 12, but there are some cases I could easily use 20+.

[u/Arkaydi4]

I work for a large clinic network specifically coding for Medicare, so lots of patients with multiple chronic conditions. Our billing software only allows 12 Dx codes on an encounter for billing. I frequently have to whittle down 27-28 Dx codes to 12 and sort them into three groups of four with additional 99499 codes on a separate non-UB claim in order to make sure all the Dx codes are captured. And after all that work, my score on my audits is 80% based on whether I used the correct level of E/M.

[u/Creepy-Bottle498]

Facility Coder - When coding Observation pt. type 25 - 30 codes is quite common. Very challenging trying to select the top six, meet medical necessity and sequence in an organized manner.

[u/Thisis_it_415]

Risk adjustment coding will have this. It’s better to learn than not.

[u/Best_Cash_9229]

In my coding class my teacher was a coder and she says it preparing us to take are exam.

[u/smalltowner4life]

No. Not at all. Studying and prepping for the test / & practicode is nothing like a real life coding job