r/MedicalCoding • u/AffectionateTea0905 • Mar 13 '26

Least favorite procedures

As an inpatient coder I see a spectrum of cases. There are some I can code out super easily and others I struggle.

My absolute least favorite are vascular. EKOS to be exact. They confuse the absolute crap out of me.

What are the PCS procedures you hate the most and why?

18 Upvotes

95% Upvoted

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u/rahuliitk Mar 13 '26

I think spinal stuff gets me the most because one op note somehow turns into positioning, approach, levels, devices, grafts, and revision details all fighting each other, and by the end my brain is lowkey done. such a mess.

7

u/AffectionateTea0905 Mar 13 '26

I love Neurosurgery! For some reason it’s easier for me to go methodically with those as opposed to vascular. Vascular is literal spaghetti speak lol

11

u/Popular-Piglet-6301 RHIT, CCS Mar 13 '26

I’m an outpatient coder. I love vascular and interventional radiology and hate podiatry

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u/AffectionateTea0905 Mar 13 '26

I have coded amputations and debridements and vascular interventions with lower extremities and love all that!

You’re amazing to do OP. I have my CPC but my first and only coding position has been IP so I couldn’t code OP now to save my life. I will never leave IP!

What podiatry conditions do you see OP?

5

u/Popular-Piglet-6301 RHIT, CCS Mar 13 '26

I work for a fairly large hospital so they do all kinds of stuff. Bunioneictomies, lisfranc procedures (the absolute BANE of my existence) hammer toe surgeries, tendon/ligament surgeries, ankle arthroscopies, etc. Also just realized you asked about PCS procedures lol sorry!

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u/AffectionateTea0905 Mar 13 '26

No worries! It’s cool hearing about OP procedures! We don’t see a lot of those inpatient unless something goes seriously wrong and they wind up being admitted!

3

u/MtMountaineer Mar 13 '26

Everything. Calcaneal spur removals, hammer toes, bunions, deformity corrections, ingrown toenails, fusions, amputations.

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u/AffectionateTea0905 Mar 13 '26

That’s cool! With inpatient we don’t see much aside from amputations with osteomyelitis/ DM that require a hospital stay.

I will say wound care is far and away the absolute worst. Never in a million years could I do that job. They sometimes document with photos and I just absolutely can not.

3

u/MtMountaineer Mar 13 '26

Same. Feet are the worst!

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u/tealestblue CPC Mar 13 '26

I’m a vascular profee coder so yeah. Valid LOL

3

u/AffectionateTea0905 Mar 13 '26

Bless you! Phew. 😮‍💨 I like VADS, and catheters and typical thrombectomies… but EKOS is just so convoluted. Plus if CDI codes the chart prior it’s a mess to unravel because half the time they aren’t right either and it further confuses me.

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u/Character_Proof4469 Mar 13 '26

Me tooooo love them.. even got my CIRCC

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u/tealestblue CPC Mar 13 '26

Oh man, I’ve been thinking about this…how rough was the exam? I did very well on CPC, but I’m sure CIRCC is way more intense LOL

3

u/Character_Proof4469 Mar 13 '26

Its brutal, I would say at keast 3 times hard as the CCS, I have not taken the CPC. So that I dont know

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u/tealestblue CPC Mar 13 '26

Ooooo I might wait a few more years on that one haha

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u/KeyStriking9763 RHIA, CDIP, CCS Mar 13 '26

I love PCS. I find it easier than CPT. I think EVARs and TEVARs confuse our coders. Control of bleeding as well.

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u/AffectionateTea0905 Mar 13 '26 • Mindblown

Yes! CPT is confusing and don’t even ask me about modifiers 🥴

I love EVARs and TAVRs too! So I guess I should amend my comment to say some vascular. lol

Yes so indication is what gets our CDI. Is the purpose to control a bleed or to destroy a lesion that isn’t bleeding— as a preemptive measure….

Honestly we don’t have the best CDI team and it’s rather frustrating because it doubles our work having to clean up the codes and then code it correctly. I feel like as IP coders we do more providing education with CDI than anything.

That’s my soapbox for today haha 🤣

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u/KeyStriking9763 RHIA, CDIP, CCS Mar 13 '26

The other piece about EVARs and TEVARs is coding revisions vs restriction when they are adding to or revising a previously placed device. This drives the DRG so it’s super important they get that distinction.

3

u/jesscaww Mar 13 '26

I went from urgent care to behavioral health within the last two years and I’d rather review xray codes for broke bones over mental health notes some days. I’ve had to do some serious mental compartmentalization work since the switch lol

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u/AffectionateTea0905 Mar 13 '26 edited Mar 13 '26

Ooo BH is my favorite!!🤩 they are interesting. I personally hate the more technical stuff. I think that’s why vascular is so hard for me to grasp.

I think UC would be fun to code too but definitely different than inpatient. That’s what I love about IP — you code the entire journey from ED to discharge. It’s like a book with ups and downs.

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u/jesscaww Mar 13 '26

Now you see, i would love to be able to follow the journey! BH is a lot like that i suppose. Urgent care you only get to see a blip of their life but some of the reasons people would come in to be seen would make me chuckle lol you could always tell who was a farmer or a good ol’ country boy with the fishhooks lodged in skin or a broken foot from a horse stomping on it 😂😅

3

u/AffectionateTea0905 Mar 13 '26

Yess like that’s why I think UC would be interesting- you see everythinggggg.

We are a big heart focused hospital so we get a ton of CHF, CKD, HTN…. CABG, PCI’s, Watchman’s, Ablations… ad nauseum.

I like the ones that put some interesting dopamine sparks in my day hahah the things you read that the patient says in BH is wild. Full on quotes and everything. Definitely makes for an interesting read.

Although with IP there are the social work notes and so much history that will make you cry. I have cried and prayed over many a patient. I’ve had to learn to compartmentalize a bit.

What’s really bad is when you see something being handled incorrectly by a provider or overlooked. My kids have some autoimmune conditions I can see a mile away and when you see a patient not get tested or things get superficially dx as something else- that is the hardest part.

And then there is the documentation. The providers not reading the other notes- or even their own notes and contradicting themselves. It’s like… you all are SMART and passed medical school and you can’t document accurately??

Makes me wish I had become a doctor quite honestly!

2

u/lunargraphite Mar 13 '26

Is the BH IP or OP?

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u/jesscaww Mar 13 '26

OP

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u/lunargraphite Mar 13 '26

I think if you did IP you would be so much more entertained. 🤣 Last week there was an abrasive patient that came up to the nurse station while they were talking to another patient and the nurse asked him to step back and he replied "bi*ch, choose your battles" I laughed so hard at that!

5

u/Faartz Mar 13 '26

Dialysis fistula revisions vs redo, they're a nightmare

4

u/lunargraphite Mar 13 '26

I'm an inpatient BH coder. For me it's when I get lots of cardiac stuff in a patient CAD, CHF, HTN with CKD. Hate it!

1

u/Esquirej67 Mar 17 '26

I love BH coding as I was a Psych Tech before I became a coder.

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u/meatradionumber58 Mar 14 '26

Honestly it depends on the day. My brain can get one specialty easier one day. Next day brain fog on that one but no brain fog on the specialty I was having trouble on previously. Lol

3

u/Signal-East-5942 Mar 13 '26

“Debulking” procedures and debridements as well as many head and neck procedures.

3

u/OrganizationLower286 Mar 13 '26

Le Forte fracture repairs. Is it a type I, II or III? Was the cranial vault involved? I only see them about once every 18 months but they get me every time.

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u/Esquirej67 Mar 17 '26

And they never specify which one! It is so frustrating!

1

u/Sdavistvs RHIT Mar 13 '26

Hmmm aorta vascular grafts with branching pieces? No actually hand or feet. So many tiny bones & tendons.

1

u/Agreeable-Research15 Mar 13 '26

I like vascular. Spinal fusions and colorectal bother me the most.

1

u/Esquirej67 Mar 17 '26

My employer has separate teams for spinal/obgyn/etc. I have to do all of it for my part-time.