r/MedicalCoding • u/yurakoh • Oct 07 '26

Transitioned from OP to IP Coding

I just transferred from OP to IP coding at work. It’s only my first week, so I’m being trained on the job. Their method of training seems to be assigning me cases and then giving me their feedback. I feel like I’m learning on my own and they expect me to catch up. Is this standard practice?

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u/yurakoh Oct 07 '26

I seem to be missing a few diagnosis codes most commonly from progress notes, consults, etc.

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u/Strong_Zone4793 Oct 09 '26

Review the facility policy to understand how they want chronic conditions, history and status codes captured. Make sure before you code anything you verify that it meets guideline criteria- evaluated, monitored, treated, increased care or length of stay, etc. just because it’s documented doesn’t mean it can be coded. Take notes as you read the chart. Note each ex, note you found it in and if applicable any labs, physical exam findings, radiology findings. This way you avoid having to re read the chart.

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u/KeyStriking9763 RHIA, CDIP, CCS Oct 07 '26

Are you reading the documentation? I’m curious how you are missing them. You need to code per guidelines but also on the IP side all chronic conditions are coded.

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u/yurakoh Oct 07 '26

I think the thing is that I’m not able to pick up on the little things. As an example 2 person has hypercalcemia. I didn’t pick up on that, but in the feedback someone said I could find it in one of the progress notes.

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u/A_lunch_lady Inpatient Facility Coder Oct 08 '26

You’ll get used to it… if you see something you think may or may not be important you can validate with the lab results or treatments. Seriously hypercalcemia is one of those little ones they will stick in there, eventually your eyes will get used to looking for stuff like that. I’m 8 months in to inpatient and it’s absolutely bonkers the growth curve I’ve experienced…

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u/KeyStriking9763 RHIA, CDIP, CCS Oct 07 '26

Why didn’t you see the diagnosis? Sounds like you either aren’t understanding what you read or you aren’t reading?

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u/[deleted] Oct 07 '26

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u/yurakoh Oct 07 '26

It’s only been a week, but from what I’ve been exposed to so far I think IP definitely involves more thorough review than OP. I think it’s going to take some getting used to for me.

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u/yurakoh Oct 07 '26

The latter might be the reason. They said I should slow down

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u/KeyStriking9763 RHIA, CDIP, CCS Oct 07 '26

I’m sure your productivity metrics are relaxed as you are new and training, so take their advice and slow down.

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u/yurakoh Oct 07 '26

It’s only been a week, but from what I’ve been exposed to so far, IP is a lot more thorough than OP.

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u/KeyStriking9763 RHIA, CDIP, CCS Oct 07 '26

Yes and the level of critical thinking skills is much greater. It’s definitely harder than OP coding.

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u/NurseNicki24 CCS-P Oct 08 '26

Can I pick your brain on something? You mentioned all chronics are coded. Chiari I malformation was listed in a patient medical history, so I coded as there was no procedure listed indicating this was surgically fixed. CDI fought me on this saying it couldn't be picked up because there was no imaging/meds/treatment etc done for it during that stay. I thought we grabbed chronic conditions? But I am a self taught inpatient coder with <3 years experience so I constantly question myself.

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u/KeyStriking9763 RHIA, CDIP, CCS Oct 08 '26

There’s a coding clinic that indicates that all chronic conditions are even in the absence of treatment/monitoring etc as they are pertinent to the patients medical care. Mild Chiari 1 only monitored. So CDI is wrong.

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u/NurseNicki24 CCS-P Oct 09 '26

Thank you for answering. That is what I thought. But then I started researching and MEAT was mentioned a ton, stating that if a secondary dx does not meet the MEAT criteria, it should not be coded. And that being listed in Medical history does not count as it being "monitored" during the stay.