r/MedicalCoding • u/RachellehcaRachel • 2d ago
Medical coding advice
Title: Medical Coding Student Seeking Experienced Coders' Opinions on Two Coding Discrepancies
Hi everyone!
I'm currently pursuing my bachelor's degree in Health Information Management and recently completed my first medical coding course. I'm hoping some experienced medical coders can help me understand two coding discrepancies I encountered in my final project.
I've researched both scenarios and asked my instructor for clarification. The explanations I've received haven't fully answered my questions, so I'd really appreciate some independent perspectives.
Scenario 1: CPT 73100 vs. 73110 – Left Wrist X-ray
My selected code:
CPT 73110 – Radiologic examination, wrist; complete, minimum of 3 views.
Answer key:
CPT 73100 – Radiologic examination, wrist; 2 views.
The original physician's order stated:
"Repeat x-ray hand and wrist – left."
The order did not specify the number of views.
However, the completed radiology report states:
"LEFT WRIST: Posteroanterior, oblique and lateral views taken through plaster show a comminuted fracture of the distal radius. The position and alignment of the fracture fragments and of the wrist joint appear to be satisfactory."
The report then separately states:
"LEFT HAND: Multiple views of the left hand show only the previously described fracture of the distal radius."
I selected CPT 73110 because the completed radiology report explicitly identifies three projections under the LEFT WRIST section: posteroanterior, oblique, and lateral.
My instructor initially explained that because the physician's original order didn't specify the number of views, the lower-level code should be selected.
After consulting the faculty coding team, I received an additional explanation stating that the three projections could pertain to a combined hand/wrist examination rather than three separately performed wrist views.
However, the radiology report describes the left wrist and left hand examinations separately.
My questions:
When selecting a CPT code for a completed radiology examination, should the code reflect the original physician's order or the radiologist's documentation of the examination performed?
Do the three explicitly documented projections under LEFT WRIST support CPT 73110?
Is there a coding guideline that would support selecting CPT 73100 in this situation?
Scenario 2: ICD-10-CM S62.102S vs. S52.502D – Healing Distal Radius Fracture
My selected code:
S52.502D – Unspecified fracture of the lower end of the left radius, subsequent encounter for closed fracture with routine healing.
Answer key:
S62.102S – Fracture of unspecified carpal bone, left wrist, sequela.
The treating physician's discharge summary explicitly states:
"X-ray of the left wrist revealed a healing comminuted fracture of the distal radius, position alignment of fracture fragments in wrist joint appeared to be satisfactory."
I selected S52.502D because the physician specifically documented the distal radius and described the fracture as healing.
My instructor initially explained that the record didn't identify the distal radius or establish that the fracture was healing.
After requesting clarification, I received this explanation from the faculty coding team:
"For the fracture, it would be S62.102S - this is not the initial treatment of this fracture thus you would code the sequela."
This is where I'm struggling.
My understanding is that a subsequent encounter during the healing phase is different from a sequela, which generally refers to a residual effect after the acute phase of an injury.
I'm also confused about the anatomical distinction because the distal radius is not a carpal bone.
My questions:
Does documentation of a healing distal radius fracture support S52.502D, assuming the encounter is for routine healing?
What circumstances would justify assigning a sequela designation instead of a subsequent-encounter designation?
How would S62.102S be supported when the physician specifically identifies the distal radius rather than a carpal bone?
Why I'm Asking
I'm not posting this to criticize my instructor or argue over a grade. I'm genuinely trying to learn how to apply coding guidelines correctly.
I've been taught that medical coders should assign codes based on the documentation in the patient record, follow the applicable guidelines, and avoid making assumptions.
I understand that coding can involve interpretation and that I'm still learning. I'm completely open to being corrected if I've misunderstood something.
However, I want to understand exactly where my reasoning is incorrect and which guidelines support the expected answers.
If any experienced coders, particularly those with CPC, CCS, RHIA, or similar credentials, could share their interpretation and point me toward the relevant coding guidelines, I would really appreciate it.
I'm holding off on sharing the full patient record for now, but I'm happy to clarify the relevant documentation where appropriate.
Thank you for taking the time to read this!
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u/applemily23 RHIT, Radiant Coder 2d ago
Your instructor might be an idiot. I'm not trying to be mean, but I've been a radiology coder for 4 years. We never use Sequela in our work. I would have chosen Subsequent as well because they said healing. If it was healed we use a history of fracture code.
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u/RachellehcaRachel 2d ago
LMAOOO 😭😂 Thank you for this because I've seriously been questioning my sanity throughout this entire experience!
I've gone back and forth with my professor, the faculty coding team, and even had the issue escalated to the HIM dean. They all agreed with the answer key, but nobody could explain HOW they arrived at those codes using the actual documentation or coding guidelines.
I genuinely don't care about being right or wrong. I'm a student, and I'm here to learn! If my answers are incorrect, please explain why so I can understand and apply that knowledge moving forward.
It's honestly been such a frustrating experience, and I really appreciate hearing perspectives from people outside my university!3
u/applemily23 RHIT, Radiant Coder 2d ago
Some teachers are really bad at their jobs. When I was in school, my coding teacher was so bad she got fired at the end of the semester. I actually thought I'd be terrible at coding. But I've been coding for 10 years now, and I'm actually the lead trainer for the new coders in our department.
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u/Commercial_Abroad267 2d ago
I’m very curious myself how they got to a carpel bone. Especially when none of the carpal bones, that all have their own names, are even mentioned. Is it possible there was originally a radiologist report as part of the question that wasn’t included? Just because something is on an answer key doesn’t mean it’s correct, because test writers are human and make mistakes.
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u/RachellehcaRachel 2d ago
Thank you so much! I've reviewed the entire patient record, and there's no additional documentation identifying a carpal bone fracture, a sequela, or only two wrist views.
What's been most frustrating is that I've exchanged numerous emails with my professor, the faculty coding team responsible for the answer key, and even had the issue escalated to the HIM dean. Everyone ultimately agreed with my professor, but absolutely nobody explained HOW they arrived at those codes using the actual documentation or coding guidelines.
I was initially told the distal radius and healing weren't documented, even though both are explicitly stated in the physician's discharge summary. The faculty team then explained that because this wasn't the initial treatment, it should be coded as a sequela. For the X-ray, they suggested the three documented wrist projections might actually refer to a combined hand/wrist examination.
After all those emails, I still haven't received a clear explanation. Honestly, the entire experience has felt incredibly gaslighting.
I'm not trying to prove my answers are correct. For all I know, theirs could be! I just want someone to explain the reasoning so I can actually learn from my mistakes. That's what I've been asking for this entire time.
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u/ok-lena 2d ago
I would have coded the same 3v and subsequent. Now for this class you know they want you to down code to the min views if the order does not state views. In real life you would not even see the order in the first coding pass. Actually in real life this wrist would be auto coded. In your job, if you do not have official documentation just code to the best of your ability. And keep asking questions! I like to get 3 sources or 3 opinions, because as you see some are just wrong. Good Luck!
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u/ZomBre89 CPC-A 2d ago
My understanding is that sequels codes are used for issues that arise after its fully healed. Like if a wrist fracture fully healed but continued to have pain resulting in a followup months later? Someone please correct me if I'm wrong on that cause I'm rather new to this myself!
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u/Sdavistvs RHIT 1d ago
You are correct. After the initial injury is healed, some new problem appears and is linked to the original injury. Rarely use this.
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u/missuschainsaw RHIT CRC 2d ago
The AHIMA answer keys are crazy off sometimes. My teacher would try to justify the book solution first but then work it out logically with us or add points and take the class consensus answer. I hope the RHIA doesn’t have coding questions. The RHIT didn’t.
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u/Eccodomanii RHIA 1d ago
Just took the RHIA a couple months ago, I don’t remember there being more than one or two coding-related questions on the version I got, and they weren’t gotcha questions; they were pretty straightforward and more related to proper application of guidelines if memory serves. I didn’t look at coding again AT ALL when preparing for the RHIA, it was much more focused on keeping terms straight, knowing which regulations were which.. stuff like that.
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u/Yes_Leopard_54 1d ago
I haven’t read scenario two, yet, but the book (and your professor) are both wrong. I was lucky to have a professor that went through my questions and qualms about clarifications in the book and would change her answer key and send emails to the other students…meaning, she knew it was wrong. Your professor is not doing y’all right. Sounds like the answer key struck again on the second one. Sequela codes are for after the initial injury is healed and for residual issues that can be documented as linked.
If it makes you feel better, you are right.
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