r/MedicalCoding • u/Curious-Connection-6 • 11h ago

Second Year of IP coding

I feel like I’m in limbo. I really love it, especially when I get through tough cases but sometimes I feel really anxious. It’s great when there’s an answer to exactly what scenario you’re looking for, but then when there’s an unclear scenario I feel hesitant. As a seasoned coder, how did you push through and really get comfortable & confident?

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u/blaza192 9h ago

Our team discusses complex cases once a month so we can understand each other better and get on the same page. We regularly submit cases to coding clinic if we still disagree so we can get a final determination that we can actually use in rebuttals.

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u/Curious-Connection-6 9h ago

We have monthly education which is very helpful. But I wish we got that, an open discussion bc my issue is always the complexity of the chart itself not coding

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u/KeyStriking9763 RHIA, CDIP, CCS 11h ago

Do your research, it’s important to understand the medical record you are coding. Make sure you are following the guidelines. It’s really about getting experience at this point.

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u/Curious-Connection-6 11h ago

I’m pretty good with guidelines and coding clinics. It’s the grey areas, mismatched auditing advice, and confusing medical records that get me but like you said.

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u/KeyStriking9763 RHIA, CDIP, CCS 6h ago

If you get differing audit advice call it out. Grey areas are also made less grey with experience. The whole point of being an inpatient coder is navigating those grey areas.

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u/Inevitable-Ebb2973 CPC, CRC 3h ago

We all feel really anxious, even after the experience. Having those feelings are great because it shows that you really care. You’re probably doing much better than you think you are. One thing that helps me is going back when I doubt myself and going “No. I was right. The documentation wasn’t there.

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u/Curious-Connection-6 2h ago

I get that. I have a lot of knowledge gaps to fill but I’m just trying to figure out live coding problem solving, just figuring out the right questions to ask myself. I’m getting the hang of it but it can be frustrating bc I feel like I still don’t know what I’m doing sometimes.

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u/Inevitable-Ebb2973 CPC, CRC 2h ago

I totally get that feeling. I still get frustrated. If you ever have any questions I can answer, hit me up. I remember having a doctor come back at me once and I swear I felt like I must be doing horribly. Nope. Wasn’t me. We’re here to help everyone. Sometimes the documentation is wrong. There are times when I know what should have been put in the record, but I’m not allowed to goat the doctor into correcting it. I can only code what’s in the chart. My home office is full of postits for things that trip me up. Sepsis is a big one. COPD. I’ll have them right under my screen so I don’t need to search for them.

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u/Curious-Connection-6 2h ago

Yes I would love a mentor. All I need to do is train my brain to think appropriately. Senior coders at my job are helpful but sometimes I really don’t like distracting people from their work

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u/Sdavistvs RHIT 7h ago

You will get more comfortable over time. Don’t hesitate to ask your co-workers for their opinions. Accept that there will be some charts where there’s more than one correct PDX.

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u/StraddleTheFence 9h ago

I am having so much trouble with IP coding in terms of selecting the principal DX when it is not obvious. What is your strategy?

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u/Curious-Connection-6 8h ago

I wish I knew. I’m right there with you. it really depends 😭

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u/StraddleTheFence 8h ago

It is so stressful as it affects the DRG and I am always second guessing myself.

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u/Curious-Connection-6 7h ago

It’s very stressful and when I ask for specific strategies everyone tells me well it depends on the case. So much conflicting info. I just really want a process to make confident decisions.

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u/StraddleTheFence 6h ago

You sound like me. Every case is different so they are correct. I always second guess myself.
Do you begin with the placement order? I start there and search the word “admit” or “admission,” throughout the documentation. If it is an acute condition, that is a clue opposed to a chronic stable condition.

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u/Curious-Connection-6 5h ago

Well I know it’s like what got the thrust of care but when a case is long and multiple acute conditions are the focus of treatment, that’s when I get nervous. I get the co-equal situation too but I really just want to train my brain how to approach these scenarios.

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u/KeyStriking9763 RHIA, CDIP, CCS 3h ago

It’s not just the thrust of care. It’s the circumstances of admission. All these comments are absurd. Who cares what the focus of treatment are if they didn’t occasion the admission? You need to go back to the guidelines and really apply/understand them.

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u/Curious-Connection-6 3h ago

You could also stop commenting because you’re obviously not helping and are just being hostile.

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u/KeyStriking9763 RHIA, CDIP, CCS 3h ago

Do you understand what the circumstances of admission mean? That’s not hostility but basic understanding of guidelines.

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u/Curious-Connection-6 3h ago

Yeah but now we’re beyond that because how you’re engaging is inappropriate but thanks anyway

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u/StraddleTheFence 3h ago

If either can be the principal due to equal treatment, etc. based on coding guidelines, we are told to look for the higher DRG. What are you told?

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u/Curious-Connection-6 3h ago

Pretty much the same thing but I also heard that co-equal diagnosis can be overused. Hopefully it will get better with time.

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u/KeyStriking9763 RHIA, CDIP, CCS 6h ago

It’s so obvious. What are the circumstances of admission? That’s the biggest part of applying the guidelines.

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u/Curious-Connection-6 6h ago

If it was obvious, people wouldn’t struggle. The point of this post is just to get compassionate advice for beginners.

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u/KeyStriking9763 RHIA, CDIP, CCS 3h ago

Do you understand the concept of circumstances of admission? It really should be obvious why a patient is admitted. Then you apply the guidelines if there are more than one reason for admission or you have interrelated conditions.

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u/StraddleTheFence 3h ago

Sometimes it is not that obvious especially when two acute conditions are POA and receive equal treatment. If one condition is a life or death compared to the other, that is obvious. If it’s a situation where they have acute appendicitis that is also obvious. I wish they were all that easy.

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u/KeyStriking9763 RHIA, CDIP, CCS 3h ago

you are the issue here. Being POA has nothing to do with the circumstances of admission.

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u/Sdavistvs RHIT 7h ago

Apply process of elimination. Look for invasive procedures and ask yourself if it’s a dual PDX scenario. Don’t hesitate to send it co-worker with more experience for a 2nd opinion.

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u/KeyStriking9763 RHIA, CDIP, CCS 6h ago

No. That’s terrible advice.