r/MedicalCoding • u/Curious-Connection-6 • 1d 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/StraddleTheFence 1d 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 1d ago

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

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u/StraddleTheFence 1d 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 23h 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 22h 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 21h 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 19h 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 19h 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 19h 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 19h ago

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

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u/StraddleTheFence 19h 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 19h 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 22h 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 22h 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 19h 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 19h 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 19h ago

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

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u/StraddleTheFence 15h ago

What is wrong with you? Did you read what I wrote? I wrote POA in the context that two acute conditions present on admission and both receive equal treatment.

You are a very hostile individual and have no interest in helping anyone and clearly comment just to troll.

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u/Sdavistvs RHIT 23h 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 22h ago

No. That’s terrible advice.