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Tag Archives: Coding

Help coding Inguinal Lymphadenopathy, deep Inguinal lymph node biopsy

I am trying to accurately code a case. the PT has inguinal lymphadenopathy and the doctor is planning a deep inguinal lymph node biopsy. Some suggested using the unlisted code 38999. Superficial node biopsy 38500, staging lymphadenectomy 38562 or biopsy deep cervical node 38510 are also suggested, but he superficial one doesn’t pay much. Your thoughts please! Thanks!

Medical Billing and Coding Forum – General Surgery

Coding QW with code 87046

I am a CPC-A and have a question on QW modifier for the code 87046 I have done some researching with nothing stating that the code 87046 needs a QW modifier. We have a clia certification for the clinic trying to bill this code but it’s being denied by Medicare without the modifier QW. Is it appropriate to bill this with a QW or not?

Medical Billing and Coding Forum – Pathology & Clinical Laboratory

Independent Coding Contractors

If anyone provides independent contract coding please consider a listing at

Each participant receives a mini website in where they can display a list of services and other pertinent details. Participants benefit from our 40,000 weekly views and will be included in all marketing efforts.

If interested please view the following link or contact me directly.


Mark Sluyter

Medical Billing and Coding Forum – Neurology/Neurosurgery

AHA Coding Clinic for ICD-10 covers orthopedic, cardiovascular coding

by Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS
Some interesting tidbits of information can be gleaned from the most recent release of the AHA Coding Clinic for ICD-10-CM/PCS to help coders as they work in the new code set.
I never thought I’d be so eager to read a release about coding instead of the newest James Patterson novel, but this newsletter highlighted topics such as orthopedic screw removals, revision of total knee replacements, heart failure with pleural effusions, leadless pacemakers, the Glasgow Coma Scale, and decompression of the spinal cord. 
Typically, when we see that a device is loose or breaking, we automatically think "that shouldn’t happen," so we opt to code a complication of the device. Well, when this occurs in an orthopedic screw as an expected outcome (typically when the patient begins bearing weight during the recovery/healing process), it should not be coded as a complication.
The correct diagnosis codes would be assigned for the specified fracture site with a seventh character identifying a subsequent encounter with routine healing, along with the external cause code (if known), also as a subsequent encounter. (Remember that place of occurrence, activity, and status codes should only be used for the initial encounter, per the ICD-10-CM Official Guidelines for Coding and Reporting.)
The ICD-10-PCS root operation would be Removal (third character P) for the removal of the screw from the specified bone.
On the other hand, some orthopedic devices can present real complications necessitating removal and replacement. For example, a patient may be admitted for a painful total knee replacement, initial encounter (T84.84xA). In order to remedy this situation, the previously placed components (tibial and femoral) are removed and replaced with new components. This ­scenario leads coders to ponder whether this should be considered a Revision or Replacement, or perhaps something else.
ICD-10-PCS defines a Revision as "correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device." In this case, the prosthesis isn’t working exactly the way it should, but the ICD-10-PCS Reference Manual states that "putting in a whole new device or a complete redo is coded to the root operation(s) performed."
Therefore, the correct root operations would be Removal (P) for taking out the old components, then a Replacement (third character R) for putting in/on a synthetic material that takes the place of the body part. 
I am confident many coders noticed that the codes for heart failure (category I50) are mostly identical to their ICD-9-CM counterparts.
But one thing that probably raised some eyebrows for coders was the Excludes2 note at category J91 (Pleural effusion in conditions classified elsewhere), which seemed to state that a code from category J91 would be assigned as an additional code when seen "in heart failure."
Of course, most coders will recall that in ICD-9-CM we normally could not assign a separate code for this situation, based off information in AHA Coding Clinic for ICD-9-CM, Third Quarter 1991. The new issue provides clarification that the same rules apply in ICD-10-CM for pleural effusions seen in heart failure patients.
The pleural effusions would only be reported separately if therapeutic/diagnostic interventions are required. Pleural effusion is commonly seen with congestive heart failure (CHF) with or without pulmonary edema. Usually, the effusion is minimal and resolves with aggressive treatment of the underlying CHF.
The issue also addresses the correct coding of a newer procedure performed for heart blocks: the insertion of leadless pacemakers. You may have asked, as I did, how in the world does this device work if there are no leads to provide the electrical impulses?
This technology has been explored for many years and is finally here. Current pacemaker devices are susceptible to issues such as lead failure or malpositioning, as well as pulse generator pocket complications, such as scar formation or even just the visible presence of the device. In contrast, these new cylindrical devices fit directly into the right ventricle, accessed via a transcatheter approach and placed into the endocardial tissue of the right ventricular apex to provide pacing capabilities.
For coding purposes, the ICD-10-PCS table 02H (Insertion, heart and/or great vessels) does not provide a specific device option for a leadless pacemaker. The correct device character should be D (intraluminal device). The full ICD-10-PCS code to be assigned is 02HK3DZ (Insertion of intraluminal device into right ventricle, percutaneous) to identify a leadless pacemaker. 
Revisions in ICD-10-CM allow coders not only to report a coma (R40.20-, unspecified coma) but also to report codes that incorporate a common tool to assess the depth and duration of comas or impaired consciousness, known as the Glasgow Coma Scale.
Per the Centers for Disease Control and Prevention, this scale helps to gauge the impact of a variety of conditions, such as acute brain damage due to traumatic and vascular injuries or infections and metabolic disorders (e.g., hepatic or renal failure, hypoglycemia, diabetic ketosis).
ICD-10-CM contains subcategories to report the three elements that go into calculating the coma scale:
  • R40.21-, coma scale, eyes open
  • R40.22-, coma scale, best verbal response
  • R40.23-, coma scale, best motor response 
If coders opt to use this reporting option, three codes must be assigned to identify each of the three elements.
Codes for the individual Glasgow Coma Scale scores from these categories can be assigned if the provider documents the numeric values, as opposed to the physical descriptions associated with those numeric values.
The eye opening response is scored as follows:
  • 4, spontaneous eye opening
  • 3, eyes open to speech
  • 2, eyes open to pain
  • 1, no eye opening
The verbal response is divided into five categories:
  • 5, alert and oriented
  • 4, confused, yet coherent, speech
  • 3, inappropriate words and jumbled phrases consisting of words
  • 2, incomprehensible sounds
  • 1, no sounds 
The motor response is divided into six different levels:
  • 6, obeys commands fully
  • 5, localizes to noxious stimuli
  • 4, withdraws from noxious stimuli
  • 3, abnormal flexion, i.e., decorticate posturing, an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bent and held on the chest
  • 2, extensor response, i.e., decerebrate posturing, an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, and head and neck arched backwards
  • 1, no response 
For example, the documentation states "Glasgow Coma Scale score was obtained upon arrival at the ED; eyes open = 2, best verbal = 3, and best motor = 5." Coders may assign the following:
  • R40.2122, coma scale, eyes open, to pain, at arrival to ED
  • R40.2232, coma scale, best verbal response, inappropriate words, at arrival to ED
  • R40.2352, coma scale, best motor response, localizes pain, at arrival to ED 
Per the Official Guidelines, the seventh characters must match for all three codes.
Subcategory R40.24- (Glasgow Coma Scale, total score) is an additional option provided that identifies the overall score as opposed to each of the three individual elements.
Those codes are:
  • R40.241, Glasgow Coma Scale score 13-15
  • R40.242, Glasgow Coma Scale score 9-12
  • R40.243, Glasgow Coma Scale score 3-8
  • R40.244, other coma, without documented Glasgow Coma Scale score, or with partial score reported 
Codes from R40.24- would not be assigned if the individual scores are documented.
Procedurally, Coding Clinic provided clarification regarding decompressive laminectomies and the assignment of the appropriate body part characters. When assigning an ICD-10-PCS code for a cervical decompressive laminectomy, the body part value states "cervical spinal cord."
The cervical spinal cord is considered a single body part value in ICD-10-PCS and would only be assigned one time regardless of the number of cervical levels decompressed to release the spinal cord.
The vertebral level designations of the cervical spinal cord do not constitute separate and distinct body parts anatomically; therefore, ICD-10-PCS Guideline B3.2 does not apply:
During the same operative episode, multiple procedures are coded if: The same root operation is repeated at different body sites that are included in the same body part value. 
Another note of caution: The ICD-10-PCS Index entry "Laminectomy" instructs coders to see Excision (B), but the objective of a decompressive laminectomy is to release pressure and free up the spinal nerve root. Therefore, the appropriate root operation is Release (N). 


Editor’s note: McCall is the director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts. She oversees all of the Certified Coder Boot Camp programs. McCall works with hospitals, medical practices, and other healthcare providers on a wide range of coding-related custom education sessions. For more information, see article was originally published in Briefings on Coding Compliance Strategies. – JustCoding News: Inpatient

coding for pre-op

Good Morning, My internal med Doc does pre-op exams for the patient’s specialist. Am I able to code "pre-op" exam for two visits, the first visit would be the initial request by specialist and reviewing chart with decision based on what is in the chart. The second visit may be needed as a followup because our Doc had to send the patient out for further testing: labs, echo, xray…and then come back for that second visit to review and then make the medical decision. Is this ok in some instances especially when a patient has not had any of the above tests in a year or so? thank you….Marla

Medical Billing and Coding Forum – Internal Medicine

Independent Coding Contractors

If anyone provides independent contract coding please consider a listing at

Each participant receives a mini website in where they can display a list of services and other pertinent details. Participants benefit from our 40,000 weekly views and will be included in all marketing efforts.

If interested please view the following link or contact me directly.


Mark Sluyter

Medical Billing and Coding Forum – Cardiovascular Thoracic

20 Best From Home Top Medical Coding Schools and Programs

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Training for at-home medical coding jobs can be completed wholly online for the greatest flexibility and career-life balance. Whether you’re a parent, disabled, retired, a military spouse, or simply attracted to working in the comfort of home, medical coding is a hot job. CNBC reported that medical coding has a prescription for fast growth since healthcare facilities have switched to electronic records. The BLS predicts that medical records management will spark 29,000 new positions for a 15 percent hiring increase. Companies like Humana, Maxim Health, and Aviacode need fresh telecommuting talent, so consider these 20 Best From Home Top Medical Coding Schools and Programs.

Our ranking zeros in on top online medical coding programs that fulfill requirements for certification, such as Certified Coding Associate (CCA). That’s because pay climbs for credentials with an average salary of $ 47,796 per year. We used the NCES College Navigator tool to search for coding schools with distance education. Each prospective program had to be regionally accredited, uphold AHIMA standards, feature at least four courses, and include virtual practicum. Preference was given to colleges holding national or regional rankings for prestige. From home coding curricula was also judged for affordability, class size, placement, credit transfer, and academic rigor.

1. Drexel University

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Located in Philadelphia’s Powelton Village, Drexel University is a private, nonprofit research hub with cooperative education for over 26,300 Dragons. According to the U.S. News, Drexel is the 96th best national university, 65th top value, and 14th most innovative school. The College of Nursing and Health Professions confers an online, six-course Certificate in Medical Billing and Coding.

Tuition Total: $ 14,364

Learn more about From Home Top Medical Coding Schools and Programs at Drexel University here.

2. University of Utah

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Affiliated with 22 Rhodes Scholars, the University of Utah is a public, space-grant RU/VH institution selectively admitting 31,500 Utes in Salt Lake City and online. The U.S. News named Utah the 111th best university and 73rd best for vets school. There’s a three-part Professional Medical Coding and Billing program delivered online with real-world 3M encoding software.

Tuition Total: $ 3,495

Learn more about From Home Top Medical Coding Schools and Programs at the University of Utah here.

3. Indiana University – Purdue University Indianapolis

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Endowed for $ 601 million, Indiana University-Purdue University Indianapolis is a public, co-educational RU/H institution “Fulfilling the Promise” to over 30,100 Jaguars. The U.S. News ranked IUPUI as America’s 197th best university and 106th top public college. Online learners can pursue the 26-credit Medical Coding Certificate through the School of Informatics and Computing for AHIMA credentialing.

Tuition Total: $ 9,233

Learn more about From Home Top Medical Coding Schools and Programs at Indiana University – Purdue University Indianapolis here.

4. Keiser University

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Belonging to the NAIA Sun Conference, Keiser University is a private, nonprofit SACS-accredited college serving over 16,300 Seahawks in Fort Lauderdale and beyond. Keiser is the South’s 23rd top school and 11th best value according to the U.S. News. Online students can prepare for the AAPC exam in the two-year Associate of Science in Medical Administrative Billing and Coding.

Tuition Total: $ 37,728

Learn more about From Home Top Medical Coding Schools and Programs at Keiser University here.

5. Albany State University

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Established in 1874 for freed slaves, Albany State University is a public, TMCF-member institution with over 7,100 Golden Rams studying in southwest Georgia and online. The U.S. News lauded Albany State as the 32nd best historically black school nationwide. The 22-credit Online Certificate in Medical Coding builds expertise in ICD-10 coding systems from home.

Tuition Total: $ 2,860

Learn more about From Home Top Medical Coding Schools and Programs at Albany State University here.

6. Weber State University

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Attracting 26,600 Wildcats to 250+ academic programs, Weber State University is located in Ogden, Utah, with NWCCU accreditation for public, liberal arts education. The U.S. News crowned Weber the West’s 76th top regional university. The Dumke College of Health Professions confers a 10-course Certificate of Proficiency in Healthcare Coding online for a median salary of $ 34,000.

Tuition Total: $ 5,340

Learn more about From Home Top Medical Coding Schools and Programs at Weber State University here.

7. Florida A&M University

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Classified as a public, land-grant RU/H doctoral institution, Florida A&M University is endowed for $ 127.18 million to educate over 9,600 Rattlers from Tallahassee and beyond. High school counselors surveyed by the U.S. News placed FAMU 173rd nationally. The School of Allied Health Sciences follows AHIMA standards for an online, nine-course Medical Coding Certificate Program.

Tuition Total: $ 7,965

Learn more about From Home Top Medical Coding Schoools and Programs at Florida A&M University here.

8. Great Falls College Montana State University

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Founded in 1969 for “Changing Lives, Achieving Dreams,” Great Falls College MSU is a two-year, public teaching institution enrolling over 4,700 students in Montana and online. Great Falls is affiliated with the U.S. News’ 210th best university and 118th top public school. Students can pursue the 63-credit A.A.S. in Medical Billing and Coding Specialist online.

Tuition Total: $ 8,374

Learn more about From Top Home Medical Coding Schools and Programs at Great Falls College Montana State University here.

9. Herzing University

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Operating 11 campuses and an online division from Milwaukee, Herzing University is a private, nonprofit Highter Learning Commission and a Member of the North Central Association accredited institution enrolling over 330 adult learners. The U.S. News applauded Herzing for America’s 142nd best online undergraduate programs. In 12 months, online students can complete the 44-credit Diploma in Medical Insurance Billing and Coding Specialist for CCSA Associate certification. For more information regarding graduation rates, median student debt for students who have completed the program, and other information, to Herzing’s consumer disclosure website.

Tuition Total: $ 12,560

Learn more about From Home Top Medical Coding Schools and Programs at Herzing University here.

10. Peirce College

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Led by President James J. Mergiotti, Peirce College is a private, nonprofit MSCHE-accredited college based on Philadelphia’s Pine Street to educate over 1,200. Peirce is acclaimed for holding America’s 132nd best online undergraduate degrees by the U.S. News. The Allied Health Division offers a 39-credit, competency-based Certificate in Medical Coding online with a virtual practice workshop.

Tuition Total: $ 17,040

Learn more about From Home Top Medical Coding Schools and Programs at Peirce College here.

11. SUNY Herkimer College

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Celebrating its 50th anniversary, SUNY Herkimer College is a two-year, public lower-division institution registering over 3,300 Generals in Upstate New York near Utica. Herkimer was picked for the prestigious 2017 Aspen Prize for Community College Excellence. Home-based learners could finish the 12-month Online Medical Coding-Transcriptionist Certificate via the Internet Academy for mastering ICD-9-CM, CPT, and HCPCS codes.

Tuition Total: $ 4,490

Learn more about From Home Top Medical Coding Schools and Programs at SUNY Herkimer College here.

12. Great Basin College

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Governed by the Nevada System of Higher Education, Great Basin College is a public, two-year career-oriented institution with NWCCU accreditation to educate over 3,400 in Elko, Ely, Battle Mountain, and online. Niche placed Great Basin as America’s 116th “Best Online College.” Each Fall, online students begin the two-semester Certificate of Achievement in Professional Medical Coding and Billing.

Tuition Total: $ 3,060

Learn more about From Home Top Medical Coding Schools and Programs at Great Basin College here.

13. The University of Cincinnati Clermont College

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Sitting on 91.2 wood cares in Batavia, Ohio, UC Clermont College is a regional public, two-year satellite of the University of Cincinnati with over 3,700 Cougars finding “Strength in Unity.” The U.S. News placed UC as America’s 135th best university and 64th top public college. Clermont offers an 11-course Online Certificate in Medical Biller/Coder with open admission.

Tuition Total: $ 7,320

Learn more about From Home Top Medical Coding Schools and Programs at The University of Cincinnati Clermont College here.

14. Kaplan University

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Training 37,000 non-traditional students, Kaplan University is a primarily online private, for-profit HLC-accredited institution of Graham Holdings Company in Davenport, Iowa, with 14 national campuses. The U.S. News declared Kaplan’s online undergraduate programs as the 156th best nationwide. Students work from home for the 39-credit Online Medical Billing and Coding Certificate or 57-credit Online Medical Office Administration Certificate.

Tuition Total: $ 14,469

Learn more about From Home Top Medical Coding Schools and Programs at Kaplan University here

15. Central Texas College

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Since opening in 1965 for Bell County citizens, Central Texas College has expanded as a public, two-year SACS-accredited school with over 39,200 Eagles in Killeen and online. In Community College Week. CTC ranked 15th among associate degree producers nationally. AAPC qualifications can be fulfilled with the 39-credit Online Certificate of Completion in Medical Coding & Billing.

Tuition Total: $ 8,775

Learn more about From Home Top Medical Coding Schools and Programs at Central Texas College here.

16. Sullivan University

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As the SACS’ first accredited private, for-profit school, Sullivan University serves over 6,000 students from in Louisville, Lexington, Fort Knox, and online. Niche recognized Sullivan as America’s 64th “Best Online College” and 157th “Best College Campus.” The College of Health Sciences awards a 47-credit, 12-month Medical Coding Diploma online with courses like information literacy, human anatomy, and CCA review.

Tuition Total: $ 18,565

Learn more about From Home Top Medical Coding Schools and Programs at Sullivan University here.

17. Minnesota State College Southeast

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Accredited by the HLC-NCA, Minnesota State College Southeast is a public, two-year technical institution headquartered in Winona since 1949 to train over 2,700 professionals. Niche ranked MSC Southeast as America’s 42nd “Best Trade School.” Through D2L Brightspace, online students can attain the 46-credit Medical Coding Specialist Diploma or finish the 57-credit Medical Coding Specialist A.A.S.

Tuition Total: $ 8,644

Learn more about From Home Top Medical Coding Schools and Programs at Minnesota State Colleg Southeast here.

18. Bellevue College

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With Washington State’s third-largest enrollment at 37,000 Bulldogs, Bellevue College stands on King County’s Eastside as a public, open-access technical institution. PayScale recognized Bellevue for the 25th highest community college ROI with a median mid-career salary of $ 63,400. Online students can undertake the four-month, AHIMA-approved Professional Medical Coding and Billing Program with CareerStep for CPC credentialing.

Tuition Total: $ 2,995

Learn more about From Home Top Medical Coding Schools and Programs at Bellevue College here.

19. Mercy College of Ohio

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Opened by the Sisters of Mercy in 1917, Mercy College of Ohio is a private, bachelor’s-level health sciences institution with HLC-NCA accreditation to educate over 1,200 future practitioners. College Values Online included Mercy among the “50 Most Affordable Small Catholic Colleges” nationwide. Attend the Virtual Open House to consider the 26-credit Online Medical Coding Certificate Program.

Tuition Total: $ 11,600

Learn more about From Home Top Medical Coding Schools and Programs at Mercy College of Ohio here.

20. National American University

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Given HLC-NCA accreditation in 1985, National American University is a private, for-profit learning system based in Rapid City, South Dakota, that’s educating over 7,900 students at 33 U.S. locations and online. College Factual ranked NAU in the top 5 percent nationally for ethnic diversity. The College of Health and Sciences confers a 12-month Healthcare Coding Diploma adhered to AHIMA standards.

Tuition Total: $ 13,212

Learn more about From Home Top Medical Coding Schools and Programs at National American University here.

Top Medical Coding Schools

What Are The Best Medical Billing and Coding Programs Online?

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Medical coding and billing is one of the few well-paid, in-demand healthcare jobs requiring solely a post-secondary certificate or associate degree at most. Good Financial Cents listed medical coder as the 20th “Best Job without a College Degree,” providing an average certified salary of $ 46,800. Online education is ideal for this digital IT profession that’s focused on the accurate organization of electronic health records. Online courses can train medical coding and billing staff to translate patients’ diagnoses and procedures into alphanumeric codes to file health insurance claims. As the health informatics field expands faster-than-average by 15 percent, the availability of online medical coding and billing options is becoming staggering. In this article, we’ll help point you to six of the best online colleges for tomorrow’s medical IT staff.

Herzing University

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Headquartered in Menomonee Falls, Wisconsin, Herzing University is a private, nonprofit HLC-accredited training institute that’s seen enrollment skyrocket by 260 percent since 2001. The U.S. News recognized Herzing for delivering America’s 142nd best online undergrad programs for $ 550 per credit hour. Adhering to the CAHIIM Academic Competencies, Herzing offers a 44-credit Diploma in Insurance Billing and Coding Specialist online over 12 months. Online courses like diagnosis coding and pathophysiology lead to a four-credit internship or research project and CCSA certification. Herzing undergraduates could also pursue the 61-credit A.A.S. Insurance Billing and Coding or 124-credit B.S. in Health Information Management.

Learn more about the Medical Billing and Coding Programs Online at Herzing University here.

Indiana University

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Endowed for $ 1.57 billion, Indiana University is a public, nine-campus teaching system in the APLU that’s regionally accredited to educate around 89,170 undergrad Hoosiers total. Graded America’s 27th “Top Public University” on Niche, IU offers the 54th best online undergraduate programs according to the U.S. News. The School of Informatics and Computing places CCA certification in reach for online learners with the 32-week Medical Coding Certificate. Full- or part-time students join each Fall to audit inpatient and outpatient health records. After the culminating, four-credit coding practicum, students can advance into the B.S. in Informatics – HealthCare Information Technology.

Learn more about the Medical Billing and Coding Programs Online at Indiana University here.

Keiser University

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Called the Keiser Institute of Technology until 1986, Keiser University is a private, nonprofit and nonsectarian SACS-accredited institution in Fort Lauderdale that’s educating nearly 18,000 Seahawks at an average net price of $ 21,129. Deemed America’s 30th “Best Online College” on Niche, Keiser is ranked the South’s 11th top value by the U.S. News. Distance learners could obtain the A.S. in Medical Administrative Billing & Coding, which meets CAHIIM standards. Conducted in English or Español, the 60-credit program features online courses from CPT-4 coding to medical ethics before an externship. Coders also have 100 percent job placement after the A.S. in Health Information Management.

Learn more about the Medical Billing and Coding Programs Online at Keiser University here.

Hunter College


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As a public, co-educational CUNY constituent, Hunter College is located on Manhattan’s Upper East Side near Lenox Hill to educate over 15,500 undergrad Hawks on a $ 99 million endowment. Ranked America’s 86th “Most Liberal College” on Niche, Hunter is the North’s 11th top public university according to the U.S. News. For $ 4,300 total, students can pursue the five-course Medical Coding & Billing Certificate in 80 hours online. Hunter also as a Combined Certificate in Outpatient and Inpatient Medical Billing for $ 5,300. Students progress through online modules like medical terminology and ICD-10 coding for CPC credentialing with exam discounts.

Learn more about Medical Billing and Coding Programs at Hunter College here.

St. Petersburg College


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Holding SACS and CAHIIM accreditation, St. Petersburg College is a public, four-year member of the Florida College System founded in 1927 that’s serving around 65,000 undergrads from Seminole to Clearwater and online. Crowned America’s 105th “Best Online College” on Niche, SPC ranked among Community College Week’s top 100 associate degree producers. Online learners could prepare for the CCA exam by completing the 37-credit Medical Coder Certificate and its two professional practica. Credits transfer seamlessly into the 70-credit Online Health Information Technology A.S. program, which has a 100 percent RHIT pass rate. There’s even a Health Data Management Advanced Technical Certificate.

Learn more about Medical Billing and Coding Programs at St. Petersburg College here.

Pace University

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Attracting around 12,700 Setters from all 50 states, Pace University is a private, nonsectarian ECAC institution tracing back to 1906 that’s located in Lower Manhattan with extensions in Pleasantville and online. Chosen as America’s 51st “Most Diverse College” on Niche, Pace is recognized by the U.S. News for the 36th best online undergrad offerings. Online students develop their e-portfolio with the asynchronous, nine-month Medical Billing & Coding Certificate program. Registering for the $ 3,995 program allows high school graduates to qualify for five certifications, including CCS and CPC-P. For taking the CEHRS exam, choose Pace’s seven-month Online Electronic Medical Records Specialist Certificate.
Learn more about Medical Billing and Coding Programs at Pace University here.

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Separating the good online medical coding and billing programs from the bad isn’t too difficult. Make certain you place accreditation, whether regional or national, at the top of your list to avoid registering at unaccredited diploma mills. Other important factors to search for are CPC certification rates, job placement, financial aid, awards or rankings, online technology, and curricular flexibility. Some honorable mentions to our above list include St. Catherine University, Drexel University, Central Texas College, Kaplan University, and Trident Technical College. The AAPC also offers online medical coding courses that cost members just $ 2,195 total for mastering ICD-10 classification.

Related Links

The 20 Best Medical Coding and Billing Programs Online

Top Medical Coding Schools

A new sepsis definition: Finding coding compliance at a crossroads

A new sepsis definition: Finding coding compliance at a crossroads

This article is part two of a two-part series on the definition changes for sepsis. Reread part one in the October issue of BCCS.


In my October Clinically Speaking column, we discussed the evolution of the definition of sepsis and its implications in clinical care (Sepsis-1, Sepsis-2, and Sepsis-3), quality measurement (CMS’ SEP-1 core measure), and ICD-10-CM coding compliance.

We emphasized that the February 2016 definition of sepsis (Sepsis-3) as a "life-threatening organ dysfunction caused by a dysregulated host response to infection," differed from the terminology of sepsis and severe sepsis that has been embraced by many clinicians, CMS, and ICD-10-CM. We also discussed how provider documentation using the Sepsis-3 terminology eliminates the term "severe sepsis," and discussed that the definition change impacted ICD-10-CM code assignment and compliance.

Definitions and clinical indicators in Sepsis-2 are available at, and definitions for Sepsis-3 are available at CMS’ definition of sepsis and severe sepsis for the SEP-1 core measure is available at


Coding Clinic update

Effective September 23, the American Hospital Association (AHA) Coding Clinic for ICD-10-CM/PCS published advice concerning the documentation and coding of sepsis in light of Sepsis-3. In Coding Clinic, Third Quarter 2016, p. 8, they stated "coders should never assign a code for sepsis based on clinical definition or criteria or clinical signs alone. Code assignment should be based strictly on physician documentation (regardless of the clinical criteria the physician used to arrive at that diagnosis)."

Coding Clinic went on to write (emphasis mine):


In my opinion, this means that Coding Clinic is saying ICD-10-CM still embraces the coding of infections without sepsis, with sepsis but without organ dysfunction, and with sepsis resulting in organ dysfunctions (otherwise known as severe sepsis), if the diagnosis is incorporated by the documenting physician. The AHA further stated that if a physician arrives at a diagnosis of sepsis or severe sepsis using whatever criteria he or she wishes, and then documents these terms in the medical record, the coder is to code it, period, end of story.

Alternatively, while Sepsis-3 states that the word "sepsis" requires the presence of acute organ dysfunction, Coding Clinic states that ICD-10-CM does not recognize this clinical concept. Unless the provider documents "severe sepsis" or associates an acute organ dysfunction to sepsis, a code reflecting this concept, R65.20 (severe sepsis), cannot be assigned. Furthermore, if a provider wishes to diagnose and document the term "sepsis" (without organ dysfunction) using Sepsis-2 or other reasonable criteria, the coder is obligated to code it as such in ICD-10-CM.


Coding Clinic, Fourth Quarter 2016

As we discussed last month, the fiscal year 2017 ICD-10-CM Official Guidelines were amended to state (emphasis mine):


In explaining this new guideline, Coding Clinic, Fourth Quarter 2016, pp. 147?149 stated (emphasis mine):


Coding Clinic went on to highlight that this concept applies only to coding, not the clinical validation that occurs prior to coding. Coding Clinic emphasized that clinical validation is a separate function from the coding process and the clinical skill embraced by CMS and cited in the AHIMA practice brief Clinical Validation: The Next Level of CDI. Access these at and


Coding Clinic then went on to say that (emphasis mine) "a facility or a payer may require that a physician use a particular clinical definition or set of criteria when establishing a diagnosis, but that is a clinical issue outside the coding system."

While I agree that facilities should standardize clinical definitions for clinical and coding validation purposes, note how Coding Clinic gave tremendous power to a payer to define any clinical term any way they want to. This may differ from that of a duly-licensed physician charged with direct face-to-face patient care responsibilities using the definitions of clinical terms he or she learned in medical school or read in the literature.

As such, while our facilities may implement clinical validation prior to ICD-10-CM code assignment, a payer that is not licensed to practice medicine and has no responsibilities for direct patient care can require a provider or facility to use a completely different clinical definition that serves only one purpose in my mind, and that is to reduce or eliminate payment for care that was properly rendered, diagnosed, documented, and coded. I’m sure that legal battles will ensue, given this caveat written by Coding Clinic.

Solving the problem

In developing a sepsis strategy in light of these Coding Clinics, allow me to remind all of you that there are three environments by which we must consider disease terminology and supporting criteria. One cannot talk about sepsis, severe sepsis, or septic shock unless he or she states what environment they are in. These are:

  • Clinical language ? Physicians have a language that we use in direct patient care that communicates well with other physicians; we learned this language in medical school, in residency training, and in reading our literature. Every physician knows what "urosepsis," "unresponsiveness," and "neurotoxicity" is; however, ICD-10-CM does not recognize these terms for coding purposes, thus we ask physicians to use different words so that we can report them using the ICD-10-CM conventions. Systematized Nomenclature of Medicine — Clinical Terms (SNOMED-CT) is a clinical language we use in our problem lists and so is Sepsis-3. ICD-10-CM is not. Not all physicians embrace Sepsis-3, thus some may wish to label a patient as having sepsis even if they don’t have organ dysfunction, which makes clinical sense to them. See the articles listed above.
  • Coding language ? As discussed, Sepsis-3 amends clinical language only; however, for coding purposes we must still document using ICD-10-CM’s language, which still recognizes sepsis without and with organ dysfunction, bases coding on the individual physician’s criteria and documentation, and requires clinical validation using reasonable criteria prior to code assignment.
  • Core measure language ? Defining cohorts with core measures, such as SEP-1, is a clinical abstraction based on clinical criteria and not necessarily based on what a physician writes. For example, the definition of severe sepsis and septic shock is completely different in SEP-1 than that of Sepsis-3. Remember, however, that in 2017, if a physician documents severe sepsis and R65.20, and severe sepsis is coded, that record will be held accountable for the SEP-1 even if it doesn’t meet the SEP-1 criteria. View this regulation at

Therefore, allow me to suggest the following strategy to ensure a balance of compliance with all three of these environments:

1.Standardize the definition and documentation of severe sepsis first. I believe that the Recovery Auditors (RA) are looking for records with sepsis codes that do not have R65.20 or R65.21 (septic shock) as a secondary diagnosis as to deny these codes and their resultant DRGs. In so doing, I believe that the definition of severe sepsis should be negotiated with and standardized by the medical staff, which could incorporate any or all of the following three criteria:


No matter what criteria is used, be sure to coordinate its development and deployment with your quality, clinical documentation integrity, and coding staff so that if a physician documents severe sepsis or septic shock, the SEP-1 algorithm can be implemented.

Also, be sure that physicians explicitly link organ dysfunctions to sepsis, or preferably, use the term "severe sepsis" so that R65.20 is not inadvertently missed by the coders. If a clinical documentation specialist or coder obtains a record supporting R65.20, be sure to notify the SEP-1 manager to determine if it qualifies for the SEP-1 core measure.


2.Develop a facilitywide definition for sepsis without organ dysfunction. As noted last month, many physicians do not believe that organ dysfunction is required to diagnose sepsis. Given that RAs are likely to use Sepsis-3 as a foundation for denying claims, we must have the statements of your internal medicine, critical care, and other physician committees as to what the definition of sepsis is for clinical and coding validation purposes. When it is documented by a provider without evidence of acute organ dysfunction, this statement can be used to rebut the RA’s denials. These will be handy if we are appealing beyond the first level.

3.Remind the RA that the ICD-10-CM guidelines are part of HIPAA and that coding is based on provider documentation. I’m sure that all of our contracts with private payers state that we will comply with federal laws, such as HIPAA. Given that the 2017 ICD-10-CM Official Guidelines state that we are to assign codes based on provider documentation, and not so much on what the RA thinks, and that Coding Clinic, First Quarter 2014, pp. 16?17, states that "the official guidelines are part of the HIPAA code set standards," we don’t want the RAs to violate HIPAA or our contracts with payers. This may require that our hospital attorneys or compliance officers weigh in, given that RAs have been known to deny codes based on provider documentation and want us to do the same.



Please recognize that this topic is very controversial and that the opinions expressed here are solely my own. I encourage all of us to discuss Sepsis-2, Sepsis-3, SEP-1, the 2017 Official ICD-10-CM Guidelines, and these Coding Clinics with our compliance officers and/or attorneys so that we can best support policies and procedures ensuring complete, precise, and compliant coding of sepsis in light of Sepsis-3. If you have success stories, please share them with me and the editor here at BCCS.


Editor’s note:

This article was part two of a two-part series. You can read part one in BCCS’ October issue. Dr. Kennedy is a general internist and certified coder, specializing in clinical effectiveness, medical informatics, and clinical documentation and coding improvement strategies. Contact him at 615-479-7021 or at Advice given is general. Readers should consult professional counsel for specific legal, ethical, clinical, or coding questions. For any other questions, contact editor Amanda Tyler at Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries. – Briefings on Coding Compliance Strategies

Radiation Oncology coding and billing

Hello! I am new to radiation oncology coding and billing. Does anyone have any resources, cheat sheets or tips they would be willing to share with me? Anything would be greatly appreciated! I am tasked with coding radiation therapy, charge entry and working back end denials that have been sitting for awhile.

Also, my employer is looking to send me to a workshop or seminar. Does anyone know of any on the east coast after October 1st?

Medical Billing and Coding Forum – Billing/Reimbursement