Evaluation

Evaluation Questions 1.) Knowledge of classification systems, such as current versions of ICD-9, CPT, Snomed or HCPCS, and skill in applying coding knowledge to a wide range of specialty areas. Also knowledge joint commission as well as medicare and Medicaid services (CMS) and/or VHA medical record documentation. -The ICD-9 (International Classification of diseases) is a medical coding manual that enables healthcare professionals to provide diagnoses in the form of numerical codes to a variety of healthcare specialty areas, such as Dermatology (skin), Cardiology (the heart), neurology (nervous system), Ophthalmology(eyes), Audiology (Hearing), The digestive system, the Respiratory System etc. The coding specialist selects the appropriate diagnostic code from the ICD-9 that resembles the patient’s condition, disease, or syndrome and places the code in box 21 of the CMS 1500 form. If there is more than one diagnosis the principal or primary diagnosis would go on line one in box 21 of the CMS 1500 form and a secondary diagnosis would go on line 2. For example, a patient comes in with a chief compaint of Angina Pectoris. However, further tests reveal that he/she also has hypertension unspecified. In this case, the question is, is the hypertension causing the chest pains, or are they two separate diagnoses. If the physician determines that the hypertension is causing the Angina Pectoris then Angina Pectoris would be the primary code and hypertension unspecified would be the secondary code because Angina is occurring as a result of the hypertension. In the case of E codes, the coder would first put down the primary diagnosis on line one in box 21 of the CMS 1500 form and the E code which is contributing to the diagnosis, condition or syndrome, would go on line 2. For example, if penicillin caused an allergic reaction in a patient, the allergic reaction would go on line 1 and the E code involving penicillin would go on line 2. If there is only an E code and the physician writes in the patient’s records, for example, “poisoning from Penicillin”, but there is no actual diagnosis in the records then the E code of “Poisoning from Penicillin” would go on line 1. Same goes for V-codes. If there is no actual diagnosis, the V-code goes on line one. If there is an actual diagnosis, the diagnosis goes on line one and V-code goes on line 2. For example, if the patient has coronary artery disease, but an assessment reveals a family history of coronary artey disease, then the diagnosis of coronary artery disease would go on line 1 of box 21 of the CMS 1500 form and a V-code of a family history of coronary artery disease would go on line 2. The ICD-9 consists of three volumes. Volume I makes up the tabular list of diseases. After looking up the diagnosis in volume 2, the coder then goes to volume I which is in front of volume 2 to look up the most current and accurate diagnostic code. First the coder looks up the main term in index 2. This could be a disease, a syndrome etc. Then the coder looks for the indented secondary term which may be the location of the condition. Then, if appropriate, he /she then looks at further indentation which may indicate “with” or “Due to”. For example, if the coder is looking for the diagnosis of “Appendicitis with perforation with peritoneal abscess” the coder would first look up the main term which, in this case is appendicitis, then go down to the indented term which is with. After “With” perforation is indented, thus you have the diagnosis of appendicitis with perforation. To find the diagnosis appendicitis with perforation, with peritoneal abscess, you would indent even further to find the peritoneal abscess. So first you find the main term (appendicitis), then you locate the actual location and whether it is “with” or “due to” any specific complication or condition. In some cases the coder would first diagnose the actual condition and then provide an additional code explaining the “with” or the “due to”. These additional codes are usually placed in slanted brackets next to the main code in the index of diseases (volume 2) letting the coder know that an additional code is necessary. Volume 3 is the index of procedural codes in the ICD-9 and is located after volume I (Tabular list of diseases) and after the E-codes section of the ICD-9. To clarify what I have just discussed above, the steps of coding using the ICD-9, include: 1.) look up the main term in volume 2 (the index of diseases). This can be a disease, a syndrome, or a condition. For example, “Arteriosclerosis”. 2.) Identify the location of the condition, disease, or syndrome. For example, Heart, or blood vessels. 3.). Make the diagnosis as specific as possible and identify if it is “With” or “due to” any specific condition etc. 4.) Look up the diagnosis in volume 1 (The tabular list of diseases) to find the most current and accurate diagnosis. 5.) If the main term in volume I suggests that there needs to be a 4th or 5th digit go down further to locate the actual diagnosis. 6.) if there is notification of an additional code in parentheses in volume 2 provide the additional diagnosis along with the primary diagnosis. The primary diagnosis goes on line 1 of box 21 of the CMS 1500 form and the additional diagnosis would go on line 2. For example, “Diabetes Mellitus” and “Diabetic Retinopathy”. The primary diagnosis would be Diabetes and the additional diagnosis would be Diabetic Retinopathy. Before actually beginning to code using the ICD-9 the coder needs to read the guidelines and conventions at the beginning of the manual. The conventions explain abbreviations, symbols, grammar, etc that are often used in volume I and 2 of the ICD-9. It is very important that the coder understands this terminology. Here is some of the terminology that the coder needs to understand before attempting to code: 1.) NEC- Means not elsewhere classified. Used when the ICD-9 does not use a code that is specific to the patient’s condition. 2.) NOS- Means not otherwise specified. Used when the coder lack the information to code to a more specific diagnosis. 3. Brackets [ ]- Used to enclose synonyms, alternative terminology, or explanatory phrases. For example, Pneumonia due to Hemophilus. An alternative term would be H. influenzae. Thus it would be written Pneumonia due to Hemophilus [H. influenzae]. 4.) Slanted Brackets [ ]-used to indicate mandatory multiple coding. For example, when the diagnosis indicates an additional diagnosis to be used. 5.) Parentheses ( )- Used to enclose supplementary words, called nonessential modifiers that do not affect the code. For example, if you see the word meninges the parentheses may be used to specify the location of the meninges, such as cerebral meninges, thus written meninges (cerebral). 6.) Colons :- used after an incomplete term. In order to assign a diagnosis, there must be one or more modifiers present that fit the diagnosis after the colon. For example, a diagnosis of Tularemia cannot be assigned until the type is specified. Tularemia: cryptogenic, intestinal, typhoid. 7.) Braces { }- used to enclose a series of term, each of which is modified by the statement appearing to the right of the brace.. 8) Includes- When you see this in the tabular list of diseases it means that the diagnostic code involves other conditions or diseases within that diagnosis. For example, if you see a diagnosis of of hypotension and then underneath that diagnosis you see the word “includes” hypopiesis”. Hypotension also includes this. 9.) Excludes- When you see this term in the tabular list of diseases, it means that the diagnoses does not involve the diseases or conditions listed below the diagnosis. 10) Use Additional Code- When you see this term in the manual it means that another code is going to be needed in addition to the primary code. 11.) Code first underlying disease- When you see this term in the manual it means that there is an underlying disease that needs to be coded first before you provide the primary code. For example, “Diabetes Mellitus with Diabetic Retinopathy”. Diabetes Mellitus is an underlying condition that would be coded first and Diabetes mellitus with Diabetic Retinopathy would be coded second. 12.) Code, if applicable, any causal condition first- When you see this term in the manual, it means that a code may be used as the principal diagnosis if no causal condition is found. Normally you would code the principal diagnosis first and what may have caused that diagnoses second. 13.) Omit Code- When you see this in the manual it means that no code is to be assigned. 14.) See Condition, See, See Also- When you see these terms in the Index to Diseases, it means that you must go and check the condition. It is very important that you check this conditon because the actual diagnosis that you are seeking may be found in a different category as opposed to the original category you are searching. For example, you might be looking for a diagnosis of hypotension under low blood pressure. When you get to low blood pressure it says “see also” or “see” hypotension which is the actual clinical condition for low blood pressure. 15.) Morphology Codes- These are codes that indicate cancer or neoplasms. They appear like this, Myelolipoma (M8870/0). Then after the code it will direct you to the neoplasm section of the manual where you will find the diagnostic code for the condition you are seeking. 16.) Bullets- indicates that the code is new. 17.) Triangles- Indicate that a code has been revised and/or changed. 18.) Other- In the manual there will often be a diagnosis that involves a 4th or 5th digit and the extra digit involves multiple sites, or other sites. Other basicly means that the diagnosis involves a site or code not included in the original diagnostic choices. 19.) Unspecified Codes- This code is given when there is insufficient information to assign a more specific code. For example hypertension unspecified. Hypertension means high blood pressure. However, we don’t know whether the high blood pressure is benign or malignant. As a result, hypertension is the only diagnosis we have. Therefore, it must be unspecified. Used hand-in-hand with ICD-9 diagnostic coding is CPT procedural coding. After assigning the appropriate diagnostic code(s), the coder then assigns a CPT procedural code(s) to the diagnostic code. The CPT code must fit the diagnosis code in order for the claim to be accepted and the provider to receive proper payment from the insurance company. If the CPT code does not fit the diagnostic code then it is likely that the claim will be rejected. This concept is known as achieving “Medical Necessity”. The CPT code(s) are placed in box 24 D and a diagnostic pointer in box 24 E is used to indicate which procedure is to fit which diagnosis. For example, if there is a diagnosis of arteriosclerosis on line 1 in box 21 and a CPT code reflecting an angioplasty in box 24 D with a diagnostic pointer of 1 in box 24 E, this means that the Angioplasty is the procedure used in the treatment of arteriosclerosis. However, if you assigned appendectomy as the procedure “medical necessity would not have been achieved. An appendectomy is performed to remove an appendix and not to treat arteriosclerosis. Therefore, the claim would be rejected. Using the CPT manual is similar to using the ICD-9. However, in the CPT manual the index is in the back rather than in the front like it is in the ICD-9. When looking up a procedural code the coder would look in the back index usually under the procedure being used. If the coder is unable to find the procedure under the procedure itself, another possible avenue is looking up the body part. In the back index the main term (procedure) or (body part) is highlighted in blue. Underneath the main term there may be a cross reference that says “see also”. Just like in the ICD-9 the coder would then check the procedure or body part that the manual tells them to see. Directing the coder to another area of the manual may also direct them to the correct CPT code . Also underneath the main term is the subterm which is not highlighted in blue. Then you have the second qualifier which is indented underneath the subterm and then the third qualifier which is indented further underneath the second qualifier. After the third qualifier is the code range for that specific category. For example, “Abdominal Hysterectomy, Resection of Ovarian Malignancy”. The main term is hysterectomy. The subterm is abdominal. The second qualifier is resection of ovarian malignancy. The code range, according to the CPT manual is 78608-78609. When assigning CPT codes, the codes are placed in correct sequential order in box 24 D of the CMS 1500 form and the diagnostic pointer in box 24 E reflects which procedure is for which diagnosis in box 21. For example, if there is a diagnostic pointer of #1 then that procedure is used for the diagnosis assigned on line 1 in box 21 of the CMS 1500 form. The most expensive procedure is always listed first. The procedures and the diagnoses must be listed in the appropriate order and each procedure must reflect the proper diagnosis to establish “Medical Necessity” and ensure that the claim is not rejected. When selecting codes from medical records documentation, codes may be on a variety of documentation. However, the paper work where you are most likely to find the Diagnosis and CPT codes are encounter forms (superbills or chargemasters), Explanation of benefits (for CPT Codes), Operative Reports (Diagnosis and procedures), and History & Physicals (H&Ps). CPT codes may also include modifiers to provide additional information about the service or procedure being performed. HCPCS Level II codes identify services performed by the physician and nonphysician providers and ambulance and durable medical equipment companies. For example, if a patient was in need of a wheel chair, this is what is meant as durable medical equipment. A HCPCS Level II code would then be added in box 24 D of the CMS 1500 form. HCPCS Level II codes ensures uniform reporting of medical products or services on claim forms, has code descriptors that identify similar products or services (instead of specific products or brand/trade names), and is not a reimbursement methodology for making coverage or payment determinations. Each payer makes determinations on coverage and payment outside this coding process. HCPCS level II modifiers are attached to any HCPCS Level II codes to provide additional information regarding the product or service reported 2.) Ability to Communicate With Clinical Staff on Coding and Documentation Issues Such As Recording Inpatient and Outpatient Diagnoses and Procedures, the use of Encounter Forms, the correct Sequencing of Diagnoses/Procedures, and/or the Relationship Between Health Care and Documentation and Code Assignment. If questions should arise regarding the diagnosis of a patient and the procedure being used I do not believe in assuming that I am selecting the appropriate codes. It is important to ask as many questions as possible and to collaborate with clinical staff as part of a team to ensure that the appropriate diagnostic and CPT codes are selected and claims are not rejected. In other words, double-checking with other team members on the diagnosis and CPT codes and the appropriate sequencing of the codes when exploring encounter forms and other documentation are essential to ensure appropriate processing of claims. I believe in being a team player and consulting with other team players when necessary. 3.) Ability to Reach and Solve Complex Questions Related to Coding and Documentation, Such as Adequate Health Information Documentation, Coding, Billing, Resident Supervision, etc. In my years working in a neurosurgeon’s office, I have always been a team player. I don’t just assume that a ICD-9 code or CPT code is correct or incorrect. Instead, I like to be thorough which usually involves exploring all details associated with the coding procedures. I want perfection. I do not want to be wrong. If it takes a longer time than it should to find a code then it takes a longer time. I know that I have a whole team of professionals there with whom to consult if I have any questions or am not sure of the exact code. Because of my knowledge of the ICD-9, and CPT Coding manuals and my knowledge of medical and billing paperwork I have the complex ability to solve complex questions related to coding and documentation. 4.) Ability to Analyze the Medical Record to Identify All Pertinent Diagnoses and Procedures for Coding, and to Evaluate the Adequacy of the Documentation. This includes the Ability to Read and Understand the Content of the Medical Record, the Terminology, the Significance of the Comments, and the Disease Processes/Pathophysiology of the Patient. I have almost 15 years experience in a neurosurgeon’s office reading, interpreting, and preparing patient medical records. In addition, I have two years experience with medical terminology and anatomy & physiology at both Heald and De Anza college where I ranged between the 98th and 100th percentile. When I attempt to look up a patient’s diagnosis I usually tend to look up the encounter forms where it includes both the ICD-9 code and the CPT code, the explanation of benefits (which includes the CPT code, the provider’s charge, what the insurance company allows, the negative adjustment, the deductible, What the patient owes, what the insurance company pays, and the total charges for each procedure). I also look at the operative reports and History & Physicals (H&Ps). My superior knowledge of medical terminology and anatomy & physiology allows me to quickly understand and pick out the appropriate diagnostic and procedural codes. Before coding a diagnosis and procedure the coder needs to understand what he/she is looking up. Normally the paperwork in a patient’s medical record is placed in a particular order in the patient’s chart. For example, in my office we had Two sides to the medical record. One side involved all the medical information ( the right side), and one side involved all the business and billing information (the left side). The medical information consisted of, in order: The doctor’s notes, medical correspondence (medical transcription reports and letters from other physician’s offices), a manilla divider, Diagnostic labs & Imaging reports (laboratory results, EMGs, MRIs, EKGs, EEGs, CATs, PETs etc.). Next would be the surgical packets which would consist, in order and by current date to least current date, the discharge summary, History & Physical, Operative Report, Progress report (notes), and pathology reports. Finally, the next section would include emergency room records and then old medical records. All the paperwork that would go into the patient’s medical record is positioned from most current date to least current date. On the business and billing side of the patient’s chart the order is as follows. Patient registration form (include the patient identifying information & demographics, and the patient’s insurance information (primary & secondary insurance), also the guarantor. Next would include a copy of the patient’s insurance card (front & back). Then there would be a blue colored divider. Underneath the blue colored divider would be consent for treatment forms and release of information forms, requests for medical information (including subpoenas) and any business correespondence (letters from lawyers, insurance companies, etc.), and insurance and disability forms. Then there would be a manilla divider. Underneath the manilla divider would be all the billing information (Explanation of benefits (EOBs, CMS 1500 forms, encounter forms). If a patient was receiving worker’s compensation, a green worker’s compensation form would be placed on top of the patient’s registration form. If there was a medication list, the medication list would be placed on top of the doctor’s notes on the medical portion of the chart. I understand that different medical facilities have different ways of putting information into a patient’s medical record. I think that with my experience with medical records and my ability to understand the patient medical records, I can learn any format suggested by any facility. In the case of electronic medical records, I already understand the paper work. All I need to understand is the facilitiy’s electronic program. Once I understand the electronic format, I will excel in this area as well. 5.) Skills in Reviewing Medical record Documentation and Assigning Current Versions of the Classification Systems Required in the Current Position, Such As ICD and CPT. Also Skills in Reviewing and Correcting System or Processing Errors, Reviewing Transmission Reports, And Ensuring All Assigned Episodes are Complete And Accurate As Appropriate to the Duties Assigned. When assigning ICD-9 and CPT codes to a patient, the coder needs to understand patient’s illness, disease, or syndrome and the procedure used to treat the condition and be able to identify the information in the patient’s medical records. Again, places where you would identify this information are in the encounter forms, explanation of benefits, and operative reports. While ICD-9 and CPT codes may be present in other areas of the medical records, these are the medical records you are most likely to find this information. After looking up the patient’s condition and procedure, the coder should be able to interpret the patient’s illness or illnesses as well as the procedure (s) used to treat the condition(s) and be able to look them up in the ICD-9 and CPT manual and assign the codes to them. If documentation in the medical records does not seem to fit other documentation, then the coder needs to be able to consult with other staff members about the errors and then change them accordingly. For example, if the operative report states one illness and procedure and the encounter form says something completely different, it needs to be researched by the coder and corrected accordingly. The coder should not just change the information without first consulting with other staff members. When I was at my last office I read every single document before putting it in the chart. If paperwork was not signed by the doctor I would immediately see that and take the document to the doctor to be signed. If there were duplicates I would shred the duplicate and put the original document in the record. I would make sure that all documents were in the appropriate order so that the documents were immediately available to other team members when necessary. I would pull operative reports to see if the diagnosis and procedure matched what was on the encounter forms. 6.) Advanced Knowledge of the Full Scope of Coding and Abstracting Including Inpatient Discharge, Surgical Cases, Diagnostic Studies and Procedures, Outpatient Encounters, and Inpatient Professional Fees for a Highly Diversified Range of Specialties and Subspecialties, Such as Orthopedics, Neurosurgery, Cardiology, Gastroenterology, Plastic Surgery, Spinal Cord Injury, Blind Rehabilitation, Anesthesia, Acute and Long Term Psychiatry Including Addiction Treatment, Hospice, Ambulatory Surgery and Other Types of Care. My vast array of knowledge and skill in both the medical and mental health field has provided me with the understanding and ability to select and abstract diagnoses and procedures from different healthcare related areas.. While I have worked in a neurosurgeon’s office for almost 15 years, organizing, interpreting, and abstracting information from patient medical records, and my 10 + years of hands-on counseling experience in the mental health field, which includes coding using the DSM IV, individual, couples, group, and family therapy, I also range in the 98th to 100th percentile in medical terminology which provides me with the ability to quickly and accurately select and abstract medical coding information regarding many different specialties. I understand much of the terminology involved in cardiology, gastroenterology, dermatology, podiatry, ophthalmology, audiology, hematology, neurosurgery and psychiatry. Cardiology is the study of the heart including the anatomy of the heart such as the ventricles, the atria, the aorta, the mitral valve, the semi lunar valve, and the tricuspid valve, disorders of the heart such as myocardial infarction(MI), atherosclerosis (hardening of the arteries as a result of the build up of plaque), arteriosclerosis( hardening of the arteries), Congestive Heart Failure (CHF) (complete death of the heart muscle in which the heart can no longer pump blood), tachycardia (abnormally fast heart rate), bradycardia (abnormally slow heart rate), Atrial and ventricular fibrillation and fluttering (abnormally fast beating of the ventricles or atria of the heart), Arrhythmias (where the heart skips a beat), heart murmurs, Tricuspid Regurgitation (the leakage of blood backward through the tricuspid valve each time the the right ventricle contracts), Tricuspid Stenosis (a narrowing of the tricuspid valve causing an increase in the resistance of blood flow from the right atrium to the right ventricle), Pulmonary Stenosis (a narrowing of the pulmonary valve opening diminishing blood flow from the right ventricle to the pulmonary arteries), Endocarditis (inflammation of the inner lining of the heart muscle), pericardial disease (disease of the outer lining of the heart), Pericarditis (inflammation of the outer lining of the heart muscle), tumors of the heart (Myxomas), Coronary Artey Disease (a condition in which a portion of the blood supply to the heart is completely cut off), and finally Angina Pectoris (chest pains). These disorders of the heart on the CMS 1500 fom in box 21 would represent the diagnostic codes in correct sequence should there be more than one condition. The treatment of such disorders (CPT Codes) might include, Bypass Surgery (where a vein is extracted from the lower extremities and used to patch up the heart muscle), Angioplasty (where a balloon is inserted often through the groin and guided up to the heart and is used to clear a artery--the prognosis of this procedure often lasts about 3 years before either another angioplasty would have to be done or bypass surgery is necessary), Electrocardiogram ( a diagnostic report or x-ray picture of the heart muscle to help assess the diagnosis), Angiogram( diagnostic report helping to asses the condition of the blood vessels) etc. These procedures would be placed in box 24 D as a numerical CPT code with a diagnostic pointer indicating which procedure is used with which diagnosis in box 24 E. Gastroenterology is the study of the stomach and intestines. Disorders might include, Gastritis (inflammation of the stomach, Gastroenteritis (inflammation of the stomach and small intestine), Esophageal Reflux (a backing up of gastric fluid causing an acidic reaction in the esophagus, Esophagitis (inflammation of the esophagus) etc. Procedures might include gastrectomy (removal of the stomach), Gastroenterectomy removal of the stomach and small intestine and certain medications as well. Dermatology is the study of the skin and skin disorders. Disorders include, Dermatitis (inlammation of the skin), Contact Dermatitis (inflammation as the result of making contact with some external stimuli), Scleroderma (hardening of the skin), Sclerodermatitis (inflammation and hardening of the skin), Malignant Melanoma (black tumors on the skin caused by too much sunlight, eventally metastasizes to the brain), Urticaria ( hives), chicken pox, mumps, measles, acne vulgaris, Rosacea (facial redness often brought on by constant alcohol use), vitiligo (loss of melanocytes results in white patches of skin), albinism (little or no melanin is formed), scabies (tiny reddish bumps brought on by mites), cellulitis (inflammation of the skin cells), Impetigo ( a condition involving scabby, yellow-crusted sores and sometimes small blisters filled with yellow fluid). Procedures used for treatment might include medication such as topical agents (cleansing agents, protective agents, moisturizing agents, symptom-relieving agents, anti-inflammatory agents, and anti-infective agents. Again, the diagnostic codes are placed in box 21 of the CMS 1500 form and the procedural codes to help meet medical necessity are placed in box 24 D. Podiatry includes disorders and treatment of feet. For example, disorders might include plantar fasciitis (inflammation of the plantar or bottom of the foot), Plantar warts (small skin growths on the bottom of the foot) etc. Procedures might include the use of medication and topical ointments. Ophthalmology involves disorders and treatment of the eyes. Disorders include, Cataracts, glaucoma, diabetic retinopathy, Stigmatism, strabismus, hyperopia (farsightedness), myopia (nearsightedness), Blepharitis (inflammation of the eyelid), conjunctivitis (inflammation of the conjunctiva), Papilledema ( a build-up of fluid in the optic nerve), Keratitis( inflammation of the cornea), Keratomalacia ( an abnormal softening of the cornea), age-related macular degeneration (loss of vision as a result of age), exophthalmos (protruding eyeballs) etc. Treatments or procedures may include Ophthalmoscopy ( a visual examination of the eyes), tonometry (a procedure used to measure fluid in the eyes), electroretinography ( a procedure that involves examining the photoreceptors in the retina of the eyes), Tachymetry (measuring the thickness of the cornea), Ct Scans & MRI’s, Keratotomy (Making incisions into the cornea..often used to treat myopia and hyperopia), keratectomy (removal of the cornea) etc. Audiology involves disorders and treatment of hearing. Disorders may include otitis (inflammation of the ear), acoustic neuroma (usually benign tumors of the ear effecting hearing) etc. Treatment may include otoscopy and other audiological procedures. Hematology involves disorders and treatment of the blood. Disorders may include Hemophilia ( a blood disorder in which an individual bleeds constantly and at the slightest contact from some external stimuli), hypertension (high blood pressure), Hypotension (low blood pressure), Orthostatic hypertension (high blood pressure while standing in a vertical position), Anemia (having a lack of blood or iron in the blood), Leukemia (cancer of the white blood cells), Lymphoma (tumor of the lymphocytes in the blood), Neutrogena (deficiency of neutrophils in the blood), Lymphocytopenia (abnormal deficiency of lymphocytes in the blood), Thrombocytopenia (abnormal deficiency of thrombocytes in the blood), Leukocytosis (abnormally high number of leukocytes in the blood) and many more. Treatment or procedures used to treat these disorders may include (Blood transfusions for disorders such as anemia), the use of Iron Supplements for disorders such as Iron Deficiency anemia, the use of vitamin supplements for vitamin deficiency anemia, prednisone or some other corticosteroid to treat autoimmune hemolytic anemia, transfusion of platelets in cases of thrombocytopenia, transfusions to replace the deficient clotting factor in cases of hemophilia, the use of antibiotics and avoidance of toxins in cases of Neutropenia, the use of Gamma Globulin in cases such as lymphocytopenia, or chemotherapy in cases of leukemia. Neurosurgery involved disorders and treatment of the nervous system. Disorders may include Brain Aneurysms, neuritis (inflammation of the nerve), neuralgia (nerve pain), Glioblastoma Multiform (severe brain tumor of glio cells usually ending in death), Spinal Stenosis (Narrowing of the spine), spondylolisthesis ( a frontward fracture of the spine), Subdural Hematomas (blood clotts positioned just below the duramater (meninges)), Cranial Hemorrhage (uncontrollable bleeding in the brain), Pituitary tumors (tumor of the pituitary gland, hydrocephalus (an abnormal accumulation of spinal fluid in the brain..a craniotomy is often done to relieve pressure on the brain), Ankylosing Spondylitis (inflammation of the spine accompanied by severe stiffness of the muscles around the spine diminishing flexibility) etc. Treatment or procedures often used in neurosurgery include Craniotomy (making an incision in the skull to remove fluid from the brain), Craniectomy (removal of part or all of the brain), lobectomy (removal of a lobe (portion) of the brain), Laminectomy (removal of the lamina (a piece of the vertabra)), Shunts (in cases of aneurysms), Epidural Steroid Injection (usually given in the small of the back..or lumbar region), Electroencephalography (procedure of assessing and producing a report of electrical activity of the brain), Magnetic Resonance Imaging (MRI) (to produce detailed images of internal structures for assessment and diagnosis), CAT Scan, and PET Scan (both which are used for assessment and diagnosis purposes), and Medication (such as Vicodin, Oxycontin, Celebrex, Ambien etc.). Finally, the specialty that I am most familiar with when it comes to codin is psychiatry. Psychiatry involves disorders and treatment of mental illness. Disorders include mood disorders such as Major Depression, Dystymic Disorder ( a mild form of depression), Cyclothymic Disorder, Bipolar I & Bipolar II Disorder, Mood Disorder Due to a General Medical Condition, Substance Induced Mood Disorder, Mood Disorder NOS (when the individual has signs of a mood disorder but does not fit the criteria for a specific mood disorder), and Depressive Disorder NOS (when the individual has signs of depression but does not fit the criteria for major depressive disorder, dystymic disorder, depression due to a general medical condition, or substance induced depression), Anxiety Disorders such as, Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder, Generalized Anxiety Disorder, Panic Disorder With Agoraphobia, Panic Disorder Without Agoraphobia, Specific Phobia (having an irrational fear of a specific stimuli), Social Phobia, Agoraphobia ( a fear of being in open spaces), Anxiety Disorder Due to A General Medical Condition, Substance Induced Anxiety Disorder, Obsessive Compulsive Disorder (OCD), Anxiety Disorder NOS, Adjustment Disorders that are classified as “With Depressed Mood”, “With Anxious Mood”, “With Mixed Anxiety and Depressed Mood”, “With Disturbance of Conduct”, or “With Mixed Emotion and Disturbance of Conduct”, Psychotic Disorders such as, Schizophrenia (classified as Paranoid Type, Disorganized Type, Catatonic Type, Residual Type, and Undifferentiated Type), Brief Psychotic Disorder psychotic symptoms are evident for 1 month), Schizoaffective Disorder (Classified as either depressive type or bipolar type), Shared Psychotic Disorder (when another person inherits or takes on the psychotic traits of another person, for example..it might occur in a couple), Schizophreniform Disorder (Schizophrenic symptoms are evident for a duration of 3 to 5 months), Substance Induced Psychotic Disorder, Psychotic Disorder Due to a General Medical Condition, Psychotic Disorder NOS (When a individual experiences psychotic symptoms but does not fit the criteria for a specific psychotic disorder), Delusional Disorder (classified as Paranoid Type, Erotomanic Type, Grandiose Type, Jealous Type, Persecutory Type, Somatic Type, and Unspecified Type), Personality Disorders such as Paranoid Personality Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, Dependent Personality Disorder, Avoidant Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, Schizotypal Personality Disorder, Obsessive Compulsive Personality Disorder, Schizoid Personality Disorder, and Personality Disorder NOS (which includes Sadistic Personality Disorder and Passive Aggressive Personality Disorder), Somataform Disorders such as Hypochondriasis, Pain Disorder, Body Dysmorphic Disorder (fear of body ugliness), Conversion Disorder, Undifferentiated Somataform Disorder, Somatization Disorder, and Somataform Disorder NOS. There are many other categories of disorders I can list here, all of which are found in the DSM IV. As far as procedures and treatments used for these disorders by therapists, MFTs, MSWs, Psychologists and Psychiatrists, they are complex and include both talk and medication therapy. Cognitive-Behavioral therapy can be used virtually for any disorder and is probably the one best received by insurance companies. It is especially used to treat mood disorders, anxiety disorders, and eating disorders. For the best results, would also include medications such as Prozac, Paxil, Zoloft, Welbutrin, Celexa, Atavan, Lithium (used for manic episodes), and many others. The medication is used to help the client maintain focus in therapy and the talk therapy itself is used to hopefully help the client resolve any interpersonal conflicts that may be occurring internally and externally. Other forms of talk therapy may include, Psychodynamic Therapy (what is occurring now is the result of past experiences), Client-Centered Therapy (The client is seen as someone who has the ability to establish and reach their goals), Gestalt Therapy (the therapist treats the client as a whole person and not as a partial person). These types of therapy as well as others can be used in individual, couples, and family therapy. The procedures coded on the CMS 1500 form would be individual therapy, couples therapy, family therapy, play therapy, group therapy etc., and not the actual therapy being used in the session.

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