Transcript [EN]: MCCG 137 Week 4 LIVE session recording

So, we're officially recording. We're in the record mode now. And thanks for joining tonight. Just go ahead and enter your full name. Thank you. Thank you. Thank you everyone for entering your name. Just giving it another couple seconds here. I see some of you trying to enter your name in the chat. I can't that when once we log off, I'm not going to see those names. So, you need to make sure that you enter with your entire name. So, if you need to log out, log back in because that's how the system is going to record it. Once we end the session, I'm not going to have no documentation of the chat. Okay? So, make sure you're doing it correctly. Okay. So, we have 19 players tonight. And so, um, for those who are unable for whatever reason for, um, being able to scan, uh, scan the QR code or whatever, you can be able to follow along. Just follow along right now. Okay? You can enter your answers in the chat and play along that way, too. Once I hit the start button, you're not going to be able to play. So, is do I need to wait for anyone? Is anybody still entering their name? Unmute yourself and talk to Professor V. Yes. Go ahead. Are you able to see my first and last name? I tried to see where I could enter it, but I'm having a hard time navigating today. What's your name? What's your name? Dominique Holly Brown. Yes, I'm seeing your name. Okay. Thank you. Was there a special link where we supposed to add our person? Um, Britney, I'm seeing your name. Once you log into the system, generally your name was going to pop up. Um, but some of us what happens is in the beginning of the session when we just started first week, I had sent out an invitation for everybody to join the session. Some of us for whatever reason ignored it and didn't um join a session um the weekly session. So if you didn't join a session, what's happening is you're not you know your name is not going to populate in into the system. Um so those are the ones who probably are going to be having issues tonight because um they may need to log in with your full name etc. Now, if they do get in, their name is probably going to come in unverified, which is okay because the system will still capture their name in that regard. Um, but some of us probably using an outside link or different email address or whatever the case may be. So, um, that's why I'm being very cautious in telling you guys, make sure that you're logging in with your name. Look, you can literally what you can do just type in the chat and see if your name pop up. If your name pop up in the chat, then you know you're good. Um, that's one way to double check. If you just type something random in the chat and your name pop up, then you know you're good. All right, I see some hands. Ayanna, you have a question? Yes, I'm I'm um I had to scan it on my phone. So, is it still going to count? Yeah, you're good. It's showing your name. It's showing you as unverified, but it is showing your name. Okay. Thank you. Uhhuh. Dominique, did you still have a question? No, I don't. I'm sorry. Adrien, do you have a question? Um, yes. It says I'm in here, but if I try to like write something in the chat, it says you cannot send messages because you're not a member of this chat because you're unverified. Um, because what happens is you didn't initially join the the um the session in week one when we got started. So, it's showing you as unverified. That's what I was talking about earlier. Yeah. So, you're going to populate as unverified, but it is it's going to you will show up on my attendance. Gotcha. Okay. Thank you. No problem. Any other questions? Just unmute yourself and ask me the questions because there's a lot of here tonight and I can just unmute yourself. Who has a question? Am I showing up? Dawn Holmes. Dawn Holmes. Yes, you are. You're good to go. Okay. Thank you. Hannah, did you still have a question? Your your hand is still up. Oh, no. I'm sorry. I thought I uncked it. Okay, go ahead and uncclick it. Adrianne, did you still have a question? No, I thought it didn't go away. No. Okay, now it did. Okay. All right. Uh, there's a lot of you tonight and thank you for joining. Thank you for joining. Yes. So, just make sure you take down your hands for now. We're going to get started now. We're going to play a little trivia game. Um, and so these are things that I have went over either in tutoring sessions or um the live sessions that we have had so far. So, it's just if you know, you know. If you don't know, don't beat yourself up. It is what it is. Um, just know that as a medical coder, there's some things that we're going to talk about tonight that I need for you to pay attention to. There's going to be a lot of uh me talking to you tonight about fundamental things that we need to know. So, let's let's go. Um okay, the first question says the principal diagnosis is defined as a condition established after study to be chiefly responsible for admission of the patient to the hospital. Is it a true or false answer? What do you think? Answer on your phone. Oh, nope. Don't don't don't call it out. Don't call it out. Answer on your phone or or your computer, whatever device you're using. And if you're in the chat and you don't have access to this, type it in the chat. So the answer is true. In the case of outpatient reporting, if a physician does not document does not identify definitive condition or problem at the conclusion of a visit or encounter, what should a coding professional do? the answer is going to be D. You're going to report the symptoms, whatever it is that the doctor gave you because we learned last week when we're doing the discussions, right? the coding discussions, we learn about uncertain diagnosises and we and I talked about that in a prior lesson as well on uncertain diagnosis section 2H and section 4H of the coding guidelines that talks about what happens when the doctor gives you possible questionable and those kind of thing uh situations. And in the case of when the doctor doesn't give you a definitive diagnosis, you use the symptoms whatever the symptoms is. Okay. A patient is admitted with acute mioardial infuction. The physician notes in the history that the patient is status postctomy and had been hospitalized one year earlier for pneumonia. At discharge, the physician documents the final diagnosis as acute mioardial inffection, status post showctomy and history of pneumonia. Which of the following diagnosis should be coded and reported? acute martial inffection cuz that was the diagnosis that was found right after the study. Okay. So there you go to code that that because that's the condition they were admitted with as well. Okay. A patient's admitted following a hip fracture. A diagnosis of Parkinson's disease and type 2 diabetes methylus on insulin are noted in the history and physical examination. Nursing notes indicate that the patients required the patient required additional care because of the Parkinson disease and because the insulin levels have to be monitored. Which of the following diagnosis should be coded and reported? All of the above. All of the above. Because why? They are all chronic conditions, right? Not going away anytime soon. So, you're going to code everyone. It's going to be up to you as a coder as to which one would be the principal diagnosis, right? Um, so that's how you're going to treat that case. The coding professional must be sure that the medical record documentation supports code assignment. True or false? The answer is true because why? Because Mr. V has a a theory, right? Something that I've taught you. If it's not documented, it never happened. Very good. Very good. If it's not documented, it never happened. Thank you. All right. Um, so therefore, that's where you got to go with. Now, Mr. V was very surprised and we're going to have a conversation in a little while about the coding project because a lot of us didn't follow that golden rule. And so, we're going to have a conversation about that. Okay. All right. We talked about neoplasm earlier. Neoplasm is a new or abdominal growth. What is neoplasm? You should know this from your terminology class or your AMP pass. The answer is true. It is a new growth. Very good. Methostasis is a spread of invasive tumor cells. That true or false question? Answer rather. The answer is going to be true. Very good. Uh, give me one second, class. One second. I got to take this call. I am sorry about that. I had to take that call. I've been without a fridge now for the past month and a half and I've been trying to get these folks to come fix my fridge and it's just with delay after delay. But anyways, metastasis is spread of invasive tumor cells and that answer is true. Thank you for waiting for me. Let's keep going. Um, benign plasms are not invasive and do not spread. True or false? The answer is true. Very good. See how we doing. Okay, Jessica is still top of the leaderboard. Okay, good job. Uh, good job everyone. Let's keep going. The term metastatic 2 indicates that the site mentioned is a secondary. So, this is testing you to see if you're reading those coding guidelines on a daily basis. Okay. Um, go ahead, answer to the best of your ability. If you don't know, that's okay. Take a educated guess. Just know that you now know that you need to be reading these coding guidelines on a daily basis because when you do your certification exams, these are the things that going to pop up in your exams. You're going to know need to know these things at all times as a coder. The answer is true. Okay. The term metastus from indicates that the site mentioned is a primary site. True or false? The answer is true. When two or more sites are described as metastatic in the diagnostic statement, each of the following sites should be coded as secondary or metastatic. Answer to the best of your ability. If you don't know, that's okay. At least now you will know what you should be looking at when it comes to that certification exam that you have to take in the future. Just take an educated guess and make a mental note that I hey I need to go back and read those neoplasm guidelines. The answer is true. In the impatient setting, the following statement should be coded rule uh rule out gastric ulcer. Should we code that statement if we see it in the impatient setting? the answer is yes. We literally just talked about it a couple minutes ago. We code these in the impatient setting because of the coding guidelines section 2H that talks about uncertain diagnosises. Let's keep it moving. In the outpatient setting, the following statement will be coded. A patient is admitted as an impatient and discharged with possible post-traumatic brain syndrome non-csychotic. the answer is true. The catch to this is the patient was in the outpatient setting but then got admitted. So that's the key because they got admitted now the rules change. You have to go by the impatient coding guidelines. So we're still on section 2H that deals with uncertain diagnosis for impatient. Okay. My written assignments should use the APA format. A lot of us are not doing this. A lot of us are saying, "You know what? Bump, Mr. V. I'm going to do my own thing, right?" And that shouldn't be because you're making it harder for me when I go to grade it. Another thing that you need to make a note of, some of us are uh when you write essays in a college format, it shouldn't be in color. It shouldn't be in green writing, red writing, purple writing. It should be in black at all times. Okay? Black. It's black ink. So, make sure that you type it up on your word document, you submit it it to um to Ultra Blackboard and um make sure you do it professionally with a cover page and then um your layout especially this week because this week you have a major essay that you're working on, couple writing papers that you have to do this week. So, make sure you're following the APA format. If you literally want a link, just Google it. Google how should the APA format appear. I literally provided links at the beginning of the session to you guys and uh some of us just ignoring it. Um so make sure that we're following what's presented to you as for what the requirements are for my class. Okay. Okay. So, everybody should have known that answer is true. As a new coder, I should devote one hour each day to reading my coding guidelines. Mr. We talked about this over and over again. For those who have been coming to the live sessions, tutoring sessions, you have heard me say this over and over again and I've said it over again. The coding guidelines is our toolbox, right? So, we have to treat it as such. If you have a plumber show up to your house without a toolbox, I'm sure you're going to send that plumber packing. That's exactly what's going to happen in the coding world. If you do not know the coding guidelines, that employee is going to send you packing. So, you got to make sure that you stay devoted to knowing what's in your coding guidelines. Okay. All right. Congrats, Jessica. Thank you. Thank you. Thank you. uh um take in class everyone that participated in this thank you so much. Is there any questions on that? Do you see where you need to make improvements? Yes. Yes. Okay. Beautiful. Make sure that you do that and and uh going forward and such. Now I want to talk to you. Um, literally I need to have a conversation with you guys and this has to do with um, let me stop sharing my screen. Um, the coding project. Um, so what I want you guys to do um, what I want you guys to do is go to your coding project. Everybody open up the week three coding project. Open it up. Um, for those who can and for those who probably don't have access to it right now, let me see if I can get it for you and share it. One second. Hold on a second. Let me see if I can pull it up and share it for you on the screen cuz I know some of you told me that you are at work. So, I'm going to try to get to it so I can bring it up. We're going to have a little conversation here for about 15 minutes before we get into the rest of the lecture. All right. So, I'm going to share my screen. Okay. Let's have a conversation class. How many case seniors do you have this week? unmute him and answer me. There's three, right? Three case scenario. Yeah. One physician scenario and two impatient scenarios. Correct. Yes. Okay. Correct. Yes. All right. Awesome. Awesome. Awesome. All right. So, and I showed you and I presented a video to everyone in week two and I invited everybody to the session and who didn't show up. I recorded a session. I posted the video in advance in week two, right? And so, you had the entire weekend, the week, and I kept sending announcements over and over again, right? For those who saw the announcements and read them, reminding everyone to do what? Watch the video before you start the project. Correct. Correct. Who can testify to that? Yes. I saw you saw those announcements. Yeah. Yes. And yet, yes. Some of us didn't do so well. Some of us didn't watch the video, didn't read the announcement clearly based on the outcome of their project, um, didn't follow through. Some of us even went so far as to make up their own scenarios, I'll kid you not, and place it as a project. And I'm like, what is this? These are not the scenarios that we're working on this week. Where did these come from? Literally, I kid you not. And I I I'm I'm at loss for words, right? We talk about the five code skill sets that um coders must have and one of them being attention to detail. And that's what you were tested on um in week three, ensuring that you read the announcements and you follow through. And I even went so far as giving everyone the opportunity to send the project to me for review. And when I just noticed that not a lot of individuals take uh opportunity of that and send it to me for review before they submitted to Blackboard, I sent an email out and I said, "Guess what? Because I don't want anyone to fail this, I'm granting an extension." How many of you saw those emails? I did. Okay. I do. Okay. But I never got any response back though. Okay. You sure about that? Okay. Let's talk. Let's Let's talk about it after the class. Okay. So, make sure you you um you meet with me so I can look at that to make sure that I didn't overlook something. Um, one of the things is some of us are sending messages to me via the and I I had had a conversation about that and I don't know if some of us missed that message. Some of us are sending me the message via um the altter instead of sending me an email per se and I told you there's a delay in that system and I don't trust it. So because of that, two days later, 3 days later is when I'm seeing a message saying, "Hey, this person is trying to reach you." And so I do not trust it because it's a brand new system. I I've been advising everyone to send me a direct email in that regard to sure that I get the messages. Um but anyways, um that individual that has issue uh with that, let me know uh after the class. Stay online so we can talk about it. Okay. Um okay so with that regard now the next thing so now that I complain about that because that's my gripe that was my biggest gripe is that a lot of individuals didn't take opportunity of that and a lot of individuals make up their own scenarios. I didn't understand that because nowhere in here did it tell you that. Nowhere in this these directions did it tell you that. Nowhere in the video instructions that I give you that I want everyone to go by. Did he tell you that? And um and so I was very confused. I still have eight projects to be graded left in one of the class. So for those who didn't see a grade yet, don't worry. I will be getting to it sometime tonight before I go to bed. I'll finish grading the the eight out standing there. And uh so you'll get a grade tonight or or early tomorrow morning at the latest. Um so don't worry about it. Don't panic. You will get your grade. Um in that regard, now I want to play a little game. Let's play um uh what what would you call this game now? Um uh we're going to be hunting. We're going to be hunting for a certain word. And there's a reason for my madness in doing this. Look at physician senior number one. I'm looking for the word asthma. Tell me if you see it. No. No. No. Are we sure it's not there? Right. 100% sure. I kid you not. I had a lot of people holding asthma for this case. I don't see asthma. What's the golden rule? It's not documented. It never happened. It never happened. Another another um hunting game. Look for the word lowbar pneumonia. Do we see low by pneumonia in this in physician center number one? No. No. No. What do you see? Double double pneumonia. Very good. Okay. And it's not just one person doing it, folks. It's a lot of individuals. These are the kind of things I'm coming across and I'm going I'm not understanding. I don't get it. Okay. Um so we got to make sure that we're coding what's in front of us. Okay. How many reason for visit codes does physician senior number one have? Who knows off hand? Two. Say the how many two two reason for visit codes. And how many first visit codes does physician senior number one have? One. And how many first codes can you ever have in a case scenario? One. One. Just one. How many admit codes can you have in a case scenario for impatient setting? Impatient setting. Primary and a secondary. No. Listen to the question. How many admit codes can you have in impatient scenario? Isn't it one? Very good. One. Very good. How many principal diagnosis can you have in an impatient scenario? The next one. One. Very good. Okay. How How many secondaries can you have in an impatient scenario and outpatient scenario? Two. Multiple. Multiple. Thank you. Multiple. As many as needed. Very good. Good answers. Multiple. As many as needed. Okay. Whatever is documented in a medical record that needs to be coded as secondary, you code it. Can you list in either the outpatient or the impatient setting? If you have a definitive diagnosis, can you list the symptoms as secondary codes? No. No. No. Very good, Jose. No, you cannot list the symptoms as a secondary code, right? You just don't right because you have a definitive diagnosis. So you just go with definitive the definitive diagnosis as a principle and whatever that needs to be coded as a secondary based on chronic conditions or other things factors that's going on with that patient at the time you code those as a secondary. Any questions on that? No. Do you do we understand some of us? So the reason um for for the visit the reason why you got put in the um hospitalized you can't use the cough and shortness of breath for that as as a reason for visit. Yes. Are you asking can they be used as secondary codes? And for that the answer is going to be no because you have a definitive diagnosis and that the definitive diagnosis is double pneumonia. You get what I'm saying? I um do you want me show you on paper so you you let me show you on paper so it makes sense. One second. Let me show you on paper so it makes sense as to how the appearance would be. Okay. So some folks are visual learners. I got to make sure I put it out there so you can see it. So you got this reason for visit code and the two of them are let me put codes because it's two cough right and yes shortness of breath and shortness of breath. And then you have the first code. Oops. And that will be the doubling pneumonia. All right. So we know our car code is going to be that R code R05. 0.9 and Mr. V needs to use a capital letter. One second. Okay. And then the shortness of bread was I think was it R06.2? Who has theirs open? I believe that that that's what the code is. And then the double pneumonia was J18.9. So what we're saying is cough and shortness of breath are symptoms of doubly pneumonia. And if you're not sure, just go to Google and type what are the symptoms of pneumonia and then I'm pretty sure it's going to populate these symptoms. So that means for the secondary code for that particular scenario, you will have none. There's no nothing else was mentioned in that statement. Does that make sense now for the individual that was asking? Yes, that's what I have. Okay. I thought I was missing something. Okay. Okay. All right. You got me now. All right. Beautiful. Okay. So, that's what you would need to do there. All right. So, where a lot of people individuals went right arai the formatting didn't use the formatting. I literally give you in that video the answers to the coding guidelines, the rationale. All you had to do left was suggest the code. I made it very easy for you in that video. And so had you taken the time to watch the video, majority of you wouldn't fail the project. So attention to detail in medical coding is very important. Okay. I went above and beyond by providing everything that you need to do to pass this project, but some of us went around it and did our own thing, which didn't make any sense to me. Um, because everything was provided to you to be successful. Did any of you not find the video helpful? Be honest. It was helpful. Say again. It was very helpful. Okay. Um, yeah. I I I I just I I'm baffled and I'm trying to figure it out because this is the first class where I had so many individuals that just literally didn't watch the video. This is the first class. Are you going over the answers on this today? I'm not. No, I'm not going to show you the answers. You're going to be for those who had it incorrect, you your requirement is to go back and make the corrections, review the feedback and make the necessary corrections because when you go out in the real world, what you're going to be taught is that when they audit you and the auditor comes through and audit your account, your accounts I should say, the audit is not going to tell you what the correct code should Hey, the order is going to give you feedback and tell you, hey, you need to go back and recode your account based on these findings in the documentation and these coding guidelines or these coding clinics. Something that you will learn about later on in one of my live lectures when we get to that point. They're not going to give you the answers when you go to take your certification exam or your employment pre-EST exam. That's something else that we need to talk about and that's another conversation that we need to have. When you get out in the real world and you start applying for jobs, before they even grant you an interview, you have to take an employment pre-est exam. Sometimes it's 40 questions, holding questions. You have to score 80% or higher before you even be granted an interview. And if you didn't know that, now you know. And every almost every job requires that. You have to take a code into a test before you be granted the next interview. So, if you ever wonder when you start applying to these jobs and they send you those pretests and say you got to take this exam and you don't get a call back from the recruiter, that's why you more than likely you probably fail the text. So, they're not they're not going to waste your time calling you back. Many times I go on social media and I see people saying, "I can't find a job and da da da." And when you drill into it and you ask them, "Well, did you get a pre-EST exam to to um to take?" Yeah. Did they tell you how well you did? No, they didn't reach back to me. More than likely, you possibly failed that exam. So, they're not wasting their time. They move on to another candidate. I'm just be honest. I've been doing this now going on 27 years. I know exactly how the the game is played in this quoting world. So that's why I do what I do. This is why I spend the extra time away from my family to ensure that I give you the knowledge. I impart the knowledge onto you to make sure you're successful in this field because I that's I'm I love doing what I do as a teacher. I love imparting knowledge and I just want you guys to start devouring it and start embracing what I'm telling you because the real world is not easy when you get out there and start applying to jobs. There's a lot of coders that are going to try to fill those seats and when you start applying and you're not getting through and you start knocking on doors and you're trying to figure out why nobody's calling you back. more unlikely. If you took a pre test and you didn't do so well on it, that's why. So, we have to pay attention. We have to read our coding guidelines. We got to be motivated enough to want to learn because if we don't, then we probably more than likely just throwing away our career. We we have to get into it. Do you get what I'm saying? I'm not I don't want to look like Don't Please don't look at it as if I'm beating up on you. is love is my passion and I I'm trying to motivate you to kickstart this career that you're getting into the right way by making sure that you're reading your coding guidelines daily. You're applying everything that I'm everything that I'm telling you to be successful in this field. Everybody understand? Yes. Feedback. Yes. You get it? Okay. Yes. Okay. All right. So, when I'm having these tutoring sessions, if if you're having difficulty coding, show up. This is for you. If you under having under difficulty h interpreting the coding guidance, show up. This is for you. Okay? Don't sit there and say, "H, I can't tonight. I'm too busy tonight." Make the sacrifice. That's what school is about. You have to make that sacrifice and show up because guarantee you when you get to those other classes, you're not going to find a teacher. You probably find them, but I've I've had feedback from other students over time that say Mr. V is the only one who does this. All these ting sessions this week, I'm having three ting sessions with you guys. Three starting tomorrow night, 8:00 p.m. Show up. You're going to be doing practical coding. We're going to be talking about the coding guidelines. We're going to be diving in. You're going to be doing hands-on coding. Today, I posted two videos. Chap on chapter 19. I went over the coding guidelines on I think it was Thursday and on Friday, we went over we actually do hands-on coding. You know how many people show up? I think it was three if I remember correctly. Three individuals show up. That was it. Okay. So, you need to start motivating yourself to say, "Hey, listen. I want this and I need to show up to these things because I'm not doing so well right now and I need to ask the right questions so I can be on par with everybody else so I can be successful." All right. Um, so with that said, I told you that I'm not here to fail anybody. So, here's what's going to happen. And I know I got a lot of emails saying, "Can I get it? Do it over, please." Well, anybody that score less than 75% on this coding project, I'm going to give you grant you the ability to go ahead and redo it. Okay? But here's the catch. You need to have it done by Friday. Actually, no. Grades are due by Thursday. So, you're going to need to get get to it and get it done. Um, actually, no. You know what? I'll I'll grant you this. I can always go back and adjust the grades. It's just going to be extra work for me because this week, you guys have a lot of assignments that I have to grade for week four. So, this is going to be a lot of extra work for me. But, it is what it is because I I don't want to fail anybody. So, you will have until Sunday morning by 9:00 a.m. Eastern time to submit to me your revised coding project. You need to watch that video, right? And for many of you that didn't do so, well, I post I gave you the link to the video again. Even though I did it multiple times in the announcements, I gave you the link to the video and I tell you, you need to watch that video and you need to make those adjustments. Anybody else, majority of you only got like probably one code wrong for those who really paid attention, that kind of thing. So, you just need to make that particular correction by week seven. So, what's going to happen is in week seven class, this is for everybody now. You're going to present the week three project and the week five project together along with a cover letter demonstrating why you're the best coder for the job. More information will be re revealed in the week six live session video. So in week six, your next mandatory session, I will have that conversation about how to uh properly set up your final project. So before we're done tonight, I'm going to be going over the week five coding project. All right, so um bear with me. All right, now that I finished with that spiel, are there any questions on what I just said in regards to redoing the project? Yes, M. I have a question. Okay, go ahead. Um, when we resubmit, do we need to resubmit through Ultra or do we need to just email it to you? Okay, you're good question. Thank you for that. All right, because I don't want to fail you again because this is you only have one opportunity to get this right. So, here's what's going to happen. I'm granting you the opportunity to email it to me for review. Once I see it's perfect, then I'm going to open up the second attempt. Only then I will open up the second attempt. So I will open up the second attempt. Then you can upload it to ultra. It's a good question. Everybody clear on that? Yes. Yes. Yes. All right. Okay. Now you're going to have to pray for Mr. because you guys I'm pretty much giving setting up myself for a lot of work this weekend that I don't necessarily need. So, I mean because I have to be grading the week four assignment which is a lot. You guys have a lot of written assignments this week. All right? And plus your final exam. So, I'm going to be burning the midnight oil trying to accommodate you guys. So, please pray for me and you know and all that good stuff. Um, so I'm I don't drink coffee, but I think I'm gonna have to get some energy drink this week. Um, to just to keep it going. All right. Um, and show up to the tutoring sessions. I can't stress it enough. They're going to be very helpful. For those who have been showing up to the tutoring sessions, don't you find them helpful? Very helpful. Very helpful. Yes. Okay, thank you. So, you can testify to the others who have not been showing up. And I know there's everybody have different circumstances, but you have to make the sacrifice, folks. You have to because this is where we do the practical coding. This is where we do the hands-on, okay? And so, you need to um because some of us are all over the map. We're coding things that is not documented. And it it worries me. It rewards me. So, um, you know, so make sure that if you can't show up, you watch the videos at least, okay? Watch the videos. Um, and and that kind of thing. I mean, I literally I I told you guys, I don't think I showed you this class this yet, but okay. So, for example, this is my my back panel for my showing all the videos I have uploaded so far. These two videos was just uploaded today. I'm I'm not on um I I I do not expect a lot of people that viewers only three people watch it and I see there's one comment on it. So I'll go back and review that later. This was from last week. This one everybody should be watching this because I posted this one last week. This is a very important video that talks about the seven characters when it comes to coding. everybody. I need to see this count improve because only two individuals watch the video and I know in that class we probably had about four people total and I have a class of 50 between the two classes. So if you don't watch this video when it comes to your discussion post there's one of the couple of your discussion post that's coming up that requires seven character coding. You're going to be in a world of hurt. You need to watch this video. Okay? Only only two individuals watch it. So go back and watch it. I posted an announcement. Um this video is uh the week three live session last week. Only 10 people watched the video. This one has 103 views which is good. Which is good and I appreciate that. But guess what happened? more than likely is is not a lot of people because if I break down into the details and go into the analytics of it, I probably going to find that not not a lot of individuals actually watch the full video. Okay. So, I can I can literally see when it drops off more detail as to when people start watching and then all of a sudden it faders off. See? You see this? And then June 12 is when it picks up and then and then more people start watching it. That kind of thing. I I track these things because I hold myself accountable too as well. I watch four areas where I need to improve. So if I see for example I lose the audience at some point in time then I know hey maybe I need to curtail what I'm saying here kind of revamp how I'm presenting the lecture etc. I hold myself accountable too as a instructor cuz I want to make sure I'm doing a damn good job in delivering the material to you guys. Okay. So I look at all these things. I look at the announcements that I make and I look at how many people is actually reading them. 10 of 22, 13 of 24, 22, 9 of 22. Literally, I can tell how many individuals are actually reading these announcements. And this is why I have the um the results I have for the coding project because not a lot of you are actually reading the announcements. So, Mr. We can tell why I had so many individuals that fail a project because you can tell right here 9 of 22, 9 of 22, 11 of 22, 13 of 22, 10 of 22, that kind of thing. People are not reading the announcement. So I have ways to track these things and know who is actually doing what. So when individuals send me questions on this and that, I know that individual didn't watch a video because I have analytics that can tell me, did you watch that video? I can tell. Did you read the announcement? I can tell. Okay. So, you need just like I'm holding myself accountable, you need to hold yourself accountable. Make sure that you're doing what you need to do. Any questions? No. All right. We're going to get into the lecture. Enough of that. Enough of you guys probably got tired of me whining now. So, we're going to do a presentation. I'm going to ask for you to grab your ICD10 book. Um because the next step now is to do a presentation on the coding of hypertension, chronic renal failure, and leftsided heart failure. Um so, we're going to do that presentation now. So, grab your ICD10 book because I'm going to do a walk through. um uh and we're going to utilize a pay a madeup patient to help achieve the a goal that we need to achieve tonight. So ICD10 CM pretty much has what we call combo coding at at times there are times when we need to uh do combination coding for particular disease conditions. There's times when we need to code an additional code when we're coding a particular condition. For example, with diabetes, diabetes has many other side effects. For example, a patient may end up having an ulcer because and condition and then the diabetic diabetes condition that they have plays a role in the care of that ulcer. It may be that the patient has hyper lipidmia which could be also a factor with that diabetes and so those kind of conditions require two code one to identify the diabetes and the next code to identify the hyperlademia um that kind of thing and it also times requires two codes because you have a situation where um you have linking that condition with the other. Um, is somebody's trying to get into the class? Because let me see something here. Okay. I keep hearing a a noise. And then when we're going through this, um, if you have any question because I can't see this right here, um, make sure that you unmute your mic, stop me, and say, "Mr. V, pause. I have a question on this." Okay. It's not going to be a long PowerPoint presentation, but I need to go through a very detailed in explaining things to you. All right. All right. All right. That slide needs to be updated. I did this presentation for AHEA the certification arm of you know what are you going to try to get certified with uh several years ago at the time I was only 21 years in field now I'm up to 26 27 years in the field and so tonight's goal is to define what hypertension is define what chronic renal failure is and define leftsided heart failure and we're going to stick with leftsided heart failure tonight because those are the symptoms this patient that we going to critique is having tonight. That's that's what he has. And so, we're going to use these symptoms to help illustrate how to actually code when you have all three of these conditions present. Okay, we're going to list and explain the signs and symptoms for each condition. We're going to demonstrate how to determine the right condition for these diagnosis. All right, so we're going to start with hypertension. What is hypertension? Hypertension out commonly called high blood pressure is when the force of your blood pushing against the walls of your blood vessels is constantly too high. Any blood pressure reading over 130 over 88 mm Ag is considered hypertension. So the complications of hypertension could include heart disease, fluid buildup in the lungs, vision loss, kidney damage, erectile dysfunction, memory loss. Those are the kind of things that can happen in conjunction with having a hypertension situation. Hypertensive situation. Less heart failure is the inability of the left ventricle of the heart to pump oxygenated blood to the body causing a backup of fluid in the lungs. The signs and symptoms include tacipenia, rails, crackles, cyanosis, and respiratory distress. Chronic kidney disease is a condition where your kidneys are damaged and cannot filter blood as well as they should. This causes excess fluid and waste products from the blood to remain in the body. The signs and symptoms include nausea, vomiting, muscle twitches and cramps, shortness of breath, chest pain if fluid builds up around the lining of the heart. So before we go to the next slide, I need you to grab your ICB10CM book for me. And the first thing I want to do, I want to identify in your book where the coding guidelines is actually placed for this particular situation. So we're going to start off by looking in the front of your book. And the front of your book is going to be page XX IIX XX IIX. Everybody go there and let me know when you get there, please. Because I can't see you. I'm going to rely on you to tell me. Just unmute your mic. When I hear majority of you answered yes, I'm there. Then I'll keep going. Yes. My book doesn't have that. Yes, every book has it. If you have the the same book as ours, you should have it. It's in the front of your book. The very front is a red and white page. You're looking for XXIX. Yes, I have it. The person that The person that said they didn't have it, did they find it yet? No, I don't. I have a red and white page, but mine is labeled ex. No, keep going then. You need to keep turning the page. I have I don't It don't go that far. It does. It should the chapter that you uh will be looking for it is going to say like chapter 8, chapter nine. Yeah. The page that you Yeah. On the page on the red and white page the it's going to be on the right hand side. It's going to be on the right side. Yeah. But you'll see chapter eight where it says diseases of air, diseases of the cholesterol. I mean the circular um system. You'll see stuff like that. If we go to the coding guidelines and I'm in the coding guidelines. I don't know if mine is not labeled correct the same as y'alls or not but it's under chapter seven. Can I ask you just to be sure? Sure. What what book do you have the front of your book? The cover page. What does it say? ICD10 CM 2025. the complete official code book. Oh, you have a different book. You do have a different book. Um, same book. You don't have the same book as us. Um, so I I don't know what page to tell you to go to. So, um, I I um tell the name of the section and I can just find it that way. Yeah, it's going to be the coding guidelines. Now, every every publisher that publish these book set up their their their books differently. Um, okay. So, not all the pages are going to be the same. The formatting of the book is not going to be the same as far as where they place the the coding guidelines, but the index and the tablet are going to be the same. Um, that's the only thing that's going to remain the same. But, um, yeah. Um, just follow along the screen for now. Maybe later after class we can get together and I can help try to help you navigate it. Okay. Um, no problem. I'm in the guidelines though. All right. Beautiful. All right. All right. So, class chapter nine of the coding guidelines talks about coding for disease of the circulatory system. And so, the focus tonight is going to be on the hypertension portion. So, kind of put your fingers there and let's flip the page. We're gonna go to Yeah, we're going to go to chapter 14 of the coding guidelines and that's going to be on page X XV. and we're looking at chapter 14 of the coding guidelines. It's not a big portion. So, you're going to rely on the lecture that I'm going to present to you tonight, but I'm just trying to get you used to where these coding guidelines appear. Okay? All right. With that said, let's start the lecture. Follow along on your screen. The coding guidelines says that we are to assign a code from communication code I13 when a patient is present with hypertensus heart and chronic kidney disease. And you're going to say how does that look Mr. V? Well for the fun of it hold your finger there where where we are in the coding guidelines and we're going to go straight to the table and we're going to go to category code I13. I13 in your book. Okay, for those who have the correct book, it's going to be on page 691 in your book. 691. And uh you can um young lady who says she doesn't have the right. You just look for code I13 in your book in your tablet. Go to the tablet portion and look for code I13. You have it. Beautiful. Beautiful. Beautiful. Okay. So as you can see I13 is there that says hypertensive heart and chronic kidney disease. Then it's broken down to I13.0 I13.1 but you notice a plus sign next to it which indicates what? Can you code that code by itself class? No no no. So that means you have to go to I13.10 10 flip the page and then you would have to go to page 62 I13.11. So those are the two codes you can code from that set. The next code set is I13.2. Can you code that code by itself? Yes. Yes. Yes, you can. Very good. You can code that one by itself. So if you notice the code title as it reads hypertensive heart and chronic kidney disease, what does it indicate? It means that the patient has hypertension and chronic kidney disease from I13 code I13 you can code those that combination code because of the patient does present with those two conditions now flip now let's go to I20.0 zero. That code says hypertension of heart and chronic kidney disease with heart failure and stage one through stage 4 chronic kidney disease. What that mean is that if the patient has kidney disease up to stage 4, you can use that combination code and if they present with heart disease as well in the medical record, then you can use that code. And if you go to P uh I13.1, it says hypertensive heart and chronic disease without heart failure, meaning that the medical record did not indicate the patient presents with heart failure. So you can code from that category code if that's what the medical record says, right? Flip the page. Let's go to I13.2. Okay, it says hypertensive heart and chronic kidney disease with heart failure. With heart failure. So then you know that's the code set you would go to when you're coding with a patient who has all three conditions present. They have hypertension, they have a heart disease, and they have chronic kidney failure. You code from that code set. Now look below I13.2. And it's the same for all the other codes that we just went over, but we're going to use this one as as the example. If you look below it, you have some use additional note clause. Do we see those? It says use additional code to identify the type of heart failure. I50 category code would need to be utilized to identify the type of heart failure based on the documentation in the medical record. And he also has a use additional code note to for you to identify the stage of the chronic kidney disease based on what's documented in the medical record. So that's what we're going to pay attention to tonight in order to code the patient that we know now as Mark and Mark presents to the ED with difficulty breeding. He complained that he has not been breathing properly for the past 7 days which became worse in the morning. He stated that his lower limbs are swollen and he has gained some weight. On examination respiration is 28 bpm juggle veins are distended and after admission and having various tests done Mark was diagnosed with hypertension leftsided heart failure with stage 2 renal failure. So we now know the severity of the stage of the renal failure that being stage two. Okay. So in coding world we can go all the way from stage one renal failure all the way to stage five. And when we get up there they may use the term ESRD endstage renal disease. Okay. So if the gas get out of whack and it's not controlled, this is where it's going to end up. It's going to be very severe for that patient at that point in time and they're going to end up on diialysis and and you know possibly needed to have the kidney, you know, replaced. Okay. So we're going to go to the book, go to your table. We're going to focus on the table and we're going to try to code Mark. So, we're going to go first to I3.0 and work our way down and we're going to code Mark. So, Mark is presented with these symptoms, these diagnosis, final diagnosis, impression, hypertension, leftsided heart failure with stage 2 renal disease. Looking at these category codes, these code sets that are there in front of you and the ones in your book which are the same. Okay. Which code represents mark to identify all three conditions? Which one would you code? I3.0. Does everybody agree? I 13.2. Yes. Okay. I don't know. The correct answer is going to be I3.0. Okay. Because the the patient does have hypertension, does have the heart problem, have chronic kidney disease, but the chronic kidney disease is in what stage? Stage two. So therefore it fits with this particular code set because this code set focuses on stage one through stage 4. Does that make sense? Yes. And for the person that says I 13.2 if you look at that code said it it goes from stage five. Right. Yeah. That's stage five. I was reading that through five. I'm sorry. Yeah. So that's why we don't use that code. So let's code the next one. The next step now is to look at the coding guideline. And I just literally went over what with you those use additional notes that you see at the bottom of the code set. So look focusing on the I13.0. It tells you that you need to code um the stage of the chronic kidney disease, right? And you need to code the stage of the heart failure. The two more codes are required to complete the scenario for mark. Okay. So with that said, now go to your ICD10 CM book and go to the I50 category code. Go to I50 category code in your ICD10 CM book because now we need to identify the code for Mark for the heart disease. Let me know when you get there. 50 FI. Okay. Beautiful. And this is what it looks like right on the screen. You see the layout, the heart failure. And what type of heart failure does Mark have? It says leftsided heart failure. So therefore, what code should we code for the heart failure? I 50.1. I 50.1 should be the code set that you would apply for the heart failure. Very good. Okay. So, next thing it says that we need to assign the stage of the chronic kidney disease. That's what the coding guidelines says and that's what that use additional code note says in your book. So now that we understand that, everyone go to category code N18 in your ICD10 CM book. Go there and let me know when you reach there. N18. I'm there. Very good. I'm there now. Awesome. Awesome. Awesome. All right. So, let's look at it on the screen now that we're there. So, Mark has what stage k disease? What stage is he? Stage two. So, what code would we use to identify the stage two? N8.2. N8.2. N.2. Very good. N18.2 would be utilized to identify the stage 2 chronic kidney disease. Very good. Okay. So with that said, mark has all three conditions and this is how it should be sequenced in your coding when you when you code it in the real world. This is how you're going to send it to the insurance carrier. You're going to show first the combination code I13.0 to indicate all three conditions are present followed by the heart failure followed by the chronic kidney disease exactly how is presented in this scenario is exactly how we're going to sequence the code. That's another thing when it comes to the coding project. Make sure that you're sequencing your situations properly. Some are listing the secondary code first and then the uh principal code second. Okay. Make sure that you sequencing it correctly. It's always going to be admit code, principal code, impatient versus the code if it's outpatient and then make sure you use a reason for visit code for the outpatient as opposed to the Mit code and then your secondaries as appropriate. In this case for Mark, we're going to have the stage two kidney disease. That's going to be the last thing that's going to be presented for that this particular patient for these particular conditions. And we are coding based on what's documented in the medical record. Nothing else. Only what's documented. Okay. So the presence of hypertension, heart failure, chronic disease is now enough to assume a casual relationship. We're reminded in the coding guideline that the word width in the alphabetical index link these conditions together. Okay. So, if you go back to the coding guidelines, you will find uh in the beginning of section 1A of your coding guidelines on the front of your book, you'll find those con uh conventions and make sure you read through them appropriately to get the appropriate verbiage and definition on how to utilize them when we come across it. These are my reference points and that's it. That's the presentation for tonight. Any questions? No. No questions. No. No sir. Was that presentation helpful? Yes. Yes. Yes. Okay. Beautiful. Yes. But I have a question though. Is this Did you record this class today? It is. Yes, it's being recorded. Yes. Okay. Thank you. No problem. All right. All right. So, what's the next thing we we're going to go over tonight? Uh, we are going to go over the week five coding project. This is the last thing I'm going to talk about tonight. The week five coding project, the requirements for it. What are the requirements for the week five coding project? Make sure you take notes, right? And you're going to follow exactly what I'm telling you because the requirements for the week five coding project is going to be slightly different from the requirements for the week three coding project. Okay? It's going to be slightly different from the requirements from the week three coding project. So, um, give me a second here and and I'm going to need to open up a new word document. Okay, let me kind of move this out of the way for now and then I'm going to share my screen. Just like the week three coding project, you do have three case scenarios. You do have three case scenarios presented. All three case scenarios I'm going to tell you right now requires two codes. two codes last week ttoring session the one I talked about for chapter 19. I would watch that video because I literally dropped the coding guidelines in that video. For those who were attended that session, you remember me giving you the hints of what the coding guidelines should be. The coding guidelines for week five are going to be different from what was presented in week three. Totally different. is going to be directly applied to each case scenario based on what's presented in front of you. If I were you, I will watch those videos from last week cuz I literally gave you the answers for these three case scenarios. Okay, now with that said, let me show you how you're going to set it up. Okay, let me go ahead and copy and copy this first and then I'll bring over my black and blank document so you guys can see how it should appear. One second. I'm doing a Ctrl Z to paste it and then I'm going to bring this over. Ah, come on. You guys can still see my screen, right? Okay, I think you can. Yes, you guys can still see my screen. You can see it. Perfect. All right, beautiful. Now, what's the difference with this week? Because the way the seniors are written. I'm not going to require any. And as you can see here, they're all outpatient cases. The physician senior, that's an outpatient obviously. And so they're all our patient senior cases. So that means we're going to be you would have typically you would have used reason for visit codes, right? And first code and then secondary or whatever you need. In this case, I'm not going to require any reason for visit codes because of the way the scenarios are written. In real world, yes, you would have applied it. But right now, we're going to focus on the fact that all three case scenarios, make a mental note of what I'm telling you. Requires only two codes each. How many codes? Two codes each. Two codes each. Nothing more. Two codes each. Another thing class. Is this a CPT class or every things start coming back to me now that you know when I'm going through this because some of these scenarios the way they're written folks are going to be tempted to code CPT um codes. Is this a CPT class or ICD10 CM class ICD10 I ICD10 CM. You should not be coding any CPT codes. And I had folks doing that and we talked about that. This is straight up just an ICD10 CM class. This is not a CP example, please. Example of what? Of the other code. Oh, the CPT code. Um, if you're not in CPT class yet, then you don't need to worry about it. A CPT code is like five characters. Um, for example, 7101 um zero. That's five characters. and it's just that's how it's written and it would represent for example I think that code represents a check x-ray a CPD code is a procedural code that is utilized in the outpatient setting when something is actually being done to a patient for example they may have an X-ray they had a surgery they did an endoscopy for example I've had in previous classes where the pat where the students try to code the endoscopy that's not needed we're not coding the endoscopy We're not coding the procedure. We're just coding the diagnosis as written. What are what's the actual condition of the patient? Are we clear? Does that help? Yes. Thank you. No problem. All right. So, how am I doing this? This is what I'm doing. First listed. Oops. going to give me the code for it. Then like I told you, how many codes sets are going to be for each scenario? Two. Two. Very good. You're paying attention. Okay. So, you're going to put the secondary. Okay. And of course, you're going to have your rationale. And you're going to have your coding guideline. Okay. And you're going to do the same thing for this one. So I'm just going to copy. Jov paste. Jov paste. And I just go through and just answer the questions. What's the first list of code? What's the secondary? I have a question. Yeah. Um, do you expect this to be an APA? No. Um, okay. So, how you have it is fine. Yeah. The when it comes to the project, this is the only one that is different. You do not need to do an APA format. None of that. Just make sure your name is on it. Okay. In week seven, what's going to different be different with it? Why it's not required in APA format is because you're going to the way you're going to format it is is going to be like a written um job application. You're pretty much writing a cover letter saying I am Kathy. I'm the best I believe I'm the best fit for this job and why. And you're going to go into detail. You're going to break it down. And then at the end of the the um your letter, your cover letter, you're going to tell the employee, hey, here are six scenarios that proves why I'm the best candidate for this position. And then that will be your second and third page. Um so your second page is going to be your week three coding project. And then your third page is going to be your week five coding project. So total you should about have about three pages for your final project that's going to be submitted. So this is why it's important to make sure that you make the corrections to the projects before you submit it to me. All right. So let's quickly uh go through them. Physician senior number one patient is coming in because they have an aic cardia due to a dermaral. What is that telling you? Was what is that telling you in essence? Low heartbe heart rate from an injection or a medicine. Sorry. Low heart rate because of inject because of a medicine. Okay. And what is that called? Say it again. Somebody said it. Allergic reaction. Allergic reaction. Allergic reaction. No, it's not allergic reaction. I think somebody said it. Overdose. Not a It's not an overdose. Underdose. Not an underdose. Adverse effect. Beautiful. It's an adverse effect. So now what you need to do is look for the coding guideline relative to adverse effect. I literally went over it last week in the week in the tutoring session video that we talked about earlier. You need to watch that video. You need to watch it. All right. And so therefore the coding guideline you need to go you need to site the the chapter which is chapter 19. Okay. And the subsections relative to the adverse effect coding guideline. Okay. So is it going to be an adverse effect rule coding guideline that you're going to be looking for. All right. Very good. So the two conditions you're going to be coding for is what? The bradic cardia and the table. You're gonna go to the tables of drug and chemical and look for what? Demoral. Very good. You're gonna go to the tables of drugs and chemical and look for demorall. Very good. Okay. So, that's what you're going to look for. And you're going to look for demoral under what column, Jose? Um, it's under cuz it was administered properly. So, it was uh Yeah, we just said it. We know it's going to be what? Adverse effect. So, we're going to look under the adverse effect column. Correct? Yes, sir. Okay. So, we're going to go to the tables of drug and chemical and we're going to look under the adverse effect column in order to pluck the code for the demoral. Is everybody with me? Yeah. And if you're not with me, you need to watch last week's video on chapter 19. I um actually we went out through it in a previous lesson too uh with the the tables of strong chemicals and the neoplasm table. So you need to make sure you're keeping up with these videos. Um so those are two things that we're going to have. Okay. So you need to read and interpret the guideline and know how to properly sequence. The goal of the week five project, I'm going to tell you right now, is to ensure that you know how to read and interpret the guidelines and appropriately sequence the codes based on what the coding guideline is telling you. That's what you're being tested on for the W5 coding project. That exactly is what you're being tested on to make sure that you know how to read and interpret the guideline and you know how to follow what is being stated in the guideline to appropriately sequence the codes appropriately. Which one is the first first listed and which one is the secondary uh based on what the guideline is telling you. Include the appropriate rationale. Who wants to include a rationale? The rationale is not going to change based on what we did in week three. It's going to be something similar. What's the rationale for this one? Patient had due to a demoral. The patient presented. Go ahead. Patient presented having radiardia due to demoral. due to an adverse effect. Very good. Say it again. Now put it all together now. There you got it. Uh the patient presented having brady cardia due to I'm not sure if it's due to an adverse effect. Yeah, exactly. Due to an adverse effect to demoral. Very good. due to an adverse effect to demoral. Exactly. All right. Hopefully you're writing this down. Okay, our patient senior number one, a patient that has cerosis of the liver just had endoscopy performed showing hemorrhagic esophageal veraces. I literally gave you guys a hint to this one earlier in my lecture series. I think it's probably going to be week two video because I literally show you the answer to this one and walk you through it. Okay. So, the patient is coming in with what condition? Of the liver. Of the liver. Is it cerosis of the liver that brought them into the um into the visit today or was it something else? It was a hemorrhage of the the hemorrhage. Hemorrhagic esophageal verices right is the bleeding as of the esophagus that's what's bringing them in today but the cerosis of the liver will be considered what c word chronic condition very good a chronic condition the cerosis of the liver is a chronic condition so they had an endoscopic performed that show that today they have esophageal veraces and is bleeding. That's what hemorrhagic mean. It's bleeding. So therefore, when looking this up, we would go to the appropriate codes for this by going to the uh verices esophageal and then hemorrhagic. Keep in mind hemorrhagic means bleeding. So therefore, we go make sure that is your code assigning the code for the one with bleeding. Here is the biggest hint for selecting the coding guideline for outpatient. Scenario number one, write this down. Your coding guideline is going to appear in the table. Is going to tell you exactly just like we had the user additional code note. You're going to have a to a note that tells you exactly what to do. And that's your coding guideline. Now your goal is to now go back to section one A of your coding guideline and pluck the section and subsection that goes along with that coding guideline that you see in your table. Okay, that's your goal. So, it's making sure that you have been reading your coding guidelines and making sure that you know how to apply the sections and subsections based on what's written there in your tablet. So, again, I'm going to say it. I'm going to repeat it cuz this is the one that a lot of folks gets wrong get wrong. Your coding guideline for this one, if you code it correctly, it's going to be right there on your tablet underneath that code set that you're coding. Okay? Just remember the goal the the goal here is that when you look at esophageal verices it is actually bleeding hemorrhagic that's what it means is bleeding so it's going to be two coets there and it's going to lead you astray if you don't follow it properly. So the hemorrhagic esophageal versus is going to be what? secondary to the cerosis of the liver. And that's going to be the key is the secondary is secondary to the cerosis of the liver. And there's going to be guidelines. Well, there's going to be notes in your table that tell you that that when you have a patient that has cerosis of the liver and they have this condition going on at the same time, it's going to be a secondary situation. Again telling you in this case that hemorrhagic esophageal verices more than likely is going to be my secondary diagnosis and the cerosis of the liver maybe might be my first code. You need to tell me that and then so I already tell you how to find the guideline for that one. Let's look at our patient ser number two. 55 year old patient had a fracture of the left kneecap 6 months ago. The fracture was healed, but he's coming in today with a staggering gate in which he will be going to physical therapy. So, he hasn't started physical therapy yet. What ICD testing codes are reported? Well, what what brought the patient to the outpatient setting today? Staggering gate. staggering gate and the patient had a fracture of the kneecap 6 months ago. So for those who haven't watched that seven character video yet, this is where you need to watch it because I literally went over this. Okay, this is going to be what type of condition. Who has been attending the tutoring sessions that remember me going over this? ongoing condition. No, it's not an ongoing condition. Remember the A, DD, and the S. Jose, I know you've been attending this. Okay, so which one is going to be? What does the S stand for? Uh, squella. Very, very good. Very good, Jose. Squella. Squella. So, it's going to be a squella condition, meaning what? L word. Meaning that because of that one, it caused more effects to the body. Yes. To the L word. I'm looking for L word. It started with an L. Lingering. No, it's going to be a late. Late. Is it latency? Late. Wait a second. Is it late? L lady effect late effect. It's going to be a late effect. So you're going to look for the coding guidelines that focuses on late effect. That's the one that you're going to be focusing on for this one. Again, you need to watch that video that I talked about earlier that goes over the seven characters. Okay? U make sure you watch that video. Let me let me see. Uh, hold on a second. Let me see if I can grab that video link for you guys and I'm going to put it in the chat to make sure that everybody that's here tonight sees it. Um, hold on one second. Let me get to it. Okay, I just placed it in the chat. The link to the video is in the chat. Okay, so make sure you watch that video. It's important. I can't stress it enough. Okay, so any questions for me? That's pretty much the project. Okay, that's is pretty much the project. So, you got to make sure that you remember there's only two codes required for each case scenario. Period. There's no CPD coding because I always get that somebody's going to try to code send me a CPT code for outpatient scenario number one. No uh no CPD coding is required for for any of these scenarios. Um so, we just do diagnosis coding. All right. So, same as we did in week three, I'm going to more create more work for myself again because I already have majority of you sending me your week three project. Now, I'm going to create more work for myself. Now, I'm going to require you to submit the week five project for me to review by Tuesday before 8:00 p.m. Eastern Standard Time. If you want me to look at it, please do not fail this one. Do not fail this one. Messages it. If you want me to review it, send it to me by next week Tuesday by 8:00 p.m. Eastern time. Folks, do not wait until the 11th hour to send it to me. Don't do that. Don't wait until Tuesday. I'm going to be here in front of my computer most likely the entire weekend because I'm going to be looking at the week three projects for the many of you that need to redo it. So, work on it right away. Do not wait until the 11th hour. Have some pity on me cuz you know I'm going to be doing a lot of work this weekend trying to create all your week four assignments plus reviewing the week three projects for many of you. Then on top of it working through the week five. now case scenarios that you need to submit in week five. So have some pity on me and make sure that I be able to get some rest come next week because I it's going to be a lot. But I'm ready for it. I'm game. I just have to make sure I get some energy drink when I go to the supermarket this weekend um to be able to pull through. Any questions for me? No. No, no questions. We are going to be meeting tomorrow night. We're going to be meeting Thursday night. We're going to be meeting Friday night. I will be sending you at some point in time either tomorrow or late in the afternoon. The case scenarios that we're going to be working on, we're going to be reviewing continue reviewing the coding guidelines in these sessions and doing practical hands-on coding. Show up. That's all I can say. Show up. Do not take it for granted. H I'm tired. I can't do it. No. Make the sacrifice. Show up so you can learn. Okay. Are there any questions for me? Oh Yes. Are you going to be sending those through um email or text message? What's that? The scenarios they would have sent your email. Yes. Yeah. I would send it through. It's not going to send to your school email. I'm going to use I don't know how it come across. I'm going to use this right here, the message tab right here. Um to send it because that's the only way I know how that works faster. So, I'm going to use this. I'll it's just that for examp I some of these messages like I said I they don't show if you try to send me something sometimes I don't see them right away so that's the only thing I have with it but when I send messages through here I find it works um so I can easily attach a word document to it easily and just send a message to you guys um so that's how I'm going to be sending it okay thank you all right now if you have questions for me please stay on uh for those who have issues that rel relative to the project or anything stay on so I can answer them. Um the system automatically takes the attendance. It shows when you log on and it shows when you log off. If you haven't weren't here for the entire 2hour session then you're obviously not going to get credit for the entire 2-hour session. So you need to make sure that um you were here for the entire 2-hour session to get the credit. Um, and so those grades will be entered sometime by the weekend. It's not going to be done right away because I have to actually pull an Excel spreadsheet and it takes time to enter them. So, just give me some grace and allow me time to enter those. Um, and uh, for those who have outstanding projects I haven't graded yet, I will try to finish them tonight or early tomorrow morning at the latest. Other than that, thank you for your undivided attention tonight. Thank you for showing up. Thank you for your participation. And for those who have questions, you can stay on. Everybody else, have a good night. All right. Good night. Good night. Good night. Good night. Good night. Good night, everybody. Good night. Good night.