# Vascular Families, Appendix L



## stnastasi (Dec 5, 2010)

I'm scheduled to take my second chance at the CPC exam next Sat. 12/11. I hope someone has examples or could tell me a better understanding when to use Appendix L in the CPT.  Is it used with selective placement of catheters? Could that be a rule of thumb?
Thanks for any help, 
Sue
CTcoastMetro@gmail.com


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## btadlock1 (Dec 5, 2010)

*CPC Exam tips*

Appendix L will help with cardiac codes of any sort - If you see terminology you're not 100% familiar with, it will help you get a better picture of what's going on. Also, some answers will require you to know whether they're talking about the right side of the body or the left, and the maps and illustrations throughout the book come in really handy there. 
-I'd tab the one with the body planes (for radiology questions), tab the modifier appendix, and tab anything that will help with cardiac codes, and make sure to write down any medical terminology that you even* kind of *think you might be unsure of later (Go through the whole glossary in the training book). 
-Some of the most helpful definitions were the prefixes for colors (cyano-blue, jaun-yellow, erythro-red - I can't remember them all, but there's a LOT - look online to find as many as you can), and the suffixes, ostomy(create an opening), otomy(surgical incision), and ectomy(surgically remove).

-The section on medical terminology is pretty small, but you really need to know it pretty well throughout the test. The other thing I'd note is a list of common abbreviations for medical conditions. There's one printed inside the back cover of the CPT book, but it's missing a few.

Taking the test itself can be kind of intimidating because of the time factor - the way I dealt with it was to bring a highlighter and some of those tine post-it note flags. 
*I'd go through the entire test, and glance at the answers to see what kind of question it was. If it looked like something I could answer relatively quickly (because it was on a subject I was comfortable with, or the answers were short), I'd go ahead and read the question, and answer it if I could. 
*If it turned out to be harder than it looked, I'd skip it - I circled the number of every question I skipped, and flagged the page. And I'd fill in the answer sheet for the ones I could answer. 
*Once I got through the whole test that way, I went back to the beginning and started over, but this time, reading every question. I'd put the ones that took more thought aside until the very end (I came back to them several times).

*You can usually eliminate 2 answers on most questions pretty easily, based on modifiers, and codes that can't be billed together. My strategy to quickly find the right one was to mark out all of the things that were similar in the anwers, and focus on what made them different. It usually comes down to one or two codes, or a diagnosis. 
*Look both options up, and highlight the important words (and, or, includes, excludes, with, numbers mentioned, and approaches for surgical procedures, "code first", "see also", etc.). If there are parenthetical notes, highlight those, too. Those details will give you the answer. 

One last thing - become very familiar with critical care codes - read the guidelines before the test and make notes by the codes mentioned. Also, highlight what services are bundled, and which are separately reportable. I remember seeing a lot of questions about that. (Especially with neonates - know the different age groups). 

I know that was WAY more than you were asking for, but I remember how much it helped. The only other piece of advice I've got to offer - TAKE THE PRACTICE TESTS if you haven't already, and make sure you fully understand the rationale on the questions you miss. A huge portion of the test consists of questions that are on the practice test (some word for word, the rest are extremely similar). Good luck!

(PS: I'm not trying to be boastful, but I made an A the first time I took it - I give all of the credit to the hints I just told you...)


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## stnastasi (Dec 5, 2010)

*CPC Exam, Vascular Famililes*

Brandi, 
Thanks so much, really.  Any tips, which direction I should take is definitely appreciated.  I seem to be progressing the more I concentrate on the practice tests.  Studying guidelines, terminology, all is great but challenging with questions & being aware of time has been  good too.  The critical care part ----- I have to delve into that yet.  
Thanks again, 
Sue


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## btadlock1 (Dec 5, 2010)

Not a problem! Time won't seem so bad if you answer all of the easy ones first. If you do take my advice, wait until you've gotten through the whole test the first time before looking at the clock. You;ll have a lot more time for the hard questions than you'd expect, and you won't feel as rushed. On the practice exams, don't try to race the clock. Make sure you really understand why every answer is right. If you really know the material, you won't have to practice answering them quickly.


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## jticbs (Dec 5, 2010)

Hello Brandi,

My name is Johnathan Tran. I passed the test first time too even thought not an A like you but I can related to some of the tips you mentioned. I think it's more about the strategy, techniques of taking the test. But now it's so hard to find a job as a coder, even with any entry level. It seems like there is no door open for new coder. I just hope that with the ICD-10 become effective in 2013, there is opportunity for new coders to step in. I am trying to learn it as soon as I can. Do you have any tips on this? Thanks. You can also email me at jt.icbs@gmail.com. Have a good day

Johnathan, CPC-A


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## rhondatalley (Dec 6, 2010)

Sue,

The main thing to remember about coding catheter placement is to use the code that describes the furthest point that the catheter reached.  For instance, if the initial punch was made into the left femoral artery and the catheter was advanced to the right superficial anterior tibial artery, then the code would be a 36247 (third order).  If the catheter was then pulled back and then placed into the posterior tibial artery, a 36248 would be added for the second third order cath placement.  Just remember that you cannot code for any area that you had to pass through to get to the final destination.  So in the instance above, you could not code for the iliac (even if you treated there) because you had to pass through there to get to the tibial.  I would utilize a vascular anatomy chart to study so you can follow the cath through the vascular family and see what the various orders are.

Good luck on your exam.

Rhonda Talley, CPC


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## btadlock1 (Dec 6, 2010)

jticbs said:


> Hello Brandi,
> 
> My name is Johnathan Tran. I passed the test first time too even thought not an A like you but I can related to some of the tips you mentioned. I think it's more about the strategy, techniques of taking the test. But now it's so hard to find a job as a coder, even with any entry level. It seems like there is no door open for new coder. I just hope that with the ICD-10 become effective in 2013, there is opportunity for new coders to step in. I am trying to learn it as soon as I can. Do you have any tips on this? Thanks. You can also email me at jt.icbs@gmail.com. Have a good day
> 
> Johnathan, CPC-A



I agree - good test taking techniques are a HUGE advantage, since they help you to utilize your time more efficiently, and focus more on the exam material than the clock. But really being comfortable with your understanding of the material will help you more than anything else by far. 

I'm not a coder by trade - never have been, actually. I started out in the business office as a commercial insurance follow-up rep. Instead of coding every visit, my job was to essentially troubleshoot claim denials (among other things). I'd analyze other people's coding for mistakes, or to find grounds for appeals, so having a solid understanding of correct coding made the job easier, and for me, more rewarding. I like to win debates, and I like to solve problems, so finding ways to use knowledge to successfully appeal all sorts of denials has been a fun challenge for me. And, as a bonus, I get experience in an assortment of specialties all at once, due to the array of providers that we manage, which is a good foot-in-the-door for a coding job later on. It's not for everyone, but it doesn't hurt to give it a shot and build your reputation with useful experience. Most hospitals and large physician groups have similar departments, and you're likely to get paid more than other new hires (and more likely to be considered for the job in the first place), by being certified. Once you prove yourself as a valuable employee, getting a coding job within the organization becomes a LOT easier. 

Don't limit yourself to applying for one certain position, even if that's all you really want to do. If you couldn't get your front door open to get into your house, you'd try to find another way in. And you'd make it into the house a lot faster that way than if you had just kept trying to open that one door. 

I, too, am hunting for good ICD-10 resources. I've subscribed to email updates from CMS and search the web for any articles I can find on it. I really want to get my hands on an actual book (CMS says there are already editions available), because I'm a visual learner, and seeing the structure and guidelines first hand would be far more useful than reading about it. If you hear of any good ideas, let me know!


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