Indexing Codes—It’s Just Like Matching Socks!

I have a large laundry basket full of socks. They are clean, but for some reason I just can’t muster the motivation to sit down and put them in pairs. I really should just go ahead and do it and keep myself from having to pick out matching black socks in the dark every morning. It’s like a ritual now—sitting on the floor, sorting through everybody’s socks, using my phone flashlight every once in a while until I find a match. It really reminds me of indexing codes sometimes…

Indexing is a foundational part of medical coding. It sets the stage for correct code assignment. But being foundational does not mean it doesn’t present a significant challenge (double negative, I know). Finding a pair of black socks in the dark means you have to sort through many different socks before you find the right one (or two). This is the same with indexing. The great news is, unlike the sock scavenger hunt, you get better at indexing every time you do it!

“I’m just having such a hard time knowing which terms to look up in the index!” This is a common complaint from students digging through the coding curriculum. The truth is, as an instructor I don’t always look up the correct term the first time either. This skill is one of those “practice makes perfect” things and looking up alternatives after coming up empty on your first try is excellent practice!

If you are feeling frustrated with this part of the process, here are some basic tips for indexing diagnosis codes:

  • Let the documentation guide you. Use the name of the condition documented by the physician as your main search term.
  • Don’t give up if you don’t find your first search option—move on to your next alternative term.
  • If you can’t find an appropriate code by searching the exact terms from the documentation, you can search under synonymous or equivalent terms. You need to be sure that the terms are truly synonymous and equally supported by the documentation; Bleeding = Hemorrhage.
  • Consider the context. Is the patient visiting the physician for any reason other than to be evaluated? Sometimes terms like admission, screening, examination, supervision, pregnancy, and therapy can be “catch-all” type categories (that is not an exhaustive list).
  • Use conventions and instructional notes (do quick review if necessary)! If the term you index has a “see also” instructional note, always check the index under both the term where you found the instructional note and under the additional term to which you are directed. This will ensure that you have the pertinent information for all of the possible correct options. You can then compare the information under both terms in conjunction with the corresponding information in the Tabular List to make the most appropriate code assignment.
  • When coding in CPT be sure to consult all of the codes in a code range provided by the index before making final code assignment.
  • Understand levels of indentation and review all the terms immediately indented under your main term in the index to increase specificity in your final code.
  • DO NOT code directly from the index—ALWAYS refer to the tabular list to make your final code assignment.

Indexing can be frustrating at first. Students often reach a level where they feel like they finally understand the documentation but struggle when they go to index the correct codes. This is just like me—I know there are plenty of black socks in the basket, finding a matching pair in the dark is the true test. I, however, will not be able to increase my sock finding abilities, whereas you get to build your indexing skills every time you crack open the book!

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