Overview
Practicode scores a case by comparing your entries to that case's validated answer key. Their score reflects how accurately they coded the medical record.
Depending on the case type, the scored elements can include:
- Diagnosis codes (ICD-10-CM)
- CPT, HCPCS Level II, and E/M codes
- Units
- Modifiers
- PCS (inpatient cases only)
- DRG (inpatient cases but only if the DRG is manually assigned)
Diagnosis pointers are not scored.
Not every item on an answer key counts as a separate, equal point. Required, optional, and alternate codes each follow different rules, and modifiers are scored together with the CPT code they belong to. The sections below explain each one.
Required codes
Required codes are the codes Practicode expects users to identify from the medical record. Each one reported correctly earns credit for that part of the case.
If a case has several required codes, you earn credit for the ones you get right even when others are wrong. One mistake does not zero out the case.
Optional codes
An optional code is acceptable to report but is not needed for full credit. Reporting it correctly does not raise the score, and leaving it off does not lower it.
Optional codes are most often secondary diagnoses or modifiers. Two common examples:
- External cause codes. Under current CPC-A guidelines, these are required for emergency department visits and optional in other settings when the documentation supports them.
- Modifier 51. This modifier is treated as optional rather than "do not code."
Important: An incorrect entry for an optional code can currently lower your score. If you are not confident an optional code applies, leaving it off is the safer choice.
Alternate codes
An alternate code is a different answer Practicode accepts in place of the primary answer key code. Either one earns full credit for that element.
Alternate and optional codes are easy to confuse, but they work differently:
| Code type | What it means | Effect on score |
|---|---|---|
| Primary answer key code | The expected answer | Earns credit |
| Alternate code | Another acceptable answer to the same coding question | Earns credit in place of the primary code |
| Optional code | An extra code you may report | No added credit; an incorrect entry can lower the score |
If your entry matches neither the primary code nor a configured alternate, it is scored as incorrect.
How modifiers are scored
Practicode scores a CPT code and its modifier as two separate elements, but the modifier only earns credit when the CPT code it is attached to is correct.
| CPT code | Modifier | Result |
|---|---|---|
| Correct | Correct | Credit for both the code and the modifier |
| Correct | Incorrect | Credit for the CPT code only (partial credit) |
| Incorrect | Correct | No credit for either |
The last row surprises people. A modifier describes something about a specific procedure. If the procedure code is wrong, the right modifier on the wrong code is not a correct coding assignment, so Practicode does not give credit for it.
Example
A case has three CPT codes, each with a modifier. That makes six scored elements: three codes and three modifiers.
You report all three CPT codes correctly and two of the three modifiers correctly. That is 5 of 6 elements, or 83.3% for that portion of the case.
Now suppose one of those CPT codes had been wrong. Its modifier would earn no credit even if it matched the answer key, because it is attached to the wrong procedure.
Why your score may not match a simple count
If you count the items on the answer key and compare that to your correct entries, the numbers may not line up. That is expected. Optional codes add no points, alternate codes stand in for a primary code rather than adding to it, and modifiers depend on their CPT code.
A case where you got the diagnosis right, the CPT code wrong, and the modifier technically matching is not "two out of three." The modifier earns nothing because its procedure code was wrong.
When an answer key is corrected
If an answer key is updated after you submit a case, Practicode rescores your submission. A correction can raise your score but will never lower it.
Quick reference
- Required: Code it correctly to earn the credit.
- Optional: Reporting it correctly adds nothing, and leaving it off costs nothing. An incorrect entry can lower your score.
- Alternate: Another acceptable answer, used instead of the primary code.
- Modifier: Scored with its CPT code. Correct CPT with the wrong modifier earns partial credit. The right modifier on the wrong CPT earns nothing.
- Diagnosis pointers: Not scored.
- Answer key corrections: Your score can go up, never down.