Coding Guidelines — Portfolio Projects
Build projects that demonstrate you can apply the Official Guidelines for Coding and Reporting (OGCR) — sequencing, conventions, and documentation rules — not just recite them.
Project 1: Excludes1/Excludes2 Conflict-Resolution Set
Level: Beginner | Time: 2 days
Work through 15-20 code-pair scenarios that test Excludes1 ("not coded here" — mutually exclusive) vs. Excludes2 ("not included here" — can be coded together) notes, explaining which applies and why for each pair.
Steps
Skills Demonstrated
Note
Chapter-specific Excludes notes are defined in the current-year ICD-10-CM Tabular List — verify specific code-pair examples against a current ICD-10-CM reference rather than relying on memory or an older source, since chapter content is revised annually.
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Project 2: Principal/First-Listed Diagnosis Sequencing Practice
Level: Intermediate | Time: 3-4 days
Code 10+ encounter scenarios across both inpatient and outpatient settings, correctly selecting and sequencing the principal diagnosis (inpatient) or first-listed diagnosis (outpatient) per OGCR Section II/IV rules.
Steps
Skills Demonstrated
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Project 3: Full Guideline Cross-Reference Portfolio
Level: Advanced | Time: 1 week
A comprehensive project applying general coding guidelines (Section I.B), a chapter-specific guideline set (Section I.C), and POA (present-on-admission) assignment together across a realistic case set.
Steps
Skills Demonstrated
Portfolio Artifact Name
coding-guidelines-portfolio
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Tips for Great Projects
Cite the specific guideline you're applying. "I used Excludes2 here because..." is a much stronger portfolio artifact than a bare code.
Work both inpatient and outpatient scenarios. Several major sequencing rules (uncertain diagnoses especially) differ by setting — showing you know which rule applies where is a real differentiator.
Use a current-year reference, not memory. Guideline content is revised annually; anything you state as a rule should be checked against a current ICD-10-CM Official Guidelines document.
Flag genuinely ambiguous sequencing calls. Real documentation is often unclear about what's "chiefly responsible" — recognizing that and explaining your reasoning is more valuable than forcing a confident-sounding answer.