Friday, July 31, 2009

Do You Want to Be a Coder?

A few months ago I held a forum for wanna-be coders and much of my presentation was devoted to hospital versus physician coding. By the time I was done, I had several people asking me how to choose between the two. This is an excellent question and one that you need to decide right off because how you proceed with joining organizations and networking will be impacted. First off, not everyone has the skill it takes to be a coder. I have, unfortunately, met and attempted to train a lot of people who just “don’t get it.” Coding requires a great deal of attention to detail that can be tedious to a lot of people. It’s also detective work – once you have all the details, then you need to be able to assemble them and make sense of them. And because these details come from medical record documentation, coders must understand medical terminology, anatomy and physiology, and disease process.

What Makes a Good Coder?

The first question to ask yourself is, do I meet the following criteria?

· Strong medical terminology, anatomy and physiology, and disease process knowledge,

· Ability to piece together clues logically,

· Strong attention to detail,

· Ability to work a full day in front of the computer without a lot of peer interaction,

· Common sense,

· Ability to research and seek out answers to questions,

· And good written and verbal communication skills for those times when you get to escape from your desk.

If you answered yes to most or all of these questions, then you are on your way. If you answered no to most of these, then you should reevaluate becoming a coder. Some things, of course, can be taught, such as medical terminology, anatomy and physiology, and disease process. Other things, like the strong attention to detail cannot be taught.

Hospital vs. Physician

Once you’ve determined that you want to be a coder, you need to decide which healthcare setting best suits you. There are coders for every healthcare setting, but the two major ones are hospital and physician. If you’ve never coded before, you may be wondering what the difference is. After all, there are only a few codebooks (ICD-9-CM, CPT, and HCPCS), so all you have to know is which book to look in right? Wrong.

Besides the coding systems, there are other differences. In a hospital, you are coding for the hospital resources, which include hospital overhead, staffing, supplies, medications, and anything else you can think of that a hospital provides to a patient that costs money. And remember: in most situations, doctors are affiliated with hospitals, not employed by them. On the physician coding side, you are coding for the physician’s time and effort as well as his office overhead. If the physician owns a surgery suite or otherwise utilizes supplies and medications, he may also bill for these items. He cannot, however, code or bill for items that were supplied by a hospital or surgical center where he performed a procedure. What it comes down to is, whoever paid for the item can code for it – this is where common sense comes in!

You may hear experienced coders and billers talk about professional versus technical coding. Professional services are those provided by the physician. So coders working for physicians are always billing the professional component. Technical services are those provided by hospitals or other facilities (e.g., ambulatory surgery centers, rehabilitation hospitals). There are some instances, however, in which a provider (hospital or physician) may bill for both the technical and professional component. For example, there are some physicians who are employed by hospitals. In these instances, the hospital can bill for both the technical and professional components and the physician is paid a salary by the hospital. Another example is of a physician who owns his own surgery center.

Another difference between hospital and physician coding is the information that is coded. In a hospital, the patient’s record is evaluated for the entire visit and all documentation is reviewed including physician reports and progress notes, orders, therapy records, operative reports, labs, and x-rays. In the physician coding setting, the coder is looking only at a particular physician and coding his part in the patient’s case. For example, although a patient may have been in ABC Hospital from June 4-10, if Dr. Smith saw the patient in consultation only on June 5, his coder can only code from his June 5 consultation notes.

The size of the practice or hospital also makes a difference. In physician offices, the coder is also the biller and, as such, must become very familiar with insurance billing regulations. Physician coders are generally also the ones to process and correct insurance denials.

In a hospital, coders are usually part of the health information management (HIM) department where they have easy access to the medical records. In addition to HIM coders there is a computerized system for assigning certain codes on outpatient cases automatically when charges are entered into the hospital’s computer system. These codes are linked to charges using a database that contains all of the hospital’s charges for every department. This enormous database is called the charge description master (CDM), or simply charge master, and codes assigned using the CDM are said to be hard coded. In contrast, the codes that are manually assigned by HIM coders are said to be soft coded. Hard and soft codes come together on the patient bill in the billing department, which is generally separate from coding. If there are any problems with the codes, the billers will send them back to the coders for correction. Once billed, the billers process the denials. So in the hospital, HIM coders are less likely to be familiar with the various insurance billing guidelines.

Finally, coding rules themselves can be different depending on the healthcare setting. One example is the application of the Official Guidelines for Coding and Reporting, which states that the first-listed (principal) diagnosis for a hospital inpatient is the reason established, after study, found to be responsible for occasioning the admission of the patient to the hospital. For physicians, though, the first-listed diagnosis is the reason for which he saw the patient for that episode. Another difference in coding guidelines is for the assignment of evaluation and management (E/M) codes. E/M codes were developed to report physician time and effort in examining a patient and determining the plan of care. Hospitals use E/M codes for outpatient cases, but have adapted the definition to be able to report hospital costs associated with patient care that are not separately reported with a procedure code.

What Type of Coding Setting Suits You?

So you need to determine the type of coding that best suits you. Do you want to work in a small office where you have control over the entire coding and billing process? Maybe physician coding is for you. Would you like work as part of a revenue cycle team and be able to view the patient’s visit episode as a whole rather than just one piece of it? Then maybe hospital coding is right for you. I can’t say which one is better, because I’ve found that people are inherently one or the other. I liken it to being either a cat person or a dog person – neither is wrong or right, it’s just what fits the individual. Can you be both? I think you can be both a hospital and physician coder, but I have yet to meet anyone who is really proficient at all areas of hospital and physician coding – there is so much out there! But that’s part of what I really like about coding… endless opportunities to learn.

Live in Colorado and want to know more? I will be soon announcing an August date for networking. We will meet in “pod forums” with three facilitators demonstrating how to code for physicians, hospital outpatient, and hospital inpatient. This is a great opportunity to see which setting is for you and network with the pros. This event will be FREE so stay tuned…

Thursday, July 23, 2009

Tribute to a Mentor

I’ve been meaning to start a blog for novice coders and wanna-be coders for quite some time, but that initial blog topic has been elusive – at least until this week when I received the sad news that Deane Poore, RHIT, one of my coding mentors, recently passed away. And as I congregated with former coworkers to pay respects to our esteemed colleague, I found myself reminiscing about my career beginnings and all the people who had a hand in my development as a coding professional. There was my mother, Nancy Stanton, RHIT, who encouraged me to get an associate’s degree in health information management (HIM); there was Lila Mayer, RHIA, who gave me a chance as an outpatient coder after graduation even though I had no experience except for the limited coding I did under her supervision as an intern; Layne Poseley, RHIA, who checked all of my work for the first year of my employment and answered countless “why’s” and “how’s”; and there was Deane, a former teacher turned coder, whom Lila brought out of retirement to teach me inpatient coding. And those are just a few of the people who got me on the right track within my first few years in the industry. From there, I have been unknowingly passed from one mentor to another, never truly realizing that the time they spent with me was one of the greatest gifts I could ever receive.

Now, after working in the HIM and coding field for almost 15 years, I have come to appreciate the fact that the way I was trained in my first coding position is not the norm. Most hospitals do not have the time or resources to take a novice and groom him or her into a quality coder. Since I started coding in 1995, the world of hospital coding has seen a complete facelift with the introduction of a new and overhaul of an existing code-based reimbursement methodology, increased coding regulation, and more focus on coding compliance. There is also the added challenge of learning to use electronic medical records (EMRs) and ensure that HIPAA guidelines are being followed. Changes to the coding industry are happening at such a rapid rate these days that employers are finding it more and more difficult to train and mentor new coders.

Nationwide Coder Shortage

The problem is the industry needs more coders. There is a nationwide coding shortage and industry experts expect this demand to increase as the nation marches toward the October 1, 2013 deadline to implement ICD-10-CM/ICD-10-PCS. To existing coders, implementation of the new system is the equivalent of telling everyone in America that starting in 2013, we will no longer speak English and that Chinese will be the new language. Many current coders are threatening to retire or change careers rather than learn the new system. That means it is the prime time for new coders to enter the field and for once, the playing field will be level – new and experienced coders alike will need to learn the new coding system.

So now is a great time to become a coder, but what do you need to know? Which healthcare setting is the right one for you (doctor’s office, hospital, rehabilitation, etc.)? Which certifications are most widely recognized? Do you have to join an association to get a job? How much money will you make? Can you work from home? These are all questions I hear from wanna-be coders on a regular basis and I would like to help answer some of them and maybe point you in the right direction.

If you have specific questions about becoming a coder, let me know and be sure to check out my Coder Coach Facebook page for updates about upcoming networking and mentoring sessions: