Monday, August 31, 2009

What Should You be Reading?

The thing I like best – and sometimes least – about coding is that it is a dynamic field. If you want to learn a trade that will stay the same, this isn’t it. But if you love to learn new things all the time and can adjust to the ever changing coding and reimbursement rules and guidelines, you may just find coding to be your passion. Like any trade that is highly technical and subject to change, there are trade publications that you should be reading. And you should start as soon as you’ve made the decision to become a coder – even if you don’t understand everything you’re reading at first.

The Basics
So what should be on your reading list? Let’s start with the basics for the job. Of course you need the latest version of any and all of the codebooks for the health care setting in which you work. For most of us, this list includes ICD-9-CM, CPT, and HCPCS Level II. And yes, you need the current year. While not all of the codes change annually, some of the changes can be significant enough to render the previous year’s codebook useless.

ICD-9-CM codes are effective October 1 of each year and if you don’t have an employer who provides this book for you and you’re responsible for ordering your own, be careful to order the right one. While ICD-9-CM has various publishers (e.g., Ingenix, Channel), the content is the same. However, you can choose the format you like best, for example, some publishers offer color codebooks, others may have illustrations. The format is not important, but if you are working in a hospital, be sure to get all three volumes (I, II, and III). If you are a physician coder, the “professional” edition, or one that contains only volumes I and II, is sufficient since volume III codes are not used in doctors’ offices.

CPT codes are effective each year on January 1 and are published only by the AMA, although you can usually order them through other publishers as well, or even through the AAPC at a discounted rate if you are a member (are you seeing the benefits of joining coding organizations yet?!). HCPCS Level II is another story. While the book is published annually with the calendar year, the Centers for Medicare and Medicaid Services (CMS) adds to the list quarterly and these updates are posted on their website. HCPCS Level II books can also be ordered from any codebook publisher and may be offered in various formats.

Once you have your codebooks on the shelf, you need some clinical references on hand. First off, this means an anatomy book. You also need to know how all those anatomical parts work – or physiology. So you if you haven’t invested in an anatomy and physiology book, this is a wise investment. Other clinical references that come in handy are a pathophysiology book, medical dictionary, and book of acronyms. The pathophysiology (or disease process) book will help you connect the dots while you code. This is what will tell you that hypotension and fever are common symptoms of sepsis. The medical dictionary is a given – I still use one even after taking 2 semesters of medical terminology and coding for nearly 15 years. And the acronym list, well, should be self-explanatory if you’ve ever looked at a medical record (for example: “45 yo WM c/o CP and SOB x24 hrs” = “45-year-old white male complaining of chest pain and shortness of breath for 24 hours”). If you want to go a step further and like to study, invest in a medical terminology book. Medical terminology books are not just medical dictionaries; they will often take the Greek or Latin root of a word and expand from there. Once you know basic Greek and Latin roots, the medical dictionary is not needed as much.

But wait! There’s more!
Remember how I said that coding was dynamic? Well, it’s so dynamic, in fact, that the annual and sometimes quarterly code revisions are sometimes outdated by the time the ink is dry, so you will need to invest in periodicals discussing the latest and greatest in the world of coding. If you joined AHIMA or the AAPC, or both (and I highly recommend you do; see my blog post titled “Getting Involved” for more details) you will start to receive publications from them on a monthly basis. Read them. AHIMA publishes the Journal of the American Health Information Management Association and various other publications including e-newsletters. You can control what you receive and how by managing your profile on AHIMA’s website once you are a member. The AAPC publishes Coding Edge and it’s nothing but coding information from cover to cover. They also send out e-newsletters on a regular basis. Looking for more? Another industry standard is Advance for Health Information Management, a **free** publication that includes a regular column titled “CCS Prep,” which discusses scenarios to prep coders for the AHIMA examination. Did I mention it’s free?! And there are job postings in the back of the publication. That means there are no excuses not to be reading it. Another good magazine is For the Record, which is free for AAPC members and people residing in certain states.

Want to know more about coding as it relates to reimbursement? To delve into the world of MS-DRGs, APCs, fee schedules, and prospective payment systems, visit CMS’ website and start browsing the listings. You can also sign up for listservs to receive updates. Be careful, though, and don’t sign up for everything. Do you have any idea how much CMS is working on at any given moment? You don’t want to overwhelm yourself! If you are a newbie, try out Medicare’s Learning Network. If you want to know where all those government billing guidelines are written, try out the manuals section.

If you are a beginner coder or CMS’ website is too intimidating for you (and don’t feel bad if it is– some days it still freaks me out a little and I use it nearly every day!), I recommend getting on the mailing lists of some of those consulting companies who offer free e-newsletters. Sometimes they will explain the coding and reimbursement for a topic in a way that is way less confusing than government speak! HCPro offers a laundry list of e-newsletters – some are free and some are not. Integrated Revenue Management, Inc. offers a free monthly e-newsletter called “Net Revenue Matters” that has general information about health care revenue cycle updates, but usually has at least one coding article.

And finally, never underestimate the power of Google! While it is true there is a lot of junk on the internet and you need to be careful where you get official coding and reimbursement advice, Google can sometimes get you to a website that will get you to another website that will get you an answer. If you are searching for clinical information, Health Finder is a search engine developed by the US government and all of the sites listed have been verified as legitimate. Emedicine has some great articles authored by physicians that can help with learning about particular diseases and procedures.

From "Born Yesterday" to Seasoned Professional
So get ready to read up and don’t feel discouraged if it sounds like Greek at first. My mother always told me that knowledge isn’t what you know, it’s whether or not you know where to find the answer and the resources listed here should get you started on finding answers. If you need to look up or google every other word or phrase, don’t fret. I’ve been there. Have you ever seen the movie “Born Yesterday” (originally made in 1950 starring Judy Holliday and William Holden and then remade in 1993 starring Melanie Griffith and Don Johnson)? In the movie, Billie (played first by Holliday and then by Griffith) is learning to read difficult books and always has a dictionary next to her. There are days when coding feels like this, but then by the end of the day you feel maybe just a little bit smarter!

Reference Links:
Advance for HIM
For the Record
Integrated Revenue Management, Inc.
Health Finder