Wednesday, December 29, 2010

New Year, New Attitude

I know many of you out there are looking for jobs. And I know that many of you are also suffering from a lot of rejection. And although I'm not much for New Year's resolutions - because let's face it, they don't usually last more than 30 days - I am a fan of new beginnings and the new year is a great time for new beginnings. Spoiler alert: I'm about to get out the pom-pons and get really Pollyanna!

First a little diversion - I love Christmas and everything about it. My house is decked out in full Christmas regalia while I'm still digesting Thanksgiving dinner and no room in my house is safe from a little holiday glitz. That said, after the new year, I love packing it all away and getting everything clean and organized and new. Of course, I am a coder, so organizing things is right on the top of my list of favorite things to do. And I encourage you to do the same - except organize your job search efforts instead.

It's time for a new perspective. The definition of insanity, according to our favorite physicist, Albert Einstein, is to try the same thing over and over and expect different results. What have you been doing that just isn't working? And how can you change your approach? If you didn't attend any networking events in 2010, start looking at calendars and planning for 2011. I know this may cost some money to attend events, but it's an investment in your future employment. I can't tell you how many people are offered jobs simply through networking. What job sites are you using to look for positions? Are you reading the trade magazines? Should you expand your search to other geographic locations? Take a look at your resume too - what can you do make your resume pop more?

Finally, check your attitude. I know this is probably the hardest thing of all because we are who we are and changing your attitude about the job hunting process is hard. But if you've been burned in 2010, now is the time to leave that negativity behind and focus on a positive new year. Put it out in the universe that this is the year you will land your anchor job, that is the job that will anchor you in the profession and lead to your dream job. Put post-its on your bathroom mirror or whatever else you need to do to keep yourself motivated and feeling positive. Spend time with positive people in the profession. And always remember that a job rejection is not a reflection on you or your skills - it's a tough competitive job market. So pick yourself up, dust yourself off, and start all over again!

It's a new year, a new you, and before you know it, a new career!

Tuesday, December 21, 2010

Recovering Encoderaholic

Most coding students spend semesters learning to navigate ICD-9-CM and CPT code books and maybe a little class time plus internship experience learning how to code using an encoder. And then they graduate and, if they move on to a position at a hospital, they start using an encoder almost exclusively. In fact, many hospitals don't purchase code books for their coders because they pump so much money into encoders. The result can be coders who forget how to use their code books all together.

In case you aren't familiar, encoders are software programs that automate the code book. This makes coding faster for the coder and also allows for inclusion of coding and billing edits and coding guidelines and advice. Not to mention, it helps us remember to put fifth digits on all those diagnosis codes! There are two types of encoders: logic-based and book-based. Logic-based encoders are probably the most popular. They ask the coder a series of questions that ultimately lead to code assignment. Book-based encoders are computerized code books in which the coder looks up codes just like in a hard copy book with a few enhancements. Both types tend to include crosswalks from ICD-9-CM to CPT and vice versa.

Sounds great, right? What could possible go wrong?

Well, a lot, actually. And I speak from experience as a recovering encoderaholic.

Don't get me wrong, I like encoders - love them, actually - and can't do my job efficiently or completely without them. But even when I have my encoder up and running, my code books are at my finger tips. And when I teach, I prefer to teach from the book. This was a hard won lesson for me. I remember a coding auditor coming to audit my coworkers and me and, in her exit interview, she made an example of me. She asked me how I came up with a CPT code and my response was "the encoder took me there" and she asked me where my CPT book was and I pointed to the enclosed bin over my desk. And she read me the riot act for not having my CPT book on my desk - and I was coding day surgeries. She then told me what I tell the coders I audit now - "the encoder took me there" is not a valid excuse.

If you're wondering why you have to spend so much time becoming familiar with using the code book, it's because it's the fundamental of coding. If your elementary learning experience was like mine, you had to learn how to do long division before using a calculator and you had to learn to tell time on a clock face before you got a digital watch. Learning to use the code book is important because you need to know the logic behind the encoding programs in order to "check your work" - to steal a phrase from math class! How will you know the encoder led you wrong if you don't know the logic?

If that's not a good enough reason for you, then chew on this. Many people are not passing coding certification exams these days and it's not because they don't know how to code. Many of them have been coding for years - with encoders. And since they have to use books on the test and they aren't efficient in looking up codes in the book, they are unable to finish the test.
You may be asking if encoders will replace the need for coders and many industry experts agree that while there is some limited application to computer-assisted coding (e.g., radiology), the skill of reading a medical record and translating it into code is a subjective skill that requires a human. So don't worry about there being no future in coding due to computerization; just worry about how you will use coding software to enhance, not replace, your coding knowledge.

Sunday, December 5, 2010

There's No Future in Coding... or is There?

When I graduated from college 15 years ago, there was a big local trend in my area to train RHITs to become utilization review (UR) case managers. In case you haven't heard of UR, they are typically nurses who review medical record documentation against criteria from insurance companies to help the doctors know when it would be best to discharge patients and they help arrange post-hospitalization care if needed. There was a local company created by an RHIT who received her first post-grad job from none other than my mom (also an RHIT) and she promised me an interview when I graduated. See? Networking is important!

Once I graduated, I called in the favor and met with her HR recruiter. The only problem was, I had just finished doing a lot of coding at an internship and I had fallen in love with it. Believe it or not, at that time there were no open coding positions. I used to joke that the only way I would get hired as a coder is if someone moved out of state or retired! So I took the interview at the UR company and it sounded okay. It sounded like something I could do and they were willing to train. They were even willing to give me raise once I passed my RHIT exam.

And then I got the call from my internship supervisor. She was excited to tell me that they had just run the numbers and decided they needed another outpatient coder. She really wanted to hire me as an inpatient coder, but this is what she could offer me to get my foot in the door. It was more money than the starting position at the UR company, but less than I would make at the UR company once I passed my RHIT. But I didn't care about the money, I wanted to code. So I took the coding job and graciously declined the UR position. And I was told by the HR recruiter at the UR company that there was no future in coding - the future was UR.

I'm sure there are still some RHITs out there doing UR, but within a few years of beginning my coding career, the coding industry exploded. We had OIG investigations and new code-based payment systems and a seemingly endless list of things to keep the job new and fresh. Now I look back on that time 15 years ago when I wondered if I was making a mistake because I followed my gut rather than looking at trends. And then I look forward at the challenges we're facing in the future of coding and can say with a resounding "hooray!" - I think I made the right decision!

Is the Future EHRs?
These days I'm starting to hear it again - "Go into electronic health records (EHRs), there's no future in coding." What?! That's absurd! I'm not here to tell you there is no future in EHRs, but don't let anyone tell you there's no future in coding either. The health information management (HIM) field has historically been divided into operations, i.e., managing patient health information, and coding.

These days the most innovative thing to hit operations is the EHR. More hospitals are moving toward EHRs that will allow for better accessibility to patient health information for continuity of care. There are programs popping up everywhere to close the education gap between HIM and information systems and the term "health informatics" is the new buzz term for the early part of the 21st century.

I have a lot of colleagues who are are firmly embedded in EHR implementations. As a matter of fact, my company is an EHR implementation company. But most of us currently working in the field know that while there is an absolute future in EHRs for any HIM professional, coding is not and never will be a dead-end career. And if you can understand how coding relates to EHRs and vice versa, you can be very marketable.

When I received my RHIT, I assumed I would go into management like my mom. She was an RHIT who had been everything from a coder in her early career to director of HIM and quality for a small psych hospital. RHITs are not typically managers, though, they are usually more ingrained in technical work. The associates program for HIM that precedes the RHIT certification exam is loaded with classes on the technical aspects of managing patient information - including coding - with a few management classes thrown in. The bachelors program that prepares one to sit for the RHIA exam is less technical and more management.

What we tell folks is, if they want to manage an HIM program, become an RHIA. If you want to be a technical worker, like a coder or cancer registrar, become an RHIT. But this isn't a hard and fast rule. I recently talked to an RHIA student who really thinks she wants to be a coder, but her fellow students are telling her there is no future in coding, the future is in managing EHR implementations. She really wants to pursue coding, though.

Follow Your Bliss
I'm not really one for corny sayings like "follow your bliss" but this is your career we're talking about. No matter what your educational background - RHIT or RHIA - if you're trying to decide between coding and EHRs, don't let anyone else influence your decision. Even if you're an RHIA who wants to be a coder or an RHIT who aspires to manage some day (it can and has been done!), go after what you want.

And don't let anyone tell you there is no future in coding or EHRs. All I see for the future of HIM is opportunity in every direction I look.

Monday, November 29, 2010

Not Sure What to do? Do Something.

I know, I know. It's been a long time since I've blogged - I once again defer to my blog entitled "It's Coding Season" for my excuse! Like many I am back at work today after a long weekend - the kind of weekend that makes you forget about reality and work and you're embedded in a euphoric state of holidaydom with family and friends. But this morning it was back to the dreaded reality that I really have a lot to do. Darn it.

Like many Monday mornings, I grabbed a cup of coffee and padded into the office where stacks of virtual work awaited me. I was instantly grateful that I took the time last week before the holiday to clean off my desk and get the real stacks of paper off my credenza. But that ended once the computer was on, email was open, and my to do list was blaring at me. And so I sat here at my desk for a bit, not really knowing where to start, all the while knowing I needed to do something - no matter how seemingly small - to whittle down that to do list and make it more manageable.

By mid morning, I was starting to feel like I was accomplishing something. It reminded me of some of the students and novice coders I talk to who are so overwhelmed by prospects and job requirements that they're paralyzed by the fear of starting a new job. So if you're not sure what to do, here's my advice - do something. Eventually you will stumble onto something valuable that will help you get your foot in the door.

Does this sound familiar? The job description has a list of job requirements that you know you can do if given the chance, but you don't have experience. They call for coding experience, and you only have classroom hours. In addition to all the things you've trained for in school and basic office duties, they also want you to be a phlebotomist or rocket scientist. My point is, they probably aren't going to find a rocket scientist who can code and fix the copier, so stop focusing on what you can't bring to the table, and let them know what you can do. Are they looking for a team player? Are they looking for someone with project management skills? If your background and education (not just coding) brings additional skills to the table that they're looking for, this is the time to flaunt them. And be sure to let them know how passionate you are about learning coding too. With perseverance and hard work, by mid-morning, you might feel like you've accomplished something.

Wednesday, October 20, 2010

Coding From Home

Wow, I've been busy - see "It's Coding Season" for details!

Maybe this link will tide you over until I can come back up for air. This is a link to my HI Careers blog about the realities of coding from home.

"FAQ: Can I work from home as a coder?"

Catch you later,

Thursday, October 7, 2010

What Maslow's Hierarchy of Basic Needs has to do With Coding

By high school, we all had learned about Maslow’s hierarchy of needs, which states that if basic human needs are met, people are motivated to achieve more. And if those needs aren’t met, people can’t be expected to aim higher. I’m paraphrasing, of course, but lately I’ve witnessed a trend that seems to be upholding Maslow’s theory. The base of the Maslow hierarchy is the physiologic needs we all require to sustain life with safety following close behind. And when these two base needs are threatened, people don’t have the confidence they need to move into the self-actualization phase.

In case you need a refresher, here is Maslow’s hierarchy starting with the most basic needs:

· Physiological – breathing, food, water, sleep, homeostasis, excretion

· Safety – security of body, employment, resources, morality, family, health, and property

· Love/Belonging – friendship, family, intimacy

· Esteem – self-esteem, confidence, respect of others, respect by others

· Self-actualization – morality, creativity, problem solving, lack of prejudice, acceptance of facts

I think the best demonstration of Maslow’s needs is observing human reaction to environmental chaos – such as Hurricane Katrina. You witness people fighting for food and water and anything else they need in order to survive. It is, in my opinion, why we need the mobilization of external resources – people whose general well-being isn’t in jeopardy – to come to the rescue. Because when your basic needs are threatened, you aren’t really thinking about how to help other people.

Basic Needs and a Coding/HIM Career

By now, you may be wondering what this has to do with a career in coding. Well, although not as drastic as Katrina, the current economic environment has taken its toll on many. People have lost jobs and that has led to losing homes. People are seeking new professions and going back to school as they’ve seen their old jobs either dissolve or be outsourced to another country. And to come into a field, like coding or health information management (HIM), which has a need for workers only to find it hard to get a start, how are those people supposed to achieve the top level of self-actualization?

I’ve read message boards on coding and HIM career websites and talked to countless novices who are trying land their first job – some who are scared for their basic needs. I’ve talked to managers and debated the issue of hiring new grads. And although I’ve been accused of being a hopeless Pollyanna, I really do get it – times are tough and employers don’t always want to take a risk on a new student. From the novice perspective, it’s very difficult to understand how an industry with a need for trained workers isn’t more welcoming. From the employers’ perspective, everything we do in HIM and coding is surrounded by risk – whether related to submitting claims for reimbursement or releasing protected health information. Employers have been hit by the recession, even in health care, so they will cut dollars where they can in order to cut down on layoffs. One of the first things to go is education and training programs. The good news is there will be increased demands for HIM and coders over the next few years. The hard part is getting started.

That said – and here comes the hopeless Pollyanna part – you must be persistent. If this is what you really want to do, you will find a way to get the experience you need for the dream job you covet. I’ve blogged about it before, but it bears repeating: start networking. Who you know is so very important.

Ready to go Viral?

While you’re working hard and networking to get the recognition you deserve, here is something not to do. Don’t spill your feelings in an online forum. I see it all the time. People are frustrated and they want to lash out and vent, but an online forum isn’t the right place. You may be sitting alone in your home typing your feelings, but once you submit it online, it’s there for the world to read.

And the world includes potential employers.

And they read these sites.

And they don’t hire hot heads they think might be HR risks.

Plus, you never know when your post will go “viral.” Seemingly innocent communications can turn controversial quickly. This morning’s news was about a college student who wrote a thesis-style paper with graphs accounting her romantic encounters with other college students. And she named names. She only emailed it to three friends, but it didn’t take long for everyone on campus to see it and now that the story ran on national television, more people will read it. Do you want that kind of exposure?

Don’t get me wrong, though, I’m all for venting. Find someone you trust to spill your guts to or vent your frustrations in a private journal. I once knew someone who was under immense pressure and had to maintain a pleasant demeanor in public at all times. She coped by purchasing some juice glasses with happy faces on them and driving to a remote area with a cliff. She would scream and throw the glasses over the cliff and listen to them smash. I have the benefit of being a second generation HIM professional. Even though my mother is retired, she’s one of the best sounding boards for me in venting my professional frustrations because she understands the field.

Matchmaking for the Professional

I recently read a novel in which the heroine ran an executive recruitment company. She had a romanticized vision of her job. She saw it as a matchmaking business – except instead of matching two soul mates, it’s about matching the person to the right employer. Her colleagues thought she was shallow and nuts. I thought she was brilliant. If you think about it, interviewing is like dating, albeit a lot less personal. And the same traits that make a person a miserable dater make them a miserable interviewee. You want to come across as confident (not desperate), intelligent (but not cocky), and knowledgeable about who you are, what strengths you can bring to the relationship, and where you want to be in the future. At the same time, you don’t want to tell them everything about your history in the first meeting.

So do what you need to do to maintain your basic needs so you can find your employment soul mate – or at least the employment version of Mr./Miss-You’ll-Do-For-Now. That may mean taking a non-health care related job to make money and keep a roof over your head while you search for the job you want, but remember to take care of yourself so you can acquire the confidence you need for self-actualization – and remain positive!

Wednesday, October 6, 2010

Have a Smurfy Career

One of my favorite cartoons as a child was the Smurfs. And although I have strong opinions on my perceived unoriginality of remakes and the making of TV shows into movies, I admit, I was oddly excited when I saw a photo of Hank Azaria donning a Gargamel costume for next year’s Smurfs movie. I then read that the Smurfs have been around for more than 50 years. I’m not good at math, but I’m good enough to realize that means Smurfs were around long before I first started watching Saturday morning cartoons. So I did what I always do when faced with a potential trivia question. I googled Smurfs.

I was surprised to find out that the Belgian creator, Peyo, was faced with two job prospects after his schooling: one in dentistry and one as an illustrator. He applied for the job at the dentist first, only to find out the job had been filled 15 minutes earlier. And to think, had Peyo gotten started earlier that morning, I would have led a Smurfless life. Devastating. Peyo began illustrating for Le Journal de Spirou in 1952, but it wasn’t until the Smurfs made their costarring appearance in Peyo’s Johan and Peewit comic in 1958 that he was launched into cartoon fame. And the world has had an obsession with these lovable little blue creatures ever since.

The obvious lesson to be learned here is that the early bird doesn’t always get the worm – something I am ever so grateful for considering my solid existence as a non-morning person. Okay, so that’s not really the lesson. I also believe in the “you snooze you lose” mentality as well. I meet a lot of aspiring coders who are looking for an “in” into the industry. And those ins are not always glamorous. Or well-paid. Even with the right credentials, you may have to take a lower paying position to get your foot in the door or take a position close to the one you really want. But who knows? With the right mix of hard work, divine intervention, planetary alignment, or just plain luck, you may find yourself on a career path you never expected. And like Peyo, it could lead you to great things.

Tuesday, September 7, 2010

It's Coding Season!

I'm sometimes asked if there's a busy time of year for coders or if it's pretty much status quo. As a matter of fact, there is a busy time of year for coders and this is it!

Every year, we gear up for all the upcoming year's coding changes. That means letting coders know which codes have been deleted, expanded, and added and letting coders, physicians, administrators, and revenue cycle personnel know how code-based reimbursement will be affected in the coming year. This may seem rather straightforward, but since we work with more than one code set with different implementation dates, fourth quarter of each year can be pretty crazy!

ICD-9-CM Codes
The ICD-9-CM diagnosis and procedure codes are updated annually with the Center for Medicare and Medicaid Services' (CMS) fiscal year (FY), which begins October 1. These codes are used to report diagnoses for all health care settings and procedures for hospital inpatients. Right now, you will find coders acquiring their FY 2011 ICD-9-CM code books and attending seminars on the code updates. Some of this year's highlights include:

Diagnosis Codes:
  • A new code for obesity hypoventilation syndrome
  • Expansion of fluid overload code to differentiate between transfusion-associated fluid overload and other causes
  • Expansion of the avian flu codes to include manifestations of the disease
  • Expansion of the blood transfusion incompatibility codes to differentiate between ABO and Rh incompatibility
  • Additional personal history codes
  • Expansion of the body mass index (BMI) codes up to allow for classification of BMI in varying increments up to 70 and over
  • A new section of V codes to report retained foreign body fragments
  • A new section of V codes to report the number of placentae associated with multiple fetal gestations
ICD-9-CM diagnosis codes are within the public domain and the 2011 revisions can be found on the National Center for Health Statistics' (NCHS) website.

Procedure Codes:
  • New code for placement of a central venous catheter under imaging guidance
  • New codes for carotid sinus stimulation components and devices
Changes to the ICD-9-CM procedure codes are within the public domain and are available on CMS' website.

The inpatient prospective payment system (IPPS), the system used for Medicare payments for inpatient hospitalizations, is also updated each year on October 1. This includes recalibration of the relative weights for the classification system used under IPPS - the Medicare severity diagnosis related groups (MS-DRGs). This year, the major changes to the MS-DRGs include:
  • A documentation and coding adjustment of -2.9%, wherein CMS will discount payments in FY 2011 to hospitals by 2.9% in order to remain budget neutral. The attempt to remain budget neutral is to counteract the financial impact of implementing a severity-based DRG system 3 years ago.
  • The addition of 12 new quality measures to be reported by hospitals under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program.
  • A revamping of Medicare's 3-day rule, which bundles payment for outpatient services provided within 3 days of inpatient admission into the inpatient payment.
Changes to the IPPS and MS-DRGs are available in the public domain through CMS' website as well as the Federal Register.

CPT Codes
Changes to CPT codes become effective with each calendar year on January 1. These codes are used to report procedures and services for physicians and hospital outpatients. Because CPT codes are owned and maintained by the American Medical Association (AMA), they are not available in the public domain. As such, finding a list of upcoming CPT code changes is often a closely guarded secret until the CPT book is published, generally around November or December each year.

The best way to get updates on upcoming CPT codes is to attend either the AHIMA's Annual Clinical Coding Meeting (September 25 and 26, 2010 in Orlando) for the national code update or the AMA's CPT and RBRVS Symposium (November 10-12, 2010 in Chicago). After the AMA's Symposium, it's common to see articles appearing in coding journals and publications discussing the upcoming coding changes.

HCPCS codes are developed and maintained by CMS to report services, supplies, and procedures that are not found in CPT. They are utilized by physicians and hospital outpatient reporting. HCPCS codes are potentially updated quarterly, although an update isn't always required that frequently. HCPCS codebooks may be purchased on an annual basis with the calendar year and quarterly updates are found on CMS' website. HCPCS codes are in the public domain and general information about their use can also be found on CMS' website.

The outpatient prospective payment system (OPPS) is the payment system utilized by Medicare to pay for hospital outpatient claims. This is updated on January 1 each year, along with the CPT and HCPCS codes. The proposed rule was published in the Federal Register on August 3 and CMS accepted public comment on that proposed rule through August 31. CMS will review the comments, make final determinations, and finalize the rule by November 1.

OPPS changes include recalibration of the relative weights for ambulatory payment classifications (APCs), the categories used to group similar procedures for payment.

Some highlights of the proposed rule include:
  • Two areas that have undergone frequent changes or requested changes will remain static for 2011: drug and substance administration and hospital outpatient evaluation and management visit guidelines
  • Establishment of a list of services that must be performed under physician supervision
  • Removal of three orthopedic codes from the inpatient-only list, making them reimbursable as outpatients under Medicare
  • A new method of paying for separately payable drugs
Information about OPPS and APCs can be found on CMS' website.

Physician Fee Schedule and RVUs
Physician payment, as outlined in the physician fee schedule, is updated annually on January 1 by Medicare. The proposed rule was published in the Federal Register on July 13 and the comment period ended on August 24. The physician fee schedule outlines the relative value units (RVUs) for each CPT code based on the amount of work the physician performs. Information on the Medicare physician fee schedule and RVUs is within the public domain and can be found on Medicare's website.

Too Much Information?
It sounds like an awful lot of information, but remember this - not every coding professional needs to learn the ins and outs of every coding and payment system. Because I work with hospital clients, I will be focusing on everything but the physician fee schedule. And those who work in physician offices will focus on ICD-9-CM diagnosis code changes, CPT/HCPCS code changes, and the physician fee schedule only. Even so, it's enough of an impact to call fourth quarter "coding season!"

Tuesday, August 24, 2010

More From the Coder Coach

Need a Coder Coach fix between blog postings? I frequently post links to articles on Facebook and Twitter. On Facebook, search for the group "The Coder Coach" and on Twitter, look for @codercoach.

Thursday, August 19, 2010

What Does ICD-10 Really Mean to New Coders?

If you haven't heard yet, the coding system is changing on October 1, 2013 from ICD-9-CM to ICD-10-CM and ICD-10-PCS. I have told a lot of new coders and coding students that this gives them a more level playing field when it comes to getting hired on as a coder. But 2013 is still 3 years away. If you are graduating soon and will be looking for a coding position, what does ICD-10 really mean to you? Should you start training on ICD-10 now so that you are well-positioned for the coding switch?

Why ICD-10 is a Good Thing for Wanna-be Coders
I always start with the prerequisite disclaimer when I talk about coders: I am a coder, so I can poke a little fun at our idiosyncrasies. Many coders don't like change. And that's part of what makes them so successful as coders - the ability to work in a routine environment coding patient record after patient record. So to coders who really dislike change, ICD-10 is like an atomic bomb. I've heard some say they will retire or find a new line of work when ICD-10 is implemented. Add those open positions to the decreased productivity that is inevitable with the implementation of a new coding system, health care reform, and the current national coder shortage, and what we have is an awesome opportunity for new coders to enter the field.

Coders who learn ICD-10 in school will likely be called upon by their new employers to share their knowledge of the new coding system with more established coders. Getting into ICD-10 on the ground level means more opportunities for new coders in the future.

Why ICD-10 Coding Jobs Won't be Super Easy to Land
While the need for more coders trained in ICD-10 will be there in 2013 and the codes themselves will be different, the one thing that makes a coder truly special will not change: navigating the medical record, deciphering medical terminology, and applying coding guidelines. These are skills that are not easily taught in school - this is the "experience" that employers are looking for when they say they want two to three years of coding experience. And while new coders right out of school will have oodles of exposure to the ICD-10 code sets, experienced coders will have that other type of experience - the type that goes beyond looking up a code in a book. That skill will still be coveted by employers.

I talk to a lot of people who are pondering changing careers and getting into coding because of what they've heard about ICD-10 and the future need for more coders. But just because we're nearing this massive change doesn't mean that it will be any easier to get hired as a coder in 2013 than it is now. There are many considerations you need to make in determining when ICD-10 training is appropriate for you.

What Kind Of Coder Do You Want to Be?
I have been trained in ICD-10-CM and ICD-10-PCS. The only reason I am trained is because I intend to do a lot of ICD-10 training myself and those who are getting educated now are the educators. I recently had someone tell me she planned to wait a couple years to get trained in ICD-10 because she heard it was so different from ICD-9-CM and she didn't want to have to learn a dying coding system. So let's start with the first question you need to ask yourself: What kind of coder do you want to be?

This is important because ICD-10 is divided into two code sets: ICD-10-CM for diagnoses, which will be used by all health care settings, and ICD-10-PCS, which will be used only by hospitals for reporting procedures. CPT will not be impacted by ICD-10 implementation and the format of ICD-10-CM is very similar to ICD-9-CM (granted all the code numbers are different!). I see the transition from ICD-9-CM diagnoses to ICD-10-CM being relatively easy (notice I said relatively - it will still be a bear!).

ICD-10-PCS is a whole different story. The procedure portion of ICD-10 is set up like no codebook we've ever seen. There is no tabular listing - only a series of tables that allow the coder to "build a code." Furthermore, the level of detail and the coder knowledge required to code an ICD-10-PCS code as opposed to an ICD-9-CM procedure code is astronomical. For example, there is one ICD-9-CM procedure code for repair of an artery. In ICD-10-PCS, the coder will need to know which specific artery was repaired and how that repair was approached.

So when people say ICD-10 is very different from ICD-9-CM, I have to ask, which code set? While the code numbers and code format will be drastically different, the way we code will be the same for ICD-10-CM as it is now for ICD-9-CM diagnosis coding. But ICD-10-PCS is like... well, CPT on steroids. The level of detail in ICD-10-PCS coding is much more specific than what's required even by CPT standards.

Why the long explanation? Well, if you plan to code for a physician office, you won't need to learn ICD-10-PCS. So I say, go ahead and learn ICD-9-CM now because the main change for you will be the code numbers themselves (and a couple of coding guidelines). If you plan to code for a hospital, you need to be prepared for a whole new game with procedure coding when ICD-10 is implemented. The good news is, ICD-9-CM procedure coding really isn't very difficult, so I don't see anyone "wasting" time by learning it now until 2013.

Do You Want to be More Than a Coder?
Let's get one thing perfectly clear here and now. The implementation date for ICD-10 (both CM and PCS) is October 1, 2013. There will be no push on that date. Everyone will be expected to be up and running on October 1, 2013. Rumor has it that this date will get pushed back, but everything I have heard from government representatives says that there will be no push on that date. So spread the word!

Let me get something else perfectly clear: ICD-9-CM will not "die" out. There will be a need for people to know ICD-9-CM diagnosis and procedure coding after October 1, 2013. Particularly if you work in a hospital, data analysis is often performed based on codes and we often compare case loads from year to year to see which services are growing, which are waning, and which are needed in the community that aren't currently offered. In the calendar year 2013, we will have data from both ICD-9-CM and ICD-10. That means a need to be able to crosswalk between codes for data analysis. And someone within the hospital needs to understand both systems. That might be you.

Take the Next 3 Years to Get Experienced
The biggest complaint I hear from wanna-be coders is that all employers are requiring 2-3 years of experience. So if my math is correct, if you wait 3 years to learn ICD-10 and it takes another 2-3 years to get experience, you won't really be working as a coder for another 5-6 years. Why wait? While it doesn't make too much sense to get trained specifically on ICD-10 right now because you won't remember it in 3 years, it does make sense to get hired on as a coder and start positioning yourself to take on a coding position in 2013. This might mean taking an entry-level position where you are exposed to the medical record, codes, or billing. Don't wait till 2013 because there will be a mad dash and employers who have open positions in 2013 probably won't have time to train someone who is complete green. As a matter of fact, I have been encouraging facilities to make education a part of their organizational culture now to lessen the impact of ICD-10 implementation.

Now is the time to hone your skills in coder detective work - where you find information in the medical record, how the patient's symptoms come together in the disease process, anatomy and physiology, medical terminology, and pharmacology. And the good news is, learning this now means you can also apply it to ICD-9-CM now and it will make it easier to make the switch to ICD-10.

Talk to Your School
If you're enrolled in a coding or HIM program or plan to enroll in one, do your homework. Ask the program director or coding instructor what the school's plan is for the ICD-10 transition. They should be referencing timelines like the one posted on AHIMA's website. If they don't have a plan now, you should be concerned.

Don't Hurry Up and Wait
I suppose the best way to sum up this posting is to say this: think of your coding education as a journey rather than focusing on the destination. Go ahead and get trained in ICD-9-CM now - it will not be a waste of time or money. Yes, you will need to train in ICD-10, but if you're credentialed, you will have every opportunity to train through AHIMA and the AAPC. And if you're employed, your employer will be be focused on training as well. Plus, I really do believe that those coders who know both ICD-9-CM and ICD-10 and can analyze and compare data across both code sets will be hot commodities.

Friday, August 13, 2010

Why Wait?

Are you currently a coding student? Are you nearing graduation? Are you waiting until you graduate to look for a job? If you answered yes to any of the above, I ask you, why wait? Start applying for coding jobs now.

We all know it can be hard to get that first coding job or even to land in an entry-level position. So if you can make it work, I recommend applying for any job now that will boost your chances of moving into a coding position. That might mean working as a file clerk or scanner (someone who scans in medical record documentation into the hospital's imaging system). Anything that will get you closer than you are today to being a coder.

If you start now you will also find that you won't be competing with your fellow graduates for the same jobs come graduation day. And for all you kinesthetic (learn-by-doing) learners out there, you may find it will help you piece together the puzzle we call health care revenue. In other words, you'll get experience!

So take this time to get a leg up on your coding career and get started! Good luck!

Thursday, August 12, 2010

The Shortcut to Being a Coding Professional

About 10 years ago when I was working as a coding supervisor in a hospital, I received a phone call from a woman who was asking me how she could get trained to become a DRG auditor. At that time, there weren't a lot of coding schools and the internet was just catching on, so I referred her to the local community college and their health information technology associates degree program. She went on to tell me that she had a masters degree in an unrelated field and she didn't feel an associates degree was necessary. She also didn't want to be a coder, just a DRG auditor. She had an acquaintance who became a DRG auditor without a degree in HIM, so she figured she could too. She heard there was good money in DRG auditing and she wanted to make good money. All I needed to do was tell her where to get the information.

Okay, a quick side note: DRGs are the result of the codes assigned on a single inpatient claim - adding, removing, or changing a code can potentially change the DRG. For example, I recently reviewed a record for a coder and changed just the fourth digit on one code and it changed the DRG. So wanting to know how to audit DRGs without being a coder is like wanting to perform surgery without knowing how to use a scalpel.

Anyway, at that moment, two things ran through my brain. 1) This woman wants the job I consider to be my next step in the career ladder and 2) She just insulted me by seriously underestimating what it takes to be a successful coder, let alone a successful coding auditor.

The Shortcut to Being a Coding Professional
Each week I jot down blog ideas and often the short snippets scrawled on my note pad show a common theme. This week, the theme is summed up by a quote from Randy Pausch in the Last Lecture (I'm almost finished reading!): "A lot of people want a shortcut. I find the best shortcut is the long way, which is basically two words: word hard." And last night as I watched the last night of performances on So You Think You Can Dance, I was further moved by a simple statement by judge Nigel Lythgoe: "People believe they can be a star without working hard."

Now I am not trying to discount this woman's abilities in her chosen field of study. And although I have 15 years of experience in coding, if tomorrow I decided to be a computer programmer, I wouldn't expect someone to hire me because I have 15 years of experience in an unrelated field. I would have to study and become and apprentice all over again. It's a long journey, but the shortcut really is the long way: work hard. Would there be skills I could bring from my background? Absolutely and I would advertise those skills. But if you take one thing away from this blog posting, let it be this. You could unintentionally insult your potential employer by discounting what it takes to get to their level. And insulted people don't hire the people who insult them.

Spending Time in the Trenches
I've been a consultant for over 9 years and the best compliment I receive from a client is when they tell me that they can tell I've worked in the hospital environment and understand the process and issues. It seems simple, but in health care, we do everything differently - especially the business side of health care. Hospitals and physicians have been in business for centuries treating patients. But it's only been the last few decades that it's become necessary to combine the human health care aspect with the concept of running a facility like a business. And that's due to the increase in health care costs and the attempts to try to control those costs. The result is an industry built around human care and retrofitted for finance. How many businesses do you know that operate that way?

When I took a health care finance class a few years ago I already had several years of coding experience and was well versed in how a hospital's revenue cycle works. So as our professor talked about the process, I decided to observe the other students in the class that came from other industries - in particular, an attorney. And as the professor talked about the charge master and codes coming from different departments and payer mixes, the attorney thought it was crazy and unreasonable. It was a completely foreign concept to her. And it will be a completely foreign concept to you too until you get your foot in the door and start observing.

The woman who called me about how to be a DRG auditor eventually got frustrated with me and hung up. I wasn't the first person to give her the community college answer.

Within a few years I was a DRG auditor and I have to say it was one of the hardest experiences I've ever had. We traveled in teams of auditors (safety in numbers!) with our laptops and portable printers. Each time we finished a record that had a coding or DRG change, we printed out an audit sheet and sent the record and audit sheet back to the original coder. At the end of the week, we sat down with the coders and they had the opportunity to refute our findings. It took a few exit interviews and a lot of tough skin to build my abilities as a coding auditor. The terrific thing about coders is that they will dig to find an answer until they can prove they're right. Some of the coders I audited were right. And sometimes (I like to think more often than not!) I was right. My point is, I worked hard and I have a lot of confidence now in my ability to both conduct and defend a DRG audit.

That Annoying Overqualified Coder
I'll never forget my first encounter with a coding auditor. She was very qualified. As a matter of fact, all of my coworkers thought she was overqualified. She was brought in to do an audit of our work and then do some education. We all sat around a table at our first meeting and introduced ourselves. She started. She listed off her years of experience, degrees and credentials, and a long list of states she'd visited and audited. It took her about 5 minutes. And then she turned to her left and looked at me and asked me to introduce myself. My introduction went something like this, "Uh, hi. My name is Kristi and I just graduated and will sit for my ART [now RHIT] exam in October... That's it."

I was humiliated that I didn't have the credentials this woman had. I sounded ridiculous after her 5 minute speech about her experience. Afterward, my coworkers said they found the whole thing hilarious. They were not happy about being audited and most of them thought the consultant was overbearing and way to focused on credentials. They thought my response was perfect. And they all reassured me that no one could possibly expect me to have any experience - I had just graduated!

Now I think back to that consultant. Was she overbearing? Maybe. Did she have experience? You bet. Was she good at what she did? Absolutely. She taught me 2 things: 1) even if you have an encoder, you should always have a CPT code book on your desk because, "The encoder took me there" is not a valid response to why you coded something the way you did, and 2) how to code bunionectomies. That first introduction sticks with me too because now I'm the consultant who to some may seem overqualified. But I will tell you this. It feels so good when someone asks me a question and my answer includes the phrase, "When I was... [a coder, a coding manager, etc]." And I know it gives me credence with the people I'm talking to.

The Brick Walls are There for a Reason

The Randy Pausch quotes will be with me for awhile because so often as I've read this book, I find myself pumping a fist in the air and saying, "Yeah!" I spend a lot of time on thinking and self reflection and much of what Pausch wrote is in line with my thinking. Anyway, another favorite quote is this:

"The brick walls are there for a reason. They're not there to keep us out. The brick walls are there to give us a chance to show how badly we want something."

Yes, it's a quote worth bolding. I have no doubts that if you really want to be a coder and have the skill and talent for it, you will be a coder. The question is, how hard are you willing to work to scale that brick wall? We all started somewhere. People have asked me how I got so far in such a short time frame (15 years). I think I like the answer that Randy Pausch gave whenever someone asked him how he got his tenure so early: "It's pretty simple. Call me any Friday night in my office at ten o'clock and I'll tell you."

Monday, August 9, 2010

Top Ten Reasons to be a Coding Professional

I would love to take credit for making up this list of reasons to be a coder, but I can't. It's a list that came out about 15 years ago and I believe it was published in The Journal of AHIMA. This list was popular when I first started coding in the mid-90s. I have yet to see an electronic copy of it, but found a photocopied list in a scrapbook (er, chart) my coworkers gave me when I left my first coding job. This list graced my bulletin board for a long time!

Some of these are a bit dated, but most still ring pretty true and I updated Ms. Scichilone's credentials as she is still a well-respected practicing HIM professional. I hope you enjoy this little bit of levity!

Top Ten Reasons to be a Coding Professional
by Rita Scichilone, MHSA, RHIA, CCS, CCS-P, CHC

10. You love to read really small print.

9. Carrying around code books is better weight training than those cute little dumbbells you buy at the fitness store.

8. Classification systems and nomenclatures make great party conversation. "I'll bet you don't know what SNODO* is!"

7. If a patient can do it, get it, or hurt it, you can code it.

6. You love explaining what you do each day - "Oh, I typically transform sixty-five or so pages of complicated clinical information written in a foreign language (medical terminology) into numeric codes that will fit on a one-page form."

5. When you get carpal tunnel syndrome from turning those pages and burning up a computer keyboard, you'll know how to code it for your insurance company.

4. You can impress your friends by saying you'll meet them after work for some 94.38 at your favorite hangout."**

3. You are passionate about acronyms (DRG, APG, HCPCS, HCFA, HEDIS, CPT, UHDDS, ICD-9-CM, CHMIS, WEDI, UB-92)***

2. When you hear "The AR days dropped again today," you get goosebumps.

1. The eternal mysteries of ICD-9-CM and HCPCS CPT-4 are transformed at your touch into essential mastery of critical clinical data indexing that can change the health of America!

*Standard Nomenclature of Disease and Operations (SNODO) was a coding system that predated ICD-9-CM

**94.38, Supportive verbal psychotherapy

*** Ambulatory patient groups (APGs) were proposed prior to the use of ambulatory payment classifications (APCs); the Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services (CMS) in 2000, the uniform bill 1992 has been updated and replaced with the uniform bill 2004 (UB-04)

Wednesday, August 4, 2010

What Are You Going to do About It?

I will be the first one to admit when I’m bad at something (like math), but as far as joke-telling goes, I think I’m actually quite good. It’s the remembering part that’s tricky. But I do have a few favorite jokes in my arsenal – a blonde joke or two (it’s okay, I’m blonde!), a couple of jokes that are only truly appreciated by kids under the age of 8, and one joke that teaches a lesson. I am going to share the latter with you now.

A damn broke uphill from a town and the entire town had to be evacuated before the eventual flooding and devastation that was going to occur. One man began to pray and asked that God protect him from the flood. The police came to his door and told him to evacuate and he said, “No thank you. I believe and have faith that the Lord will provide.” The police left. Soon the flood waters were starting to make their way into the town and the man was forced to move to the second story of his home. He prayed again and asked God to protect him. A motor boat with rescuers came by offering to take the man to safety but again he said, “No thank you. I believe and have faith that the Lord will provide.” The rescuers sighed and shook their heads and moved on. Soon after that, the flood waters were so high the man had to take refuge on his roof. He maintained his prayer for safety. In one final attempt to clear the town, rescuers came by in a helicopter but the man refused to get on board. He said, “No thank you. I believe and have faith that the Lord will provide.” Soon there was no place left to climb and the unfortunate man drowned. When he got to heaven and spoke to God he said, “Lord, I believed in you and had faith that you would save me. Why did you let me drown?” And God said to him, “I provided you with the police, a motor boat, and a helicopter. What else was I supposed to do?!”

I’ve heard the joke many times – sometimes as part of a sermon, sometimes as an anecdote to get people to realize they have more control over their lives than they think. I receive many phone calls and emails from students and novice coders who are frustrated with the hiring process. And since I’ve committed to mentoring, I try to find time to respond to each of those emails. I am always happy to give a little pep talk or give a little advice that may guide them in the right direction. But occasionally, I get an email that is a series of complaints and blame games and all I can think is: what are you going to do about it?

Don’t get me wrong. No one loves a good venting session more than me. I even have friends that I can email and rant to and they won’t take it personally. I can type a 2 page email and usually get the response, “Feel better now?” and usually I do. I am all for venting frustration. But at some point, you have to make a decision to do something about the problem or change course. Otherwise you’ll go crazy. Think of Einstein’s famous quote about the definition of insanity: “doing the same thing over and over again and expecting different results.” So if you’re stuck in venting mode or you haven’t tried a different attempt at getting what you want, it’s time to break the monotony and move on.

I recently started reading The Last Lecture by Randy Pausch with Jeffrey Zaslow. I don’t get a lot of time to read and I am by no means a speed reader, so it will probably take me at least a week to get through this “quick read.” The story, if you are unfamiliar, chronicles the last lecture given by Randy Pausch, a professor at Carnegie Mellon University before he succumbed to pancreatic cancer. He was 47-years-old and left a wife and three young children behind. His lecture entitled “Really Achieving Your Childhood Dreams” was really directed at his children (the lecture was recorded) and is so inspiring, it yielded a spotlight on a national TV news program, the book, and countless videos on YouTube.

In the book, Pausch dedicates an entire chapter to his parents and their parenting skills. One of the things his parents did for him was to encourage him to find answers to the unknown. This is something I felt I had in common with him – my parents were always telling me to “look it up” if I didn’t know an answer. In fact, my mother always told me, “Knowledge isn’t what you know; it’s whether or not you know where to find the answer.” And as much as I hated the look-it-up-response (I actually thought they were lazy), I appreciate it now because now I don’t rely on someone else to figure everything out for me.

I am at a point in my life where I am probably the happiest I’ve ever been. And I’ve noticed that as a happy person, the last people I want to be around are unhappy people. Unfortunately, I have a few in my life – friends, acquaintances – who every time I talk to them dump every last problem on me and then wait for me to speak. Sometimes I mess up and give them advice. What I’ve found to be more effective is to ask them what they plan to do about it. If all they want to do is complain about their situation and aren’t willing to do anything about it, there’s really not much else I can do other than listen and wait it out until they’re done. But every once in awhile, I see something flicker in their eyes and I can tell they haven’t really thought what they would do about it. And I sometimes suspect they’re waiting for someone to tell them what to do. My hope is that my question is a virtual slap-in-the-face to get them past the complaining stage and onto the fixing stage.

Are you one of these people? Are you waiting for the magic opportunity that will get you into the coding profession? Have you really tried everything to get into the industry? I defer again to Randy Pausch, who created a list of childhood dreams. On that list was “being in zero gravity.” His students won a contest that enabled them to experience NASA’s plane “The Weightless Wonder,” which helps astronauts get used to a zero gravity environment. Unfortunately for Pausch, no faculty was allowed. So he found a loophole and withdrew his application as faculty and resubmitted it as press (for which he had to do some additional work to get the story into the media). It worked and Pausch was able to cross one thing off his childhood to do list. So I ask you again, if you’ve tried to get a job and have failed, what are you going to do about it?