Monday, February 1, 2010

Coding Sure Isn't What I Thought it Was Going to be!

When I enrolled in HIM school, I never envisioned my career would end up the way it has. For those of you keeping score at home, let me briefly outline how it has turned out. I am a senior consultant - and the only coding professional - for a small consulting firm that specializes in hospital revenue cycle management and electronic medical record conversions. I do project-based work that involves improving coding and charging accuracy with our clients. Right now that means working closely with cardiac catheterization and interventional radiology coders and auditors. In the coming months and years it means hours of developing ICD-10 training materials and helping the coding workforce get ready for the switch in 2013.


Well obviously as a child I didn't think "I want to grow up to be a coding professional" but even once I selected an area of study and was taking classes, I was having trouble visualizing what my days would be like - which is pretty sad considering my mother had been in the business for about 20 years and all my stuffed animals had medical records when I was a kid. I knew about the HIM field, but I didn't really know about it. I guess I imagined that some day I would go to work as a manager in an HIM department like my mom, but I couldn't really figure out how to get there or if it was right for me.


"I Don't Want to be a Coder"

When I took my first coding class I hated it! I didn't understand it and the statements the instructor gave us to code were confusing. I constantly arrived at the wrong code and sometimes didn't even know what to look for. And unfortunately at that time, I never wanted to ask questions because I didn't want to feel stupid. When they handed me an inpatient medical record for the first time I wanted to cry. How was I supposed to put it all together and come up with the right codes - the ones everyone else in the class seemed to have no trouble getting? I vowed that I would never be a coder and rebelled by not renewing my free updates for codebooks for the coming year. And then I decided I would follow my mom's path and go into the operations side of HIM, focused on legal health information issues, completion of medical records, and the general management of health information.


And then it happened. Enlightenment. Divine intervention. My aha moment. Or whatever you want to call it. I went to do an internship at a local hospital and they started me out on emergency room records. All of a sudden it started to make sense. Practical application of coding was something I excelled at. Instead of being given statements to code, I was given (small and manageable) medical records that represented real people with real problems and it was my job to translate those problems into a set of codes. That excited me.


Don't get me wrong. I coded a lot of things wrong in the beginning and that initial feeling of looking at an operative report and wanting to cry didn't go away quickly. When I was assigned a senior coder to check my work, I was amazed that I could get so many wrong and she still thought I had potential. And now, nearly 15 years later and with substantial experience in the training and education of coders, I understand what she saw. I was only there three weeks, but I learned so much and by the end of the internship I knew I was meant to be a coder. My internship supervisor thought so too. Within a month of graduation, she had another coding position approved and I had my first job as an outpatient coder.


Why Don't Employers Want to Train Inexperienced Coders?

It's a long road from learning coding in school and applying it in the real world. I receive emails from wanna-be coders across the country asking me why it's so hard to get a job as a coder and this last week I had another epiphany as I presented an intro to diagnosis related groups (DRGs) to a group of coding students at one of my Coder Coach events. It was the first time I had deconstructed a complex topic like DRGs and presented it in an "introductory" format to coding students. And as I listened to their questions and watched the look of awe on their faces as the complexity of code-based reimbursement started to sink in, I was reminded how much I've learned and how hard it is to explain that coding isn't just looking up a code in a book.


The long and the short of it is this: health care providers are being scrutinized from every angle and the best way to prevent increased scrutiny is to decrease risk. The best way to decrease risk is to ensure that staff is well educated and experienced. Unfortunately, our industry isn't doing a very good job of replenishing the ranks as coders move on to advanced coding-related jobs in other departments or with other companies. There are coding jobs to be had, but trying to get one as an inexperienced coder is really tough. So what you have to know how to do is convince your future employer that you are the right choice.


What Your Future Employer Needs to Know About You

As health care dollars become tighter and patient premiums rise, provider budgets are being slashed. The first thing to typically be cut from any budget is education dollars. Ten years ago it was much more common to find an employer willing to pay to maintain dues for professional organizations or to send employees to regular educational seminars or classes than it is today. So the first thing your employer needs to know is that you are so committed to this profession that you will pay for your own education.


But here's the best part - so much of what's out there to learn is free. It just takes time to acquire it. If you want to be a coder so bad you can taste it, this will be a labor of love for you. If you are reading this now thinking I'm nuts ("how dare she suggest my employer not pay!"), then maybe coding isn't for you. Like any career profession, what you get out of coding will be relative to what you decide to commit to it. So if you want to be an inpatient hospital coder, now is the time to start learning about DRGs. At least learn the lingo. If you go into an interview for an inpatient coding position and they are asking you about CCs and MCCs and decreasing case mix and you have no idea what they are talking about, your chances of getting the job aren't good. So let your employer know what you will do for them to expedite the training process.


What You Need to Know About Your Future Employer

I've worked with a lot of coding students over the years and there have been some stars and there have been some duds - and it doesn't take long to spot the difference. The stars haven't always been perfect, but they have an enthusiasm and skill that can't be taught in a classroom. Some of the duds just didn't have the skill. And if you don't have the skill to be a coder, trying to force your way into it is like trying to fit a square peg in a round hole.


Are you wondering if you have the skill and if it's recognizable? If so, work on getting that interview and once you get the interview, ask to take a coding test for the employer. A good coding test, even if "failed" as far as percentages go, can show a prospective employer if you have the skill to be a great coder once trained.


Of course, many people wonder why someone would hire an inexperienced coder when they could have an experienced one. That was what I wondered when I graduated and here is what my mentor/first employer told me: experienced coders have picked up bad habits along the way; hiring someone with the skill to be a good coder means the employer can train them the way they want. There are no bad habits to erase.


Use Your Employer - and Let Them Use You

Okay, that sounds less than appealing, but I mean it in the most positive way. The best jobs I've had have been the ones where there has been "mutual using" of each other. The employer takes advantage of the employee's strengths and willingness to learn and in return, the employee gets the most wanted commodity: experience. No matter how mundane a project may seem, there is probably a wealth of experience to be gained by taking the project. You won't really know how much you've learned until people start coming to you for advice or you find yourself knowing exactly how to handle a situation because of your previous work. This might mean sitting on an inter-departmental committee, working claim denials, or reading up on a Medicare memorandum about how they will (and won't) pay for certain services based on documentation and coding.


Keep an Open Mind

Whatever you decide to do or wherever you work, remember to keep an open mind. My career sure didn't turn out the way I thought it would - it turned out better than I ever imagined! If you put yourself into a boxed category you will stifle your growth, but if you believe in limitless possibilities, you just might soar! So be bold and good luck!



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