Friday, July 23, 2010

Now Blogging in Two Places!

If you haven't had the chance to check out AHIMA's HI Careers website yet, you definitely should. Besides all the great information for HIM and coding job seekers, they've recently added a series of blogs from industry pros - including yours truly. I will continue with my Coder Coach blog as well - now you just get to read me in two places! Plus, you get the added benefit of hearing from others as we tackle some FAQs about getting hired in HIM.

AHIMA's HI Careers website

Thursday, July 22, 2010

Even My Dad's on Facebook - Are You?

Like most people these days, I'm on Facebook. Actually, I maintain a couple of Facebook accounts: one personal and one professional. It's been fun to connect with people from my past and see what they're all up to. And I have to admit, when my brain gets a little fried, it's a quick and simple distraction to see if anyone has posted anything interesting or entertaining. For over a year now, I've tried to convince my parents that they need to get on Facebook so they can reconnect with people from their past. Even so, I was shocked the day I received a friend request from my father.

I'm not one of those people who is afraid to "friend" my parents. They're actually pretty cool and I get along well with them. Plus, I subscribe to the idea that if I'm uncomfortable having my father read it, I shouldn't be posting it on Facebook to begin with. But my dad has only recently become semi-tech savvy. I received my first email from him about a year ago. So getting a Facebook request from him was major. Mom's request came in soon after his and was a little less shocking because she's into gadgets and is one of the few people I actually text.

My point (and I do have one) is this: so many people tell me they don't do Facebook because it's too much work. These people are often people who are looking for jobs. And all I can think of is, if Facebook is too much work and you want to be a coder (and potentially code from home), you are looking into the wrong business.

Let me demonstrate. I have 7 email accounts in varying states of maintenance. One personal, one for my company, one for The Coder Coach, two for clients, and the rest are accounts that were set up for miscellaneous purposes and very few people have those email addresses. I have 2 Facebook accounts, a LinkedIn account, and a Twitter account - although I only tweet professional tidbits because I personally find it a bit ridiculous to let people know what I'm up to at every moment of the day. I also have an instant messenger (IM) account, which one of my clients uses for quick questions.

And that's just "social" media. I am able to VPN into 2 of my clients in order to access their systems, which consist of a logon to the VPN, a logon to their server, a logon to the electronic medical record (EMR), a logon to their coding system, and an encoder. I also have various online memberships (e.g., AHIMA, AAPC) that require passwords to access member-only information. And frequent flier and hotel point programs. I currently maintain over 100 passwords.

In order to maintain all these accounts and passwords, I have my main work laptop, laptops from some of my clients, and an iPhone. I also have a personal laptop, which gets turned on about once every 3 or 4 months because I can't stand to be on the computer when I'm not working. I run dual monitors on my desk so I can look at applications side by side. I have 2 phone numbers, a fax number, and 2 different ways to connect to the internet. In other words, I'm well connected - at least when all the computers are working properly.

I admit - this is extreme. For the typical coder working from home, though, there will be at least a computer and 1 or 2 huge monitors for reading EMR documentation (remember, paperless means no paper - everything is online) and the login credentials to get into a VPN, remote server, and whatever systems you'll be using. When something goes wrong or doesn't work properly, you are the first line of IT defense. You can't just get an IT guy over to your house right away.

So if you want to be a coder and work from home and you aren't on Facebook because it's "too complicated," think about either changing your reason for not being connected, get connected, or find a new career that doesn't involve computers. And try to filter what you tell a potential employer about your issues with technology. As medical records move to an electronic format, you will need to be more tech savvy. After all, if my dad can do it, so can you!

Wednesday, July 7, 2010

Getting Through an Operative Report - Without Crying

One of the things I love about the mentoring I do for students is it reminds me of what it was like to be a newbie. And I don't just mean the excitement of being on the cusp of a new career. I am also grateful to be humbled and reminded that I knew absolutely nothing when I got started. These days when I stand in front of an audience of coders or students and teach the latest and greatest on whatever topic I'm discussing for that day, it's the culmination of years of experience and hours (or weeks) of research and preparation. But you might be interested to know that in my first coding job I did come home from work on more than one occasion in tears.

I can't explain that helpless feeling when you've trained so hard - and studied and taken numerous tests and graduated, etc. etc. etc. - and you land that first job and they hand you an operative report. And you freeze. Because it's like Greek. You have no idea what to do. Where are the short coding scenarios you learned in school? What does that first paragraph really say? You know you could find the code if you could just figure out what the heck the darn report says (incidentally, I now consider myself trilingual: English, medical terminology, and coding!). You know you're qualified, but are you really?

So I sometimes forget when I'm working with new students what it was like. Of course, there are still days when I feel like crying because I keep getting myself into uncharted territory. I actually relish researching and "figuring out" things that other people may abandon because they are too foreign or "difficult." But it wasn't always that way. I used to be an overconfident novice coder who, when a chart was placed in front of her, did a lot of tap dancing to make it look like she was competent. The good news is, 15 years later, I feel competent (most of the time anyway!).

The Word Search
I've worked in coding education now for about 8 years. In that time I've been asked to work on a lot of different projects related to coding education. In addition to training coders, I've been asked to evaluate people to see if they would make good coders. And I always start with the word search test. Do you like word searches? If not, you might want to consider a different career. Because coding is one big word search. You have to decipher the medical record (or operative report) and decide which words are important and which ones you can ditch.

Bunionectomies are a Kick
The first time I was given a bunionectomy report to code, I'm pretty sure I cried. After all, the procedure title was something like "Mitchell-Chevron," which meant nothing to me. And I knew enough about coding to know I had to read the report to figure out if it really was a Mitchell-Chevron. And the report was surely about 4 pages - pretty standard for a thorough podiatrist. And when I went to a class to learn how to code bunionectomy procedures, I realized that out of the entire 4 pages, I focused on about 3 sentences. That was it. The rest was coding garbage. In case you're wondering, a Mitchell-Chevron bunionectomy involves removing the medial eminence (AKA bunion) and making an osteotomy (bone cut) into the first metatarsal (the foot bone connected to the big toe). I'm still amazed that it takes 4 pages to describe that.

Deciphering the Operative Report
I am often asked to explain how to decipher an operative report. Well, it depends on the procedure, really. And if you are a new coder and you ever have the opportunity to go to a seminar where they will present case studies, this is the best way to learn. I've taught dozens of classes and nothing drives home my point more than walking through the cases and coding them. But I will give you some basic elements here to get you started. While these rules don't apply to all specialties (e.g., interventional radiology has "special" rules that drive the even the most experienced coders - that would be me - batty!), this should get you started on some of those basic surgical reports.
  • Rule 1 - Doctors Lie: Admit it, you watch House and have heard him say on more than one occasion that patients lie. Well, Dr. House, I would like to point out that doctors lie too. They will state the procedure one way in the title and then proceed to describe a completely different procedure in the body of the report. For example, the doctor may state a left heart catheterization was done, but after reviewing the report, the catheter never made it all the way to the heart - only to the coronary arteries. So keeping this in mind, you should never believe what you read in the procedure title. Honestly, I rarely even read the procedure title anymore - it's often fiction. As for Dr. House, I would love to see a strong-willed coder have it out with him on the show about his documentation, which I'm sure is a mess.
  • Rule 2 - Get a Medical Dictionary: There's no excuse anymore. When I learned how to code, we were still using Windows 3.1, so there was no way the hospital was using the internet. But even without online resources, I had a medical dictionary on my shelf. And it was used often. How will you know if something is important if you don't even know what it means? While you're at it, make sure you also have access to an English dictionary. I know it's a novelty, but you will also find complex nonmedical words in the operative report (or even in your code descriptions). If you don't know what it means, look it up. Tedious, I know, but you will learn. Of course, you might feel like Billie Dawn from Born Yesterday, but you will learn. (Don't understand the movie reference? Look it up!).
  • Rule 3 - Just Like Ragu, It's Probably in There: In school we hear terms like "it's bundled" or "separate procedure" but what does that really mean? Well, it means it's integral to the main procedure and don't code it out separate. What's included? Well, pretty much anything that has to be done in order to accomplish the main procedure. Taking out an appendix? Well, then the incision (or creation of ports for laparascopic instruments) is included. So is the closure at the end of the procedure. I don't know about you, but if I have my appendix taken out I sure hope the physician remembers to suture me closed at the end. All those things are like regular ingredients in Ragu pasta sauce - tomatoes, oregano, garlic. It's in there! So don't code each component out separately. Now, had they decided to do a liver biopsy while in there, that's different. That's like throwing a banana in the pasta sauce. So it gets coded separately.
  • Rule 4 - You Will Only Use 10-20% of the Operative Report: Don't feel like you need to use every word in the operative report to code the case. The fact is, the operative report isn't about you, it's about the patient and it's a communication tool for clinicians. It just happens to double nicely as a recording of everything that happened to the patient and can substantiate coding and billing. It's up to you to determine what's important in the documentation. There's a reason we use coding for billing - your codes actually fit on a 1-page claim form so the insurance company doesn't have to read through every single medical record.
  • Rule 5 - Know the Procedure: Okay, maybe I should have led off with that one. Medical terminology is, quite literally a foreign language. In fact, it's at least two foreign languages: Latin and Greek. So when you say "it's Greek to me," you're being quite literal. A really good medical terminology class will solve a lot of problems. You may think esophagogastroduodenoscopy is a really big word until you break it down and realize it's visualization (scopy) of the esophagus (esophago), stomach (gastric), and part of the small intestine (duodeno). You also need to know your anatomy. You need to know when they operate on a structure that's part of a bigger structure (e.g., mesentary of the intestines) vs. a different organ altogether (like in the appendix/liver example above). After you learn medical terminology and anatomy and physiology, that's half the battle. The rest of the battle can typically be solved with Google. Come to think of it, there are few things that can't be solved with Google. I'm pretty sure there will be a support group some day for Google-aholics, but in the mean time, I highly encourage you to google a procedure if you don't know what it is. I never remember what a Whipple procedure is. But I can google it in about 10 seconds. Just be careful which website you select from your Google search list - something from the Mayo Clinic is probably more reliable than
  • Rule 6 - There is Crying in Coding, Just Don't Let Anyone See It: Oh, how I wish I could tell you I had that one down. But I'm pretty transparent when it comes to being frustrated. And I've had students cry in frustration when trying to code case studies. But try to minimize your public displays of tearful frustration and remember this - we've all been there and this is hard. It's okay to not know all the answers all the time.
I hope this at least gets you moving in the right direction. When people ask me how I learned everything I know I, 1) laugh, because I know there is so much more for me to learn, and 2) tell them how the rules above worked for me.