Code for the Day: A Day at the Spa 8E0KX1Z

The last few weeks have been more than the usual crazy.  I knew going into September that I was going to have to take every rare opportunity I found for a little relaxation.  Since August, I have spent more weekend nights away than at home and while most of my trips have been for fun and not work, I am a person who relishes a routine schedule and values downtime - probably like a lot of coders out there.

My September travels began with a trip to North Carolina for a wedding followed closely by a work trip to Kansas City for training.  The whole time I had my eyes open, considering ideas for my blog and looking for inspiration in the normally mundane daily grind.  I have a few ideas that will take more thought before putting to paper - er, PC - so stay tuned.  But it was something quite literal that inspired today's code for the day: a heavenly day spent at the spa with coworkers.

I know what you're thinking. A relaxing day at the spa with coworkers is an oxymoron.  Well, you haven't met my coworkers!  We spent a nice Sunday morning at the spa and I do believe the topic of work came up only once and very briefly before we moved on to more important topics, such as, admiring each others' nail color and inquiring about the various facials, wraps, and massages we all received.

Oh, the massage.  Actually, after a busy week of lugging heavy suitcases and flying across the country and back and then back to the midwest and back again had left my feet as sore as my shoulders.  I was pretty much a goner after the pedicure, but I subjected myself to a hot stone massage anyway and I remember wondering afterward if there was a code for feeling like jello, because it's been awhile since I've felt that complete relaxation.  In fact, I did something I pretty much never get to do that afternoon: I took a nap!

My attempts at locating a jello code were not fruitful, so I went with the more obvious and here it is - the code for the day:

• 8E0KX1Z, Therapeutic massage

This code is found in ICD-10-PCS in one of the sections we trainers like to call the "stuff in the back of the book."  Most of the stuff in the back of the book includes codes we aren't likely to code and provide evidence that at one time, there were plans for PCS to replace CPT (this is not happening - I repeat, CPT is not going away!).  But I like this code and it was so appropriate for my weekend.

On a side note, I am not crazy about advertising on my blog, but I have to give mention to this amazing spa.  If you ever find yourself in Denver and need a little pampering, the folks at Woodhouse Day Spa will take great care of you.  This particular location at 17th and Ogden is located in the historic Merritt House.  There's just something about relaxing in this Victorian setting that makes it seem extra special!

Solution to Yesterday's Word Search

+ S + + + + + S Y R O T A R I P S E R U T C A R F + + + + + + + + + + + + + + + 
+ U + + + + + I G C + D G E V I T A R T S I N I M D A + + + + + + + + + + + + + 
+ B + + S + + S O H + + P C + + L Z + + + + + + + + + + + + + + + + + + + + + + 
L A T N E M P O L E V E D O R U E N + + + + + + + + + + + + + + + + + + + + + + 
O C + + Q + + R O M + + G N C + + E + + + + + + + + + + + + + + + + + + + + + + 
+ U + + U + + E I O + + L S D D H U + + + + I + + + + + + + + + + + + + + + + + 
+ T T U E + + L S T S T A T U S G L + + + N + + + + + + + + + + + + + + + + + + 
+ E + P L + + C Y H + V U R M + N F + + P + + + + + + + + + + + + + + + + + + + 
+ + H + A C M S H E O + C U + O I N + A V R + + + + + + + + + + + + + + + + + + 
+ + + Y E T E O P R + + O C I + N I T A + E + + + + + + + + + + + + + + + + + + 
+ + + T P + I R B A T + M T G + E I P + + M + + + C + + + + + + + + + + + + + + 
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+ + + D + Y R H N Y + C R V S N R + + O + S + E + + + + + + + + + + + + + + + + 
M A N I F E S T A T I O N E T O C D A + R S X + + + + + + + + + + + + + + + + + 
+ + + B C + + A E L B A E G A T S N U E + I + + + + + + + + + + + + + + + + + + 
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+ + A O + + + M O + S N H O I T E I E T Y N + G + + + + + + + + + + + + + + + + 
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+ + C L + D O + V I + R C C P + B + I + M S H C N + + + + + + + + + + + + + + + 
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E S E P T I C E M I A N + N B C + + + A + + + R + + + + + + + + + + + + + + + + 
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+ + + T N A N G I L A M + R I + B + V + + + R R + + + + + + + + + + + + + + + + 
+ + + E + L I + + + + + + + C H R O N I C + + Y + + + + + + + + + + + + + + + + 
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+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 

Code for the Day: Is Now a Good Time for a Z56.1 (Change of job)?

In case you haven't been paying attention lately, there are a few things happening in the health care industry.  We have Obamacare, the insurgence of accountable health organizations, implementation of electronic health records (EHRs), and a firm date for ICD-10.  If you google "fastest growing industries" you will find many of the top 50 jobs are within health care.  And according to the US Bureau of Labor Statistics, the job outlook for a medical records/health information technician (including coding) is projected to grow faster than average at 21% by the year 2020.

For a lot of people pondering a change in careers, these statistics might seem like a no brainer, yet the transition to ICD-10 has a lot of people wondering:  is now a good time for a Z56.1 (Change of job)?

A selection of my codebooks - note the ancient green SNODO book!

I do get email from people asking me this very question.  Is now the right time to become a coder, or should I wait?  The job of a medical coder is very attractive because most coders work from home and many work on a flexible schedule.  I've had Facebook friends from high school and other walks of life telling me that they are passing my blog information onto their friends and family because they are interested in coding.  But I continue to hear the question - is now a good time?

In typical coder fashion, there is no short answer!

First things first, though.  Now is a great time to become a coder.  But it's not going to be easy if you decide to start now.  We do have ICD-10 coming up on October 1, 2014.  But most coding programs will have you graduating before then, which means you will learn both ICD-9 and ICD-10 (oh, and CPT too!  But CPT isn't changing).  You could wait a couple of years so you don't have to learn both systems, but here are 10 compelling reasons I think you shouldn't wait:

1. Coding is 25% the codes themselves, 25% the coding guidelines, and 50% knowing how to navigate the massive word search that is a medical record (or operative report) and only abstract and code the right stuff.  This last 50% is the hardest part about being a coder and it takes equal parts natural skill and practice (lots of practice!).  Start practicing now.
2. The industry is abuzz with talk about what current coders will do when ICD-10 is implemented.  Some have already said they intend to move on.  You will want to be trained and ready to go when their positions are vacated.
3. You'll be "closer to the books" when it comes to ICD-10 and will probably get more intensive training than coders in facilities (except the coders I intend to train, that is!).
4. Training to become a coder takes time.  You can't finish a class on September 30, 2014 and expect to land a job on October 1, 2014.  You won't be ready.
5. Employers are about to freak out.  They have to implement ICD-10 in 2 years with limited resources and lots of moving parts.  They need to train their existing coders and my guess is, in about a year, they will not be as willing to take on a newbie as they are now.  If you wait, you may find it hard to get a job in 2014.
6. When it comes to ICD-10, all coders are on a level playing field - except for that 50% abstracting thing - which means you will have the opportunity to roundtable and network with experienced coders who will be just as clueless about ICD-10 as you are.  But you will have an advantage - they will be pulling up lots of old ICD-9 references and you will be asking them "why" a lot (e.g., "why can/can't I code X with Y?").  While you might think you are naive, this is critical to everyone learning ICD-10 - you will give the experienced coders something to think about and you may find you know more than you think.
7. Experience, experience, experience.  In coding, nothing is more of an asset than experience.  You could have all the coding credentials in the world, but without experience, they mean nothing to your future employer.  The more experience you have before October 1, 2014, the better.
8. There are lots of great cost-effective and maybe even free opportunities to network and learn.  All coders are looking for ways to come together and learn ICD-10 right now.  In Colorado, our ICD-10 Task Force has created ICD-10 Coffee Chat Meetups every other month.  We come together with cases and discuss ICD-10 coding in a roundtable format.  And it's free.  Your local AAPC chapter or AHIMA component state association may also have something available, so check it out. 
9. Attitude is everything.  If you tell a potential employer, fellow coder, or educator that you plan to wait because it doesn't make sense to learn ICD-9 and ICD-10 too, it's a huge red flag.  What it tells me is you don't want it badly enough.  Will it take extra work to learn ICD-9 and ICD-10?  Absolutely.  Will learning both pay off?  In spades - and it's not just about knowledge, it's your attitude to tackle the unknown.  I will take a positive attitude and willingness to learn over a stubborn attitude with experience any day.
10. ICD-9 will not be used on claims after September 30, 2014, but it will still be needed and we will still need people who know how to use it.  Many auditing entities, including Medicare's recovery audit contractors (RACs) are several years behind in their auditing and someone will need to double check audit findings and verify their validity.  Likewise, various groups and agencies who use coded data (e.g., Health Grades) are looking at old data as well.  If you can code both ICD-9 and ICD-10 and better yet, compare data between the two, you will be an asset.

So what are you waiting for?  Get going!

Do You Have the Skill to be a Coder?

Perhaps you got stuck on the word "skill" above.  If you did, you're very astute.  Try as they might, not everyone has the skill to be a coder.  It takes a lot of knowledge in the medical sciences, detective abilities, and knowledge of coding guidelines.  Do you have what it takes?

I usually ask people who want to be coders if they like word searches.  A prompt "no" makes me a little wary.  Because medical records are word searches - you won't truly read an entire medical record because there simply isn't time.  And, as I am fond of telling some of the newer coders who find their way into my classes, just because there's a code for it, doesn't mean you assign it.

Here's a little word search for you to test out your skill.  The words are some that we see often in coding and are found forwards, backwards, up, down, and diagonally.  Yes, it's hard - but so is coding!  I will publish the solution tomorrow.

C S R G N V T S Y R O T A R I P S E R U T C A R F T A L S V I D B Q O U I N E I 
S U P K K H N I G C Y D G E V I T A R T S I N I M D A I H K V D Q G U Z X G R W 
E B V Y S L Q S O H I X P C C Y L Z P V P E G G K U P W T C O L W T B X B P I X 
L A T N E M P O L E V E D O R U E N S S X O Y V M G U V H Y R N M R X X B B V I 
O C S M Q O E R O M F E G N C V N E Z S G M P Q L I C M C B C Z H L H O H V J V 
G U R U U V O E I O A H L S D D H U B I F X I T P K M T R E M I V N I H O S V S 
S T T U E C Q L S T S T A T U S G L V U W N L B N T Y M R C M M G X P P Q U D S 
H E D P L J J C Y H O V U R M V N F J O P R T X J H A E K T E G Y G Q G S P Q I 
U W H Y A C M S H E O L C U O O I N P A V R M N K B P D B X W Z Q V F Z W X B J 
F Q X Y E T E O P R F U O C I U N I T A B E D C Y S F E Y B E C T C Z M O A I L 
C N S T P S I R B A T E M T G Z E I P S B M N X F C Y Y U J H O B K V K L U H H 
I W D I U E R E I P N H A I E G E P T T Y I I F O Q K R H P Q E L G H L E K B X 
U E C D S Y R H N Y S C R V S N R H I O Q S I E T K J R L O R R N Y R Q M E Z P 
M A N I F E S T A T I O N E T O C D A X R S X C V O B T P I L P K E L E F H P S 
W R U B C I S A E L B A E G A T S N U E K I Y B C X V O P R Z V V D H D L T I M 
F M K R V O I M P N E G G C T T A I S I S O N G A I D M I J P C H K X H U W Z R 
X Y A O U Q H M O I S N H O I T E I E T Y N I G A G O J V J N S O H X J E P L Q 
C F F M Y N O I T A N I B M O C S N T J M O X T T B E X N F V E D J P L X P J V 
A S T O Z C T P G Q O S V M N T D Y E S P C I D Y C H X C I P J Z F N W U C I P 
P A E C R A S F Y P E O Y E A Q X P B D T L S P W F A T E H E K X C X W Y C V S 
Q I R K U D U E V R H D G N L M B K A K O O A G T N W Q W W F T G U H D N R W X 
X V C L U D O E V I E R C C P Y B V I G M S H C N V Q Y R M G X V J Y X L K C V 
V G A U E I I A U N T E R O H E L U D I S E A S E Z V T Q A D W K O E X B U G N 
S V R J H T T P H C G D Q U A V Y M L L K R J U S W O X S K V V F I Y V F M C Y 
E S E P T I C E M I A N T N B C R I C A X M L R F D H Z E X L H E M Z Z O C C V 
N D N I O O E L J P M U T T E L T R W T T F C G V T C L C E F W Q H X Z Y R E I 
R K M N D N F M M A S A E E T W I I H N C O Q E M W T D A O Y P M Q M D U G E L 
W N N T N A N G I L A M N R I S B Z V E N X R R X C Z B H S B O Q E I X N K O S 
P S Z E P L I C H L T A L J C H R O N I C F F Y J J C D D O D H X W R Q H R O K 
E U M G D N L K U W S U Z T A O B R R C T W Q M E K T A D W M V B M C V R Z M G 
T T O R E W U E F R D H J X T T G X U N D Y U A A V W P H H A T G J Z J A J G C 
N E L A D W S S X J L U V O M W A C B V I P S Z Y O P G P O T L G F N K Z I J J 
R R D L U P N V F G I H D Z B W L A X J W I V M I O H X Z L T R O F X X X M O Q 
W G L U Y H I Z L L N K D U Q B K O T K K P Q C V F K K I U T C C X F L B H T K 
W D O B E M A A D Y T O R A N P R X S S N Y V S X D Q N X Y D N Q T T R E H V K 
M N H A F U P K N E F K S A P Y H W M D N G O S N Z D O N X C X E E V H K K R P 
H Q L T D H W G K R P Q P F U V V E Z J J N O X Y I R I V N V A Q U F M Q W A E 
I W E O C D A K I A S N R G L I M H D E Q B H M O X F N K U I A T U V J C Q R Y 
F W N T B A I Z O W V M H J O T K N X S A N M K S H X F F D O C N S S E A H A O 
F A C L G Y M L E P P E Z L J A H I R H Y B K N H L M Z C L G R L R E E D C T G 

Word List: 

ACTIVITY
ACUTE
ADDITIONAL
ADMINISTRATIVE
AFTERCARE
AHA
AHIMA
ALPHABETIC
AMBULATORY
AMI
ANATOMY
APPROACH
ATHEROSCLEROSIS
BURN
BYPASS
CAD
CEREBROVASCULAR
CHEMOTHERAPY
CHRONIC
CMS
COEXIST
COMBINATION
COMORBIDITY
COMPLICATION
COPD
DIABETES
DIAGNOSIS
DISEASE
DRG
EGD
ENCOUNTER
EVALUATION
EYE
FRACTURE
GESTATIONAL
GLAUCOMA
HYPERTENSIVE
INFECTIOUS
INFLUENZA
INPATIENT
INSULIN
INTEGRAL
MALIGNANT
MANIFESTATION
MONITORING
MORBIDITY
NCHS
NEURODEVELOPMENTAL
NEWBORN
OBSERVATION
OUTPATIENT
PAIN
PHYSIOLOGY
PLACE
PRINCIPAL
RECONSTRUCTIVE
REMISSION
RESISTANCE
RESPIRATORY
SCREENING
SEPTICEMIA
SEQUELAE
STATUS
SUBACUTE
SURGERY
SYMPTOMS
TABULAR
THREATENED
UHDDS
ULCER
UNDERDOSING
UNSTAGEABLE
VAP

Word search created using http://puzzlemaker.discoveryeducation.com/.   

Code for the Day: Pillow Fights in the Dark Are a Bad Idea - Y93.83

I am that geek who asks for copies of my operative reports.  My doctors usually look at me a little weird and tell me how boring they are, but nonetheless, I collect operative reports.  I have certain friends, family, and coworkers who have joined the cause and will ask for copies of the report for whatever procedure they had done recently.  In fact, I recently acquired a tonsillectomy.

While this may seem to be a rather strange collection, for me it's purely educational.  I like to teach from real operative reports, so I collect them and use them in training materials.  A couple of weeks ago, I dusted off one of my previous procedure reports in preparation for ICD-10-PCS training.  It was for a septoplasty and turbinate reduction after what one of my doctor's not-so-lovingly referred to my as my "100-day cold."  When I finally saw a specialist, she determined that I had trouble due to a deviated septum, which was caused by an old fracture - probably during childhood.

When I told my mother that I had a deviated septum, probably due to an old nasal fracture from childhood, she could see where I was going.  We both knew how my nose got broken and who did it. 

My brother and I were pretty close growing up.  Only three years apart in age, we spent a lot of weekends and cold snowy days playing together.  On the fateful night in question, I remember we were in his room having a pillow fight.  Mom and Dad were watching TV in the living room.  We had been smacking each other around with pillows for a bit when we decided to add a degree of difficulty.  Let's turn out the lights!  It's all fun and games until someone gets smashed in the nose with a fist.  Unfortunately, it was my nose, which immediately began gushing blood.

I remember thinking one thing and one thing only: if I holler loud enough, my parents will come down the hall to see what's up and my brother will get in a lot of trouble for decking his little sister in the nose.  It didn't work.  I had a lot of nosebleeds as a child and my brother had watched my Mom stop the bleeding many times before.  Within seconds, he had me lying on the bathroom floor with one of the nosebleed-approved washcloths and he was mopping up the blood, making sure I was pinching the bridge of my nose, and telling me shut up before Mom came down the hall.  Duh.  That was the point!

The bleeding stopped.  Several minutes later, Mom came down the hall, asked what happened, saw that my brother had the situation under control, and returned to the living room.  Well, that plan kind of backfired.  It seems the fact it actually was an accident and his nurturing nature prevented him from getting in trouble. 

At any rate, about 25 years later I found myself sitting in the office of an ENT who wanted to straighten out my septum.  And then I realized that there's a code for this after-the-fact injury and I was very excited! 

• S02.2xxA, Fracture of nasal bones, initial encounter
• Y93.83, Activity, rough housing and horseplay
• Y92.013, Bedroom of single-family (private) house as the place of occurrence of the external cause

The codes here refer to the initial injury, had I received medical treatment. I love that there is a specific code for horseplay as the activity.  And check out that place of occurrence code - it's pretty darn specific, down to the bedroom of a single-family home.

Of note, had my doctor documented in my record at the time of surgery that this was due to an old nasal fracture, I could have used this code:

• S02.2xxS, Fracture of nasal bones, sequela

As for my brother, he loves this story.  I remember relaying the saga to him one evening when we both happened to be in the same state during a business trip.  When his wife phoned soon after that, he proudly declared to her that he had broken his sister's nose.  "Just now?!," she exclaimed and then he had to tell her the story.  It's funny now - especially years after the surgery.  But if you have kids, just warn them.  Pillow fights in the dark are a bad, bad idea.