How to Get Started in a Medical Coding Career

I'm trying something new and launching a video blog.  You may have noticed that I haven't written much lately and that's mostly because I can't write anything quickly without a million edits.  And with a full time job and small child, ain't no one got time for that!  Not that the videos aren't without outtakes and redos, but they do seem to be quicker (when I put all vanity aside and ignore the bad hair days).  The frequency of videos is yet to be determined, but you can bet it will be related to how often I decide to do hair and makeup while working from home!  It only took me just over a month to get the nerve to post this first video.

This episode was inspired by countless social medial posts where people are asking how to get started as a medical coder, so that is answered here.  Where do you find a program?  AHIMA or AAPC?  CCS or CPC?  Don't enroll in a medical coding program without watching this video first!  And share this video with anyone you know who wants to be a medical coder.

In the video, I mention two websites and here are direct links to the pages that will help you locate coding schools:

• AHIMA
• AAPC 

Both websites have information about coding schools with face to face instruction as well as web-based instruction.  Best of luck to you!

I Bet You're Wondering What I've Been Up To...

Oh wow, has this been a crazy fall! Up until this year, "Rocktober" was a term we used in Colorado whenever our beloved Colorado Rockies made it to the playoffs. This year Rocktober took on a whole new meaning for me. And while it was a great month, I am so happy to say it's over and now I can concentrate on the less busy holiday season. Yes, October was that busy!

As you saw from some of my blog postings, I kicked off October in true coder fashion by attending the AHIMA Convention and Exhibit in Salt Lake City. What a great opportunity to learn the newest, latest, and greatest from some of the nation's best HIM and coding minds and get in some serious networking as well. This year was particularly busy at convention as I was honored with an AHIMA Triumph Award for mentoring, mainly due to my efforts with the Coder Coach blog and some of the networking and educational events I've hosted over the last couple of years. It was an incredible honor and to help commemorate the occasion, I took my personal and professional mentor - my mom (pictured here with me) - along with me. It's hard to tell who was more excited about my award!

This was also the first year that I was chosen to speak at the national level. I presented an outpatient track at the coding meeting on the overlap between coding and charging in the cardiac cath lab. As if that wasn't enough, I just couldn't say no when another Triumph Award recipient and fellow Coloradan, Dee Johnson, asked me to be a part of the Student Academy. Dee is a student at Arapahoe Community College, my alma mater here in Colorado, and was a key planner in this year's Student Academy. The academy is a free event for students in AHIMA programs at the convention each year. I was a part of the mentor lightning rounds where several established professionals spent a few minutes with each group of students to share our experience and answer questions. All of that and Apolo Anton Ohno too! The Olympic athlete and Dancing with the Stars champion was our closing keynote speaker and he had an inspiring message about giving it your all.

Once I was back at home, there was no rest for the weary as I delved into not one, not two, but FIVE client trainings. For those who aren't aware, training sessions take about 4-5 times as long to prepare as they do to present but the work is always well worth it when I get to training. That is my favorite part of my job because it combines two of my great talents: coding and talking! My last week of training involved three training sessions, work-related road travel, a snow storm, and, of course, that inevitable sinus infection as a result of a crazy month. I would love to tell you that following that last training on October 28 I headed out for happy hour with my friends, but truth be told, I had a nice evening vegging out on the sofa and catching up on all my DVR'd shows!

So here we are in November and I'm trying to wrap a few things up before the holidays. Last weekend I met with a fantastic group of super coder geeks (birds of a feather!) who were so amazing to not only spend their own time coding some records in ICD-10, but to also give up a Saturday to come together and talk about the results. This is a project that the Colorado Health Information Management Association's (CHIMA) ICD-10 Task Force has undertaken to assess documentation readiness for ICD-10. I have had a great year chairing this task force and working with an enthusiastic group who is making great strides as a clearinghouse for ICD-10 information in the state of Colorado.

Last week I was interviewed by ICD-10 Watch, a terrific resource for anyone interested in ICD-10. We specifically chatted about the fantastic opportunities that await coders as we transition to ICD-10. The interview is recounted in the blog posting How ICD-10 can create opportunities for medical coders.

Whew, I think I need to take a nap now that I've recounted the previous month's events! I plan to get back to the ICD-10-PCS series in another week or two, but bear with me - November's calendar is starting to fill up, so it might be 2012 before I can give the series the attention it deserves. In the meantime, I hope everyone has a terrific holiday season.

Spotlight on Certification: The Certified Coding Associate (CCA)

I get a lot of questions from interested individuals about coding certifications. Like it or not, employers are looking more and more to credentialed coders to staff the workforce. It's almost impossible to get hired without a coding certification -but which one is right for you? What do the different certifications say about your qualifications? And what will you have to do to maintain your certifications?

I thought I would help out by spotlighting different coding credentials. There are two main organizations I will focus on and there are a lot of certifications. So be patient - I will get to all of the AHIMA and AAPC credentials eventually! And remember - I hold certifications with both organizations, so I'm not here to sell you on any single credential. If you plan to work in hospitals, AHIMA credentials are more widely recognized whereas physician offices usually require AAPC certifications. Before you decide which organization to join, do your homework and find out what credentials they require where you want to work.

I'd like to start with the newest AHIMA credential, the Certified Coding Associate (CCA).

I've never taken the CCA exam because when it came out, I was already certified as a Certified Coding Specialist (CCS). And while many aspire to be a CCS, AHIMA doesn't recommend taking that exam until one has at least 2-3 years of experience as a hospital inpatient and outpatient coder. But what about those people who have taken coding classes and want to prove they know a thing or two so they can land an entry-level coding position? Enter, the CCA credential.

AHIMA created the CCA credential to demonstrate one's "coding competency in any setting, including both hospitals and physician practices." In essence, it lets your future employer know you've taken the core coding and HIM classes. When I talk to people who are trying to begin coding careers, I often hear them say something along the lines of, "Why should I waste my time with an introductory credential?" or, "It's a waste of money."

Well, from my perspective, if you have taken the time and effort to take the CCA exam, it tells me one big thing: you're serious about coding as a career because you took the initiative to study for an exam. And if I were hiring, that is something I would definitely take into account. Coding certifications cost money - it's an occupational hazard. But being without a coding credential most likely means not having a career as a coder. Which do you want more?

CCA Specs
The CCA credential, as mentioned, is available through AHIMA. It costs $199 for AHIMA members to take the test. If you aren't a member of AHIMA and plan to work as a hospital-based coder, I highly recommend joining. Again, another cost that is important to your career if you're serious about working as a coder. If you aren't a member of AHIMA, the cost is $299. The CCA credential is the only HIM credential worldwide that is accredited by the National Commission for Certifying Agencies (NCCA), although I've heard AHIMA is seeking the same approval for other credentials.

As for content, it's not just coding. And I think this surprises a lot of people who take the test. It also tests for HIM-related competencies. That's something to keep in mind when you're studying for it. There are six domains that make up the CCA test:

1. Health Records and Data Content (20%)
2. Health Information Requirements and Standards (14%)
3. Clinical Classification Systems (36%)
4. Reimbursement Methodologies (10%)
5. Information and Communication Technologies (6%)
6. Privacy, Confidentiality, Legal, and Ethical Issues (14%)

The tasks for each domain are outlined on AHIMA's website along with FAQs and other important exam information. If you plan to take the CCA exam, I recommend spending a lot of time on the CCA page.

CCA Jobs
The CCA credential is still relatively new for those of us who have been around for a decade or so. And I admit, as a profession, we're a little slow to accept new ideas sometimes. Job postings may not state the CCA credential as one that is accepted. My general rule is, if the job calls for a CCS and you have the CCA, apply for it. The employer may not get enough job applications from qualified individuals. And if it was me, I would certainly look at a CCA with more interest than someone without any certification. The credential is catching on, though, and I'm starting to see it in job postings. So, do I think it's a credential worth getting? If you don't have any other certifications, then yes. Absolutely!

Curious about whether or not to take the CCA if you have an RHIT? If so, check out this past blog of mine on the HICareers website: "Should There be a CCA After RHIT in Your Title?"

Two Track Mind: ICD-10 and Vascular CPT Coding

Do I seem like a stranger? Because I feel like a stranger. These days I have two things on my mind: ICD-10 and the CPT coding changes for vascular procedures. And pretty much anything outside of these two topics isn't getting much of my attention lately - including blogging. So in an effort to provide you with a recent blog post - and to keep my attention focused on the tasks at hand - I figured I would blog about what I've been up to recently. This will give some insight into the challenges that existing coding professionals are facing today.

Before I let you in on what's been on my plate, I should mention that there is no crossover between these two topics. They are two very different aspects of coding that use two entirely different parts of the human brain. Or at least, they use two very different parts of my brain! When asked why I am so deeply involved in two areas that are so vastly different, all I can say is, I love a challenge. And challenged I've been!

CPT Code Changes

I know what you're thinking. "It's March, Kristi, the CPT code changes were effective January 1 so that's old news." Well, the reality is, it takes some time to get used to new codes. Since I spend a significant amount of time as a subject matter expert (SME) for my clients in the realm of cardiac catheterization and peripheral vascular interventional radiology coding and charging, I can tell you that 2011 has presented my clients with some significant challenges. First of all - the deletion and nearly complete overhaul of the cardiac catheterization section of CPT. If you have a chance to look at a 2011 CPT codebook (I recommend the Professional Edition since it shows all code changes in color-coded fashion), and compare it to a 2010 book, you'll see what I mean.

My biggest challenge? They changed the code descriptions and code numbers, but in many cases used the same digits - just in a different order. A dyslexic's nightmare and yes, yours truly is dyslexic. There are a couple of perks now - we no longer have to worry about coding left ventriculography separately, it's bundled into the left heart catheterization code, and for the most part, supervision and interpretation (S&I) codes are a thing of the past.

The peripheral vascular coding is getting really interesting. This year the American Medical Association (AMA) decided that leg revascularization procedures could be more effectively reported using bundled codes. This new Wal-Mart approach to coding is becoming more commonplace in interventional radiology (IR) coding. What do I mean about Wal-Mart codes? Well, vascular IR coding has historically involved the separate reporting of all procedure codes, including the catheterization or approach, which is typically a no-no in coding. The end result is often a list of 4 or 5 codes to describe one procedure. Wal-Mart coding is "one stop shopping" where everything is included in a single code. Maybe I should call them Ragu codes for those who remember the old Ragu pasta sauce commercials. You know - "It's in there!" This Wal-Mart or Ragu concept of coding means unlearning many complex IR coding guidelines that have been ingrained in our brains over the past few years.

The new leg revascularization codes are set up based on a heirarchy - angioplasty followed by atherectomy followed by stenting - with newly established vascular territories. The iliac territory consists of three vessels. The femoral-popliteal territory is treated as a single vessel. And the tibioperoneal territory as three vessels. To make things more confusing, the AMA deleted all of the atherectomy codes from Category I in CPT and moved them to Category III.

And because IR is arguably the most difficult area of CPT coding (as an IR SME I may be biased), someone has to research all this and educate coders on the changes. Thus, I find myself updating training materials with these changes and presenting the changes. If the areas of cardiac catheterization and IR interest you, I suggest you acquire a solid foundation on basic medical coding first. These 2 areas are difficult for even the most seasoned coders.

ICD-10-CM and ICD-10-PCS

Well if you're a coder, a coding student, or have done any research at all about the coding field, you know we're in for a huge change with the implementation of ICD-10-CM and ICD-10-PCS in 2013. I would like to say that all organizations are in full swing and getting ready for the transition. What I'm hearing as I talk with organizations, though, is that they are just getting started - a full 1-2 years behind the recommended schedule.

In recent weeks I've taken my ICD-10-CM/PCS trainer recertification through AHIMA and kicked off a Task Force through the Colorado Health Information Management Association (CHIMA). As chairperson of the ICD-10 Task Force here in Colorado, I've had the chance to meet with providers and organizations who will be impacted by the ICD-10 code sets. And I am also embarking on a project through AHIMA to get ensure that Colorado Medicaid is ready for the transition.

In addition to that, I'm preparing presentations for the spring conference season and developing ICD-10 tools and training programs for my company. Here's a shameless plug for The Wilshire Group - just in case you're looking for some additional ICD-10 references! My favorite part is the ICD-10 countdown. I've set this as one of my home pages so I can feel the urgency every time I open my browser!

Prepare for Your Challenge

If you really have a passion for coding, then this commentary got you really excited to learn more. I wish I could properly convey how much more difficult coding is than simply looking up a code in a book. And I wish you could get an accurate depiction of what your daily work will look like as a coder. But the truth is, you don't really "get it" until you get into it and although I know so many are frustrated because they can't get the required experience to get hired, I've said it time and again - keep trying to find an angle to get the experience you need to get your foot in the door. And once you're in, I hope you're ready for the challenge because it's a constant learning experience.

Back Away from the Keyboard...

This morning my alarm clock went off at 7:00am, just as it does on most work days. Like most anal-retentive coders, I have my morning routine, which includes the usual suspects like brushing teeth and shuffling into the kitchen for that all important initial cup of coffee. Once my breath is fresh and my eyelids are open, I flip on the computer and wallah! I'm at work for the day. My work day routine begins by scanning my work, Coder Coach, and client email accounts. Sometimes I venture onto the Coder Coach page on Facebook to see if anyone has posted anything. Maybe I send or receive an IM to or from a client or coworker. Maybe I actually pick up the phone and call someone (not terribly likely). But rarely, in my daily dealings as a remote coding consultant, does my work involve face-to-face communication with people. And frankly, I miss it.

Let me be clear. I love communicating through email. I have relationships with friends in other states solely based on email. I have trouble communicating with people who hate email. I have access to six email accounts, Facebook, Twitter, LinkedIn, and Yahoo IM on my iPhone. In other words, I am always virtually connected to just about any of my contacts at any given time. But there is no substitute for in person communication. And that's part of the reason why my Coder Coach events are not offered in an audio conference format.

I've been asked by several people from out of state to offer my Coder Coach events as webinars. Besides the fact that I have oodles of experience as a webinar presenter - for several years I presented 2-3 webinars per month - and I understand all too painfully well everything that could possibly go wrong with the technology aspect of the presentation (I know Murphy well!), I have no desire to feed into the increasing trend of discouraging face-to-face communication. And speaking of feeding, public speaking is one of my favorite things - it energizes me and feeds my desire to keep going with my career. Webinars just aren't the same. Frankly, my pets don't seem as enthused about learning coding as my human audiences (normally) do!

And it's not just the novices who want to network from afar. This new year means a lot of committee and board work for me. And even though my board meetings are offered in a conference call format, I try to attend the meetings in person. Two of the committees I work with have decided not to offer conference calls for their meetings because the chair persons are growing concerned about the lack of face-to-face networking among professionals. There are more opportunities to get educated remotely and that means that those face-to-face networking opportunities are more important than ever. Because if you're trying to break into the industry, look for a new job, or just (as my father used to say), "blow the stink off," you need to get away from your gadgets, get out of the house, and start talking to people.

So I encourage all of you to back away from the keyboard every now and then... that is, after you've researched online for the best local networking event. And get out and meet someone in person!

For local events near you, visit AHIMA's state component association web page at http://www.ahima.org/about/csa.aspx or the AAPC's local chapter finder web page at: http://www.aapc.com/localchapters/find-local-chapter.aspx.

Happy networking!

I Have a Degree, Why do I Have to Volunteer?

I meet so many people who are out there looking for their initial break into the field of coding. And so many of them are discouraged when they are continuously told that they need experience in order to be eligible for hire. The first recommendation I make is always to volunteer and many times that advice is met with resentment - "I have a degree - why should I have to volunteer?"

Well this is where I usually try to put on my politically correct attitude and explain why but I think what I'm going to start saying is "I have a degree, certifications, and 15 years of experience and I volunteer." As a matter of fact, I can't name a single person in the coding field who's successful who doesn't continue to volunteer because so much of the coding profession is governed by volunteers. And if you're a member of AHIMA or the AAPC and you don't feel like you're getting enough out of your membership (or, like me, you're just really passionate about what you do), you have the ability to get involved and affect change.

So let's talk about what volunteering entails and the kinds of doors it can open.

Pink Ladies and Candy Stripers
If you've ever visited a hospital you've seen them. They sport little lab-type coats in pastel (usually pink) colors and work in the hospital gift shop. They're the volunteers that most of us think of when we think of volunteering in a hospital. Or maybe you were picturing the candy cane jumpers of the candy stripers. Well, there's more to volunteering in a hospital than being a pink lady or candy striper.

There is a department in each hospital responsible for selecting, training, and scheduling volunteers. And since most people who offer to volunteer in a hospital prefer to work directly with patients and the public, this leaves prime voluntary real estate in the HIM department. If you offer to volunteer at a hospital and specifically request to work in the HIM department, chances are pretty good the competition is low (unless you told your fellow classmates about this blog!).

Okay, so volunteering in an HIM department isn't going to be glamorous. You won't be coding charts your first day there. But if they use paper records, you might be hunting for records for the coders to code. You might be scanning in paper forms into the electronic medical record. The point is, once you're in the department, you can start to observe the inner workings of an HIM department. And if you pay attention and ask questions, your experience will come quicker than you ever imagined.

Professional Volunteering
I used to feel bad for not spending more time at the local animal shelter volunteering. I just felt like I needed to be doing something in my spare time rather than meeting my friends for dinner. But I soon realized that I had ramped up my professional volunteering so much, that it was probably okay I didn't have time to go pet 200 cats on a Saturday afternoon. My pets appreciate that I don't come home smelling like 200 cats anymore!

The best career advice I can give is to join one or both of the national coding associations: either the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA). If you want to get hired, you go where the employers are and they're members of AAPC and AHIMA. But becoming a member isn't enough. Now you need to network. And members of the AAPC and AHIMA network at events. So you need to go to the meetings and start talking!

This is usually where someone tells me how expensive those events are. And that cost is on top of the membership fees. If you don't have a job, you don't have the money to attend. Yes, it's a catch 22, but there's a loophole! The people who put those programs together are professional volunteers. And often, as a reward for their work, they get to attend for - wait for it - **free**. Or maybe a hefty discount. The point is, if you really want to attend, there are no excuses.

The professional organizations are made up of local organizations - state and/or regional - and they usually have boards. Boards are made up of elected individuals who are volunteering to run things on a local level. Whether it be a local AAPC chapter or your state AHIMA component state association, the boards get together for regular meetings to keep the organization afloat. They also discuss issues pertinent to the industry and how hospitals and physicians are reacting. Just attending these meetings can be an eye opener to the real challenges HIM and coding professionals face. There's also a lot of networking that happens at these meetings. I've both hired and been hired from networking at such events. And if you offer to chair or sit on a committee, it can be a great way to show off your skills and work ethic and make employers stand up and take notice.

I currently sit on a board that has a student liaison and at one of our meetings I had the opportunity to chat with her. She was so excited to be there and so excited about the chance to be a part of the board. I asked her how she heard about it and she said a mentor recommended becoming a member and from there she took the lead and asked the president about getting involved. We happened to have the student liaison position available.

But once you're in, I recommend keeping up the volunteering. I know a lot of colleagues who complain about how the organizations are run. These are usually people who don't vote in the organization elections or offer to help out either. So I look upon professional volunteering much as I do being an American citizen. I vote to earn the right to complain when things don't go how I'd like. And I volunteer in organizations so I can be a part of the change - even though things don't always go my way!

Put it on Your Resume
Volunteering isn't just a futile exercise to torture you and make you give up your precious time. It's a key component of your resume. Put everything you've done as a volunteer on your resume because it shows your commitment to the industry and it could mean the difference between equally qualified applicants.

When I first started running for board positions, I remember how inconsequential my volunteer experience looked compared to other candidates. But just build them one at a time - we all have to start somewhere. And over time, you'll see your list snowball. Here's an example of my volunteer history, as it appears on my resume:

• 2010-2011 - First Year Director, Colorado Health Information Management Association (CHIMA)
• 2011 - ICD-10 Task Force Chair, CHIMA
• 2009-present - Coder Coach mentor
  
• 2009 - Past President, Northern Colorado Health Information Management Association (NCHIMA)
• 2008 - President, NCHIMA
• 2007 - President-Elect, NCHIMA
• 2005-2006 - Program Co-Chair, NCHIMA
• 1999-2001 - Data Quality Committee Chair, CHIMA
• 1998-1999 - Alternate Delegate, CHIMA

It's a Small, Small World
Here's an important thing to keep in mind when volunteering. Coding is a very small industry in the grand scheme of things, so be careful what you say about whom when you are working in a voluntary capacity. Or any capacity, really. Don't burn bridges because it's not a matter of if, but when will you come across this person again? And don't think moving out of state is going to help out much. There a lot of coding professionals, myself included, who cross state lines. And rumors spread like wildfire, which can be both good and bad for you. Make sure you're one of the people that when someone decides to gossip, they say, "Have you ever met _____? She did some work on a committee I was on and she has great potential for the future!"

So come on out and join my colleagues and me for some volunteering - it's not just for novices!

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.

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)

Happy Summer!

You may have noticed a blatant absence of new blog posts. I've been busy with a new client and taking advantage of summer, which, I'm sad to say, is almost over (boo!). That's meant a break from my Coder Coach events and, yes, my blogging too.

But fear not! I will be posting some small blog posts to tide you over until September and I just submitted a couple of blog posts to AHIMA's HI Careers website, so you won't miss out. Be sure to check out my latest HI Careers post entitled "Experience for the Inexperienced" at www.HICareers.com and be sure to also check out the other blogs and offerings the website has to offer.

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

How the Coder Coach Spends Her Time

You’ve read the blog postings before – I am very passionate about helping folks break into the industry. And as I step on my soap box to tell novice coders to be persistent and network, someone inevitably asks me if I hire new coders. The honest answer is no, but it’s not because I wouldn’t if I had the opportunity. The truth is, as a consultant, I am working with clients who expect - and pay a premium for - experienced coding knowledge. And because I am not in a position to hire new coders, I write this blog, present monthly Coder Coach events, and tweet relevant articles I come across. When I give that answer, the next inevitable question is, “What do you do as a consultant?” So I thought I would take a moment to tell you what I’ve been up to lately – in my day job.

Because I work for a small company, we get a wide array of requests, so to many, my job may seem like a crazy schizophrenic mess. I can’t possibly put down everything I do without writing a small book! So I decided I would take the last couple of weeks and give you the rundown.

I’ve been working with a client for about a year to improve their coding and charging accuracy in the cardiac cath lab. While that may seem simple and straightforward, the client is a large teaching hospital and training the coders isn’t enough – we also need to talk to the nurses, techs, and doctors about documentation. Last week I traveled to the client and presented seven identical training sessions to the nurses and radiology techs in the cath lab on how to improve their documentation. Each presentation was two hours. And that two hour presentation took about a week to prepare for. In between training sessions, there were meetings with cath lab and HIM management and time spent one-on-one with one of the coders who had questions on some cases. I had an extra treat last week when we were invited into the cath lab to see some procedures being performed.

During the evenings last week I put the final touches on two presentations I needed to submit for this week’s AAPC chapter meeting and also met with my boss about a potential new contract that would significantly impact my summer work deadlines. After traveling home, I attended my first board meeting as a director for the Colorado Health Information Management Association where we planned our strategic initiatives for the coming year and I took a few moments to stress the importance of hiring new pros and expressing a need to get more employers on board (I just want you to know that I’m also preaching to my peers!).

This week my time was split between clients as I prepare for training a client next week on injections and infusion coding and follow-up with my cath lab client on the issues from last week and plan the next round of training. I spent several hours analyzing client data and doing a couple of chart audits. Last night I spoke at the AAPC chapter meeting and networked with some folks a bit. Today I will be pulling together the handouts for the next Coder Coach event and again preparing for next week’s training.

Over the coming weeks and months, I have several training sessions to prepare for with clients, client reports that need to be written, and client meetings that need to take place. I am also working on our company’s plan for ICD-10 training, writing white papers on ICD-10 implementation and training and presentations for two AAPC chapter meetings next month. We don't want to think about it, but fall is right around the corner and it's the busy season for consultants as we study the code changes and read the Federal Register for changes to code-based reimbursement for next year. Amid all of these tasks are a myriad of other little “to dos” and more than one project I’m not yet aware of. In my spare time (?!), I blog, network, and do other miscellaneous things for the Coder Coach group and soon will also be blogging for AHIMA's new HI Careers website.

So if you ever ask me what I do and I pause and say, “Um,” it’s because I’m trying to remember exactly what it was I did that day!

Repost: Make $40K Working from Home as a Medical Coder!

We've all seen or heard those bold tag lines in print ads and on television and the radio advertising the lucrative opportunities in medical coding and billing. But can companies and schools who make these claims really get you ready to enter the work force? Maybe, but there are some steps you should take before you give your money to any education institution. Let me first state that I am neither here to endorse nor denounce any school or college. I am simply trying to arm prospective students with the knowledge they need to make the best choices about their future careers.


Step 1: Assess Your Community's Need for Coders
Before you hand any money over for that coding program that promises to deliver, you need to do a little homework about your local job market. Yes, it is true - there is a national shortage of coders and the need for more coders in the future is only expected to increase. But that doesn't mean that coders are needed everywhere. Some places may be saturated with coders and others may have a desperate need for them. Are you willing to relocate in order to get the job of your dreams?


The "American Dream" of the coder is to work from home, but the reality is most remote coders are experienced. Most employers require new coders to work in the office setting before allowing them to log in from the comfort of their pj's and fuzzy slippers. So if you are banking on working from home, add a couple years onto your telecommuting goal. If you aren't willing to relocate and there aren't coding positions in your area, you will have a tough time finding a job. While you're searching your local job market for coding positions, see which coding certifications they are requiring. This is going to be very important for Step 3 below.


You should also start to look at what the salaries are for your area. Salaries will range by region and health care setting. Hospital coding jobs typically pay more but they also typically require more expensive education.


Step 2: Determine What Type of Health Care Setting You Want to Work In

This is a tough one to determine if you don't know anything about coding. But think about what type of environment you prefer to work in: physician office or hospital? You may think, "What's the difference?" Plenty. Not only does each setting have its own preferred set of coding credentials, the coding rules and sometimes even the coding systems differ according to health care setting.


Coding for the physician setting generally involves both coding and billing for physician time and effort. This can vary from coding for one or a small group of physicians to coding for large billing offices or health maintenance organizations with hundreds of physicians. Often physician coders become very knowledgeable of a specific specialty, such as cardiology or orthopedics.


Coding in the hospital is segregated from billing. Because coders are coding for the hospital resources (e.g., equipment, nursing and ancillary staff), they are coding entire hospital stays rather than individual physician visits. Most hospital coders code a variety of cases and generally aren't specialized - although some difficult areas of coding like interventional radiology may result in the training of specialty coders within the hospital.


I'm over simplifying the differences, but you get the gist of it. You may want to start by perusing websites for the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) and read through their online information to see if one triggers an interest over the other. While it's not a hard and fast rule, AAPC-credentialled coders are typically recognized more by physician groups and AHIMA-credentialled coders are recognized more by hospitals.


Step 3: Pick a School That Will Prepare You for Certification

Can you get a coding job without coding certification? Yes. Is it likely? No. If you want to be a coder, you will need to be certified. Pick your school based on the certification it will prepare you for and be wary of schools that offer their own certification - they are typically not accepted by employers. Your future employer should be determining what type of coding certification you need, not the school. The two reigning accrediting bodies for coders that are recognized by employers are the AAPC and AHIMA.


Probably the best way to pick an educational program is to go to either the AAPC or AHIMA's websites and choose one endorsed by the organization with the certification you aspire to get. By doing this, you know you are getting your coding education from instructors and/or schools who have been "checked out" by industry experts.


The AAPC has online and instructor-led courses that prepare the student to take either the Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H) coding certificate. Some of these courses may be applied toward credit at the University of Phoenix. There are also various other colleges and schools that will inform you that they prepare their students for AAPC-certification.

AHIMA does things a little differently by accrediting colleges that meet their stringent requirements for program content. While AHIMA has historically been known for certifying individuals who have completed either associates or bachelors degrees at AHIMA-accredited instutions, they also realize the need for coding certificate programs. Many of the schools that offer AHIMA-accredited coding programs also offer degree programs and you may find the counsellors trying to talk you into a degree program. If all you want is to be a certified coder and are not seeking an associates or bachelors degree, don't be distracted from your goal. Stand your ground and tell them you only want the coding certificate. If you are seeking an AHIMA-accredited coding certificate program that will prepare you for AHIMA certification, go to their website (http://www.ahima.org/) and search schools in your area. There are also search options for distance learning if there isn't a school in your area. AHIMA has the following coding credentials:

• Certified Coding Associate (CCA)


• Certified Coding Specialist (CCS)


• Certified Coding Specialist-Physician (CCS-P)
  

As mentioned previously, which credential you get depends on what employers in your area are looking for. You can get dual certification through both AHIMA and the AAPC if you choose.

Step 4: Get Specific Information About Course Requirements

If you choose a coding school that is not AHIMA-certified or affiliated with the AAPC, you need to look at the course content and determine if it will meet your needs. If you plan to work in a physician office setting, you will need to learn ICD-9-CM diagnosis and CPT procedure coding. You should also look to see if there are any classes about physician reimbursement (look for terms like fee schedule, and relative value units (RVUs).

If you want to work for a hospital, you will need to learn ICD-9-CM diagnosis and procedure coding as well as CPT coding. Hopefully your program also has at least an introduction to hospital code-based reimbursement including diagnosis-related groups (DRGs) and ambulatory payment classifications (APCs).

These tidbits of information may sound like Greek to you if you are just beginning to research the coding industry, but you need to look for these things. You may find a school that also has classes regarding front desk procedures - this is typically an indication that the class will prepare you for a position in a physician's office. If you find a program that includes information about electronic medical records and computers, that's a bonus. You will definitely be using a computer as a coder and you should become familiar with the types of systems you will be using.

You should ask questions about the teaching staff. Are they credentialled themselves? I've met many coders who are excellent and aren't certified, but if you plan to get certified, you should have an instructor who's been there and taken the exam.

What kind of curriculum do they use and where does it come from? Is it written by credentialled coders? This isn't as important if you found your class through the AAPC or AHIMA since all of their curriculum is generally pre-approved. If it's another school, though, it could be crucial.

You absolutely need to ask if you will be required to do an internship or externship. If the answer is no, you should reconsider your education options. I got my first job from one of my internships and it's an excellent way to get practical experience. If they do require an internship/externship, you should ask if it's your responsibility to find an site or the school's. AHIMA-credentialled schools generally work with internship sites to place their students. If you have to find your own practicum site, you need to start networking and finding an institution that will work with you. This generally means signing an agreement with the internship/externship site and you may need to initiate that. The AAPC has Project Xtern, a program that teams aspiring coders with externship sites to get them coding experience. Get more information on Project Xtern at this link.

Step 5: Ask About Job Placement

Will the school help you find a job? If they say yes, ask specific question about their job placement rate and what type of employers they work with. If not, don't despair - you may have to send out 50 resumes and apply to some non-traditional coding jobs, but you can get a coding-related job if you are passionate about the industry and persistent with your efforts.

Step 6: Never Stop Learning

Once you get your coding education completed and get your certification, it's only the beginning. In order to maintain your coding certification, you will need to submit continuing education hours to your credentialling organization every year or two. The only constant in coding is that it's dynamic - once you learn the rules, they often change them. So if you are looking to master an industry that will remain static, reconsider your career choice.

What if I Have a Degree/Certificate From an Unrecognized School?

It happens. Maybe you've already received your degree in medical coding and just found out you spent a lot of money and no one recognizes your degree or certification. What now? It's not the end. What you need to do is make sure you are a member of either the AAPC or AHIMA and get credentialled. You might need to set up your own internship or externship site and do a lot of reading and online research to catch up on some of the things you might have missed. Most of all, you need to start networking with industry professionals, so join your local AAPC chapter or AHIMA component state association.

My Upcoming Speaking Engagements

As of today, here are my planned speaking engagements. I hope to see some of you there!

• Thursday, June 17, 2010 - "Cardiac Catheterization Coding" and "The Importance of Networking in Coding", Colorado Springs Chapter of AAPC, Colorado Springs, CO


• Tuesday, July 13, 2010 - "Taking the Shock out of Electrophysiology Coding" - Denver Chapter of AAPC, Denver, CO


• Thursday, July 15, 2010 - "Vascular Interventional Radiology Primer" - Loveland Chapter of AAPC, Loveland, CO


• Thursday, September 2, 2010 - "FY 2011 CMS IPPS Update" - AHIMA Audio Conference

Kristi

ICD-10-CM, ICD-10-PCS... ICD-WHEN?

The buzz in the industry right now is the implementation of new code sets for reporting diagnoses and hospital inpatient procedures. The new coding systems, collectively referred to as ICD-10, will be implemented on October 1, 2013. That may seem like a long time away, but to coders, it's like telling everyone in America that they have less than three years until we only speak Japanese here and that English will be outlawed. In other words, it's a big deal. So many experienced coders and coding students are all asking the same question: when do we need to learn ICD-10?

ICD-9-CM vs. ICD-10?
First, let's get straight what exactly we're talking about. Currently, we use the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to report diagnoses and hospital inpatient procedures. ICD-9-CM is divided into three volumes:

• Volume 1 - Tabular list of diagnosis codes (lists all codes with their descriptions)
• Volume 2 - Index of diseases
• Volume 3 - Tabular list and index of procedures

ICD-9-CM diagnosis codes are used by every health care setting (e.g., hospitals, physicians) to report patients' conditions. Volume 3 procedure codes, on the other hand, are used only for reporting procedures on patients in the hospital inpatient setting. They are not used for hospital outpatient or physician services, which are reported using Current Procedural Terminology (CPT) codes. As a result, you will see ICD-9-CM code books sold as either the physician's edition (volumes 1 and 2 only) or hospital edition (volumes 1, 2, and 3).

It seems logical, then, that ICD-10-CM will replace ICD-9-CM, but it's only partially true. The diagnosis portion of ICD-10 is part of the clinical modification (ICD-10-CM) and the procedure portion is part of ICD-10-PCS (Procedure Coding System). In order to simplify, some articles will refer to the system collectively as ICD-10 or ICD-10-CM/PCS. When it comes time for training, though, you want to make sure you are getting trained in both CM and PCS if you plan to work as a hospital inpatient coder.

Why Change?
I've often been asked if it's such a big deal to switch why we don't just stick with ICD-9-CM. There are many reasons for making the switch to ICD-10, but here are the main reasons:

• ICD-10-CM/PCS offers better specificity in reporting diagnoses and procedures
• The US is the only G7 nation that does not use a version of ICD-10, which makes comparing data worldwide difficult
• The structure of Volume 3 ICD-9-CM codes does not allow for proper expansion of the code set in order to report new technologies

Will CPT be Affected by ICD-10?
When the proposed rule announcing implementation of ICD-10 was released, there was a lengthy discussion about the possibility of replacing CPT with ICD-10-PCS. Researchers determined, however, that the two coding systems were developed for different purposes, which did not make them interchangeable. CPT was developed originally to report physician services while ICD-10-PCS was developed for hospitals. The use of CPT will not be impacted by implementation of ICD-10-PCS and it will still be required for reporting on physician and outpatient hospital claims.

How Different is ICD-10?
While the general format and look of the ICD-10-CM tabular section doesn't look too different from ICD-9-CM, the codes themselves do. Existing ICD-9-CM code format is 3-5 numeric digits, except in the case of V and E codes. ICD-10-CM codes have 3-7 alphanumeric characters. To me, the codes look more like license plate numbers! The method of looking up a code is similar to ICD-9-CM - you locate the main term in the index, consult the secondary entries, and then consult the tabular listing to confirm code assignment.

ICD-10-PCS codes are very different from ICD-9-CM procedure codes. Coding in ICD-10-PCS understands a great understanding of the procedure performed, as the main index term is the root operation rather than the eponym or name of the procedure. For example, there is no term in the ICD-10-PCS index for "Whipple procedure." The coder must know which of the major root operations this falls under and code appropriately. Once the procedure is located in the index, the coder will find only the first 3-4 of the total 7 character code listed. Those first characters will lead the coder to tables, not a tabular list, that allows for building the rest of the code.

Who Will be Affected Most?
There is much debate about who will be most affected by implementation of ICD-10. For physician offices, although physicians and their coders will not need to learn ICD-10-PCS, they will need to learn ICD-10-CM. If the physician uses a superbill (a list of commonly used codes for that practice), it will need to be redesigned - and expanded - to include the ICD-10-CM codes. Some physician practices may find it tedious to continue to code using a superbill as it goes from a dual-sided to a multi-page document. Practices that do not currently use superbills and rely on coders to assign ICD-9-CM codes will need training in ICD-10-CM.

Hospitals, although only required to report ICD-10-PCS codes on inpatient claims, may choose to collect ICD-10-PCS data on all patients (including outpatients) in order to compare data internally. It is common practice currently for hospitals to collect ICD-9-CM procedure codes on all patient, even though they are "scrubbed" from the bill. As such, hospital coders will need to learn both ICD-10-CM and ICD-10-PCS. Of the two coding systems, ICD-10-PCS is expected to require more education as the structure is completely different from ICD-9-CM procedures. In addition, the clinical knowledge required to assign an ICD-10-PCS code is much greater than that needed to assign an ICD-9-CM code. I think coders with CPT coding experience will find the transition easier because of the level of detail needed to report those codes.

Current Preparations
Right now AHIMA and the AAPC are training future ICD-10 trainers in preparation for training the masses. Software companies that utilize ICD-9-CM codes are currently applying the General Equivalency Mappings (GEMs) to map between ICD-9 and ICD-10 codes and beta testing the new code sets to ensure they work accurately. As an industry, experts aren't recommending that front line coders get trained prior to 2012, however, it is recommended that employers conduct a gap analysis to see what training their coders need and provide medical terminology, anatomy and physiology, and pathophysiology training starting now.

ICD-When?
If you are a coding student, AHIMA recommends that your educational institution begin ICD-10 training in 2011 for associate and baccalaureate degree programs and in 2012 for coding certificate programs. If you plan to code prior to October 1, 2013, you will still need to learn ICD-9-CM coding and if you plan to graduate in 2012, it is likely you will learn both systems. For those considering enrolling in a coding program, determining the ICD-10 education schedule of the school will tell you a lot about the institution. Beware of the school with no plan.

The best part of the transition is that this is a great time for new coders to enter the field. This is a do-over, only it's the experienced coders doing to do-over and they will struggle with it just like new coders. It's going to be a level playing field for anyone interested in being a coder. So if you've ever considered it, now is the time!

Make $40K Working from Home as a Medical Coder!

We've all seen or heard those bold tag lines in print ads and on television and the radio advertising the lucrative opportunities in medical coding and billing. But can companies and schools who make these claims really get you ready to enter the work force? Maybe, but there are some steps you should take before you give your money to any education institution.

Let me first state that I am neither here to endorse nor denounce any school or college. I am simply trying to arm prospective students with the knowledge they need to make the best choices about their future careers.

Step 1: Assess Your Community's Need for Coders
Before you hand any money over for that coding program that promises to deliver, you need to do a little homework about your local job market. Yes, it is true - there is a national shortage of coders and the need for more coders in the future is only expected to increase. But that doesn't mean that coders are needed everywhere. Some places may be saturated with coders and others may have a desperate need for them.

Are you willing to relocate in order to get the job of your dreams? The "American Dream" of the coder is to work from home, but the reality is most remote coders are experienced. Most employers require new coders to work in the office setting before allowing them to log in from the comfort of their pj's and fuzzy slippers. So if you are banking on working from home, add a couple years onto your telecommuting goal. If you aren't willing to relocate and there aren't coding positions in your area, you will have a tough time finding a job.

While you're searching your local job market for coding positions, see which coding certifications they are requiring. This is going to be very important for Step 3 below. You should also start to look at what the salaries are for your area. Salaries will range by region and health care setting. Hospital coding jobs typically pay more but they also typically require more expensive education.

Step 2: Determine What Type of Health Care Setting You Want to Work In
This is a tough one to determine if you don't know anything about coding. But think about what type of environment you prefer to work in: physician office or hospital? You may think, "What's the difference?" Plenty. Not only does each setting have its own preferred set of coding credentials, the coding rules and sometimes even the coding systems differ according to health care setting.

Coding for the physician setting generally involves both coding and billing for physician time and effort. This can vary from coding for one or a small group of physicians to coding for large billing offices or health maintenance organizations with hundreds of physicians. Often physician coders become very knowledgeable of a specific specialty, such as cardiology or orthopedics.

Coding in the hospital is segregated from billing. Because coders are coding for the hospital resources (e.g., equipment, nursing and ancillary staff), they are coding entire hospital stays rather than individual physician visits. Most hospital coders code a variety of cases and generally aren't specialized - although some difficult areas of coding like interventional radiology may result in the training of specialty coders within the hospital.

I'm over simplifying the differences, but you get the gist of it. You may want to start by perusing websites for the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) and read through their online information to see if one triggers an interest over the other. While it's not a hard and fast rule, AAPC-credentialled coders are typically recognized more by physician groups and AHIMA-credentialled coders are recognized more by hospitals.

Step 3: Pick a School That Will Prepare You for Certification
Can you get a coding job without coding certification? Yes. Is it likely? No. If you want to be a coder, you will need to be certified. Pick your school based on the certification it will prepare you for and be wary of schools that offer their own certification - they are typically not accepted by employers. Your future employer should be determining what type of coding certification you need, not the school. The two reigning accrediting bodies for coders that are recognized by employers are the AAPC and AHIMA.

Probably the best way to pick an educational program is to go to either the AAPC or AHIMA's websites and choose one endorsed by the organization with the certification you aspire to get. By doing this, you know you are getting your coding education from instructors and/or schools who have been "checked out" by industry experts.

The AAPC has online and instructor-led courses that prepare the student to take either the Certified Professional Coder (CPC) or Certified Professional Coder-Hospital (CPC-H) coding certificate. Some of these courses may be applied toward credit at the University of Phoenix. There are also various other colleges and schools that will inform you that they prepare their students for AAPC-certification.

AHIMA does things a little differently by accrediting colleges that meet their stringent requirements for program content. While AHIMA has historically been known for certifying individuals who have completed either associates or bachelors degrees at AHIMA-accredited instutions, they also realize the need for coding certificate programs. Many of the schools that offer AHIMA-accredited coding programs also offer degree programs and you may find the counsellors trying to talk you into a degree program. If all you want is to be a certified coder and are not seeking an associates or bachelors degree, don't be distracted from your goal. Stand your ground and tell them you only want the coding certificate.

If you are seeking an AHIMA-accredited coding certificate program that will prepare you for AHIMA certification, go to their website (www.ahima.org) and search schools in your area. There are also search options for distance learning if there isn't a school in your area. AHIMA has the following coding credentials:

• Certified Coding Associate (CCA)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist-Physician (CCS-P)

As mentioned previously, which credential you get depends on what employers in your area are looking for. You can get dual certification through both AHIMA and the AAPC if you choose.

Step 4: Get Specific Information About Course Requirements
If you choose a coding school that is not AHIMA-certified or affiliated with the AAPC, you need to look at the course content and determine if it will meet your needs. If you plan to work in a physician office setting, you will need to learn ICD-9-CM diagnosis and CPT procedure coding. You should also look to see if there are any classes about physician reimbursement (look for terms like fee schedule, and relative value units (RVUs).

If you want to work for a hospital, you will need to learn ICD-9-CM diagnosis and procedure coding as well as CPT coding. Hopefully your program also has at least an introduction to hospital code-based reimbursement including diagnosis-related groups (DRGs) and ambulatory payment classifications (APCs).

These tidbits of information may sound like Greek to you if you are just beginning to research the coding industry, but you need to look for these things. You may find a school that also has classes regarding front desk procedures - this is typically an indication that the class will prepare you for a position in a physician's office. If you find a program that includes information about electronic medical records and computers, that's a bonus. You will definitely be using a computer as a coder and you should become familiar with the types of systems you will be using.

You should ask questions about the teaching staff. Are they credentialled themselves? I've met many coders who are excellent and aren't certified, but if you plan to get certified, you should have an instructor who's been there and taken the exam. What kind of curriculum do they use and where does it come from? Is it written by credentialled coders? This isn't as important if you found your class through the AAPC or AHIMA since all of their curriculum is generally pre-approved. If it's another school, though, it could be crucial.

You absolutely need to ask if you will be required to do an internship or externship. If the answer is no, you should reconsider your education options. I got my first job from one of my internships and it's an excellent way to get practical experience. If they do require an internship/externship, you should ask if it's your responsibility to find an site or the school's.

AHIMA-credentialled schools generally work with internship sites to place their students. If you have to find your own practicum site, you need to start networking and finding an institution that will work with you. This generally means signing an agreement with the internship/externship site and you may need to initiate that.

The AAPC has Project Xtern, a program that teams aspiring coders with externship sites to get them coding experience. Get more information on Project Xtern at this link.

Step 5: Ask About Job Placement
Will the school help you find a job? If they say yes, ask specific question about their job placement rate and what type of employers they work with. If not, don't despair - you may have to send out 50 resumes and apply to some non-traditional coding jobs, but you can get a coding-related job if you are passionate about the industry and persistent with your efforts.

Step 6: Never Stop Learning
Once you get your coding education completed and get your certification, it's only the beginning. In order to maintain your coding certification, you will need to submit continuing education hours to your credentialling organization every year or two. The only constant in coding is that it's dynamic - once you learn the rules, they often change them. So if you are looking to master an industry that will remain static, reconsider your career choice.

What if I Have a Degree/Certificate From an Unrecognized School?
It happens. Maybe you've already received your degree in medical coding and just found out you spent a lot of money and no one recognizes your degree or certification. What now? It's not the end. What you need to do is make sure you are a member of either the AAPC or AHIMA and get credentialled. You might need to set up your own internship or externship site and do a lot of reading and online research to catch up on some of the things you might have missed. Most of all, you need to start networking with industry professionals, so join your local AAPC chapter or AHIMA component state association.