What You Need to Know About Coding Using EMRs and Encoding Software

I haven't been perusing as many coding sites and Facebook pages recently as I was a couple of years ago, but I did recently come across a post that captured my attention.  Someone was asking if there was a way to get trained in a popular electronic medical record (EMR) to help them meet the requirements of a job.  It seems many employers are looking for work experience with a certain EMR before considering a person for a position.  Is this fair?  Well, it may not seem fair if you've never worked as a coder, but if you have, chances are pretty good you've had exposure to some of the major EMR software vendors.  For those of you who don't have any practical EMR experience, here's what you need to know.

Is it reasonable to require EMR experience?
First of all, if you've never coded before and your coding school didn't have a relationship with an EMR vendor allowing you to learn the system, any reasonable hiring manager is not going to expect you to have experience.  And if they aren't reasonable, then you don't want to work for them anyway (problem solved!).  If I pick up your resume and see you have taken some coding classes and have never worked in the healthcare field but are "proficient" in EMR software, I am going to have more than a few questions for you.  How did you get your EMR experience?  Which systems did you use?  What did you like or not like about it?  In other words, I won't believe you have experience with it and I will try to weed that out of you.  Or even worse, I may be inundated with resumes and feel like you're lying about something on the resume and I may not have the time or energy to do any investigating.  Your resume may be relegated to the "no" pile.

Fact: your employer will train you
Here's a fun fact.  Even if you've worked as a coder for 2 years using a certain EMR software, you will have to have training at your new facility.  You may think you know everything there is to know about a certain EMR software, but they are all customizable.  As a consultant, I've used the same EMR software at several clients and they are all a little different.  You may find documents stored in different places.  Your favorite EMR feature at Hospital A may not have been "turned on" at Hospital B.  So expect to be trained on the same software you've already been using every time you change employers.

EMRs are from Mars, encoders are from Venus
EMRs aren't the same as encoders.  Of course the EMR is where you will find the medical record documentation, but it is also where you will find financial information and abstracted data.  Encoders and computer assisted coding (CAC) software are usually separate from the EMR.  As a matter of fact, there aren't a lot of EMR vendors who are also in the business of encoder software.  That makes two different kinds of systems you need to be aware of.  But have no fear: while it's a plus if you have been trained on an encoder, you can expect your employer to train you there too.

You need to understand interfaces
Rather than obsessing over how to get trained on a particular EMR or encoder, here's something more important for you to focus on: you need to understand software interfaces.  Because your EMR and encoder are coming from two different vendors and they have to talk to each other, they rely on interfaces.  How that's set up is not important to you (although it's very important to the information technology department), but how and why you enter data the way you do is based on interfaces.  I've coded for lots of hospitals with lots of different computer systems, but in general, here's how it works:

1. You pull up the patient in the EMR.
2. If you work with a CAC product, you launch the CAC by clicking a button in the EMR.  This opens the CAC using an interface, so that it automatically pulls up the patient you are working on in the EMR and displays medical record documentation for coding.
3. If you don't have a CAC, you review the medical record documentation in the EMR and then launch the encoder using a button in the EMR.
4. Once you are in the CAC/encoder, you code the record.  This software allows you to look up codes and save them to a list.  When you're done, you click a complete button, and then you find yourself back in the EMR in the abstracting screens.
5. If the interface is working properly, everything you entered in the CAC/encoder is shown on your abstracting screens.  This is also where you can assign surgeons and dates to procedures as well as any other abstracted data your facility chooses to collect.
6. You send the account to billing in the EMR by indicating the account is complete.

(Most) EMRs don't have grouper software

Groupers are the magic software that calculate DRGs and APCs based on assigned codes.  Grouper logic is something that is built into CAC/encoder software, but not into EMR software.  If you ever need to make a change to codes to rebill an account, you can't just change the code in most EMRs.  It's pretty standard practice to reopen the account, relaunch the CAC/encoder, make corrections, send them back to the EMR through the interface, and then send for rebill.  This concept is something that many coders don't understand and, I would argue, this concept is more important than knowing the ins and outs of any particular EMR product as a new hire.

Knowing how to code is more important than anything

After all this, the most important thing you need to know to get a coding job is how to code.  Your employer can teach you everything I've mentioned above specific to your facility.  And they can also work with you on enhancing your coding skills.  But it's more important for you to focus on coding, coding guidelines, and a cursory background in coding reimbursement than it is for you to know an EMR inside-out.  

Top 10 Cringe-Worthy Things Wannabe Coders Say

My blog is over six years old!  Seriously, I just checked.  In the last six years as I've put myself out there as the Coder Coach, I've spoken either personally, over the phone, or via email to hundreds - okay, it's really probably dozens - of coders and tried to answer their questions about what it takes to be a coder.  I've been amazed at how those answers have changed since then, from the evolution of technology, which allows most coders to work remotely to finally seeing ICD-10 come to fruition. So I figure it's about time I published my top 10 list: the most cringe-worthy things people say when they tell me they want to be a coder.

Don't get me wrong.  My intent is not to put anyone off, but over the last six years, this coding thing has really caught on and I wouldn't want to steer anyone into a career that isn't right for them.  So take a moment to read through the list and decide if you're guilty of any of these. Since David Letterman's Late Show is no longer a thing, consider this my replacement Top Ten List.

And before you get upset, please read the sign: I'm not arguing, I'm just explaining why I'm right.  In other words, I'm being a coder (occupational hazard).

Number 10:Which type of coder pays the most?

Answer:  A really good one.  Focus your efforts on landing a job and then mastering it.  If you choose your work setting solely for making money, you may find yourself miserable and (maybe) sort of well off.  If you choose to follow your passion, the possibilities - and pay check - are pretty much endless.  Employers are willing to pay good money for really good coders who don't complain about how much they hate their jobs.  I don't actually do any hiring, but if I did, I would hire the hungry novice coder with a good attitude and a willingness to learn over the experienced grouchy coder who seems to hate her job.

Number 9: Should I be a hospital or physician coder?

Have you ever seen the movie City Slickers?  The answer is in that movie when Jack Palance says the meaning to life is "one thing."  Billy Crystal asks him, with great interest, what that one thing is.  The answer: that's what you've gotta figure out.  You and only you can decide which setting is right for you and there is no right or wrong answer.  I love getting an inpatient hospital chart and trying to figure out the latest surgical procedures and how to code them.  I would rather poke my eyes out with a dull pencil than assign an E/M level to a physician's chart.  I know other coders who love E/M coding.  It's like being a cat person or a dog person.  You will probably find that you like one more than the other and there is no wrong answer (unless you are not a cat person, and then we can't be friends anymore).

Number 8: No one will hire me with the coding credential I have; they all want something else

This is probably going to sting a bit, so brace yourself.  Why did you pay to get credential without first looking at local job postings and doing some research?  If you are reading this before going to school or getting certified, then do your homework before you pay any money to any educational institution.  All kinds of people will tell you anything to get your money.  Only local employers will be honest about what credentials they want.

Number 7: Where can I get free continuing education credits?

Free CEUs are out there, you just have to look for them.  Most AAPC local chapters offer free monthly educational sessions.  There are opportunities to summarize articles and get credit.  Coding Clinic offers a quarterly webinar that is free.  Other organizations offer free CEU credits.  Do an internet search and you may be surprised what you will find.  Did you do something, like attend grand rounds at a hospital, that you thought was very educational but you don't have a certificate?  Contact the certifying body and see if they will grant you CEUs for it.

Number 6: I can't afford to join AHIMA or AAPC

This one might sting too.  Find a way to make it happen.  As far as I'm concerned, when I hear this, it tells me you don't want it bad enough.  Granted, I started very young and was still living at home when I first joined AHIMA, but make no mistake, I worked hard to get where I am today. Find a way to afford that membership and show people you are serious about a coding career.  And if you have a credential through and let your membership lapse, you likely lose the credential.  You worked hard for that credential - don't let it go.

Number 5: This is my second (or third) career; I can't afford to start at the bottom

This is a great second or third career for people who discover they missed their passion until later in life.  But here's the reality: you still likely have to start at the bottom.  I've seen people find their way into coding by some very unusual means, but the ones who make it are the tenacious ones who won't take no for an answer.  Pretty much no one starts out in their dream coding job.  You will have to pay your dues.  And please don't think that means  I can't appreciate your experience in your previous profession.  There are definitely things you can bring to the table, but remember that in coding, you are a novice.  I'm a great coder, but I'm pretty sure if I decided to change careers tomorrow and become an aerospace engineer, there would be a bit of a learning curve. 

Number 4: Will you mentor me?

It's an innocent question and I'm flattered.  Really.  But I decided a long time ago that I would mentor from afar by penning this blog.  I don't have a consistent schedule to be able to spend a lot of quality one-on-one time mentoring.  But if you email me a specific question, I will do my best to answer it.  My advice is to find someone local to mentor you.  Ask them if they can meet you once a month for lunch and come prepared.  What are the questions you want answers to?  What challenges have they had in their career that they wish someone would have told them when they were getting started?  This is a great entry into your local coding network.

Number 3: I went to school for (fill in the blank) months/years and I'm certified; I'm qualified to be a coder anywhere

No.  You're really not.  I went to school too for two years and let me just tell you that even though I learned some good fundamentals, the real coding world is nothing like I thought it would be.  I learned everything I really needed to know about being a coder on the job, not in school.  I've now been coding for more than 20 years and I hold four different certifications and I have a news flash for you: I am not qualified to code anywhere.  I lack the practical experience of a physician office coder.  I find coding radiation oncology charts waaaaaayyyy outside my comfort zone.  And please don't ask me to fill out an IRF-PAI for inpatient rehabilitation.  In other words, after 20 years, I am not all that and a bag of chips, so please don't insult the world of experienced coders by thinking you have this all figured out.  I learn something new each. and. every. day.  Keep an open mind and be willing to learn - and admit when you're in over your head.  Natural curiosity and a willingness to learn is a good thing.  Acting too big for your britches is not.

Number 2: How can I get experience if no one will hire an inexperienced coder?

I would give anything if people would stop asking me this question.  Because honestly, I don't know the answer.  I don't know what your background is.  I don't know what your aptitude for coding is - and it is a skill that many people don't possess.  I don't know where you've applied or how hard you've tried to sell yourself.  And probably most importantly, I don't have a clue what it's like to try to get a job today because the atmosphere is so different from 20 years ago.  But this is what I do know.  Don't limit yourself to coding jobs.  Find a job - any job - that will require you to have coding knowledge.  When you do an online job search, search on the code sets (ICD-10 or CPT) and not the word coder.  There are so many jobs out there that revolve around coding that aren't traditional coding jobs.  Getting your foot in the door is one step closer to getting that traditional coding job - or something even better than you ever imagined.  And don't forget to network.  If you want to work with coders, surround yourself with coders.  Who you know may be your golden ticket.

And the Number 1 Cringe-Worthy Thing Wannabe Coders Say is: I want to be a coder because I want to work from home

AACK!!!!  Not a good lead in!  And if this is the first statement out of your mouth when you go into an interview, you probably won't get hired because here's a huge industry secret: hiring managers hate hearing that's why you're there.  It's like going on a first date with someone you just met and gushing about how badly you want to get married and have 6 kids. It's just not done.  If this is the real reason you want to be a coder, please re-evaluate.  Coding is a great career if you love it.  If you don't love it, you will be miserable for 8 hours every day.  And if you are miserable at home for 8 hours a day, that can be really depressing.  Also think about the child care aspect.  I often hear people say they want to work from home because they can't afford child care.  Many coding contracts require you to have child care in place.  Coding takes intense concentration and you can't babysit a kid at the same time.  Working from home is a great perk, I will admit, but it is not the reason I have the job I have.  I refer you back to Number 10 above: follow your passion.  If you're lucky, you can make some good money while you do what you love... from home... in your bathrobe.

Article Review: The Coder Coach Responds to "Industry Disconnect"

I'm afraid today's topic won't be quite the entertainment fodder that many of my readers have come to enjoy because this is a serious topic and one that I am very passionate about. And it deserves a serious blog posting!  Someone recently asked me on my Facebook page what I thought about a recent cover story published in For the Record Magazine.  "Industry Disconnect" by Selena Chavis is a great read for anyone who has been pounding the pavement looking for a coding job.  It is also a must read for any coding professional with hiring power.  In short, this article highlights the biggest threat to the future of the coding industry: the ability to hire, mentor, and train recent grads.

It's no secret how I feel about mentoring our future workforce.  My thoughts are well documented throughout the Coder Coach and my colleagues in the state of Colorado know how outspoken I am about the topic of mentoring coders.

So when I was asked, I thought, wow, what a great topic for my blog.  Here are my thoughts on the article: it illustrates an accurate, although bleak, outlook on the future.  But all is not hopeless.  This article has some great points, but it also brought to mind some myths about coding mentoring and training that I would like to address.

Myth 1: There is a disconnect between coding schools and employers and no one cares or is doing anything about it
Partially true.  In general there is a disconnect between schools and employers, as documented in the article.  It is not true that no one cares.  Hello!  Are you reading my blog?  I currently sit on Colorado Health Information Management's Student Alliance Task Force - a mouthful, I know!  This is an alliance made up of CHIMA members and directors from the local HIM schools and we spend our time trying to figure out how to get better and more meaningful internship experiences for students.  There are a ton of road blocks and we are trying to decide how to break them down.  More on that in a sec.

Myth 2: Hospitals will only hire people who can hit the ground running
I hate this myth.  Because, in my experience, there is no such thing as a coder who can hit the ground running.  Okay, that was deep.  Let me repeat with more emphasis,  there is no such thing as a coder who can hit the ground running.  It's true that new grads take more time and as the article mentioned, there is only so much you can teach in a 2-year program that will prepare people for a future in electronic medical records, privacy and security, coding, cancer registry, and the list goes on.  It is unrealistic to expect new coders to be able to hit the ground running and it's ridiculous to exclude new grads thinking they won't have anything to offer.  I have never hired a coder - novice or experienced - who didn't need on the job training.  It's true that you can teach an old dog new tricks, but it's equally true that old habits die hard.  A new coder may not have experience, but as Linda Donahue, RHIT, CCS, CCS-P, CPC mentioned in the article, it is easier to teach new habits than correct old ones.  If you can absorb information like a sponge, you may have a serious future in coding.

On a side note, I decided to test this no-such-thing-as-hit-the-ground-running theory, so I called up my friend and newest coworker, Sandy Giangreco, RHIT, CCS, RCC, CPC-I, PCS, COBGC, CPC, CPC-H and AHIMA-Approved ICD-10-CM/PCS Trainer (are you getting the impression that Sandy has a little experience?!).  I asked her if she felt like she'd hit the ground running and she said sort of.  Now keep in mind that Sandy has many years of excellent coding experience (and a couple certifications!) and was hired by Haugen Consulting Group as a Senior Consultant.  We don't have to teach her how to code.  But she is trying to get used to our way of doing things and our training materials so that she can further develop more materials and peer review other content.  She is not up to speed yet.  But it's only like her second week, so I'll cut her some slack!

Myth 3: If hospitals take the time to train people, they will just leave and take those skills elsewhere
Oh waaaa.  Oops, did I type that out loud?   This is something that industry leaders need to get over.  We no longer live in an era where people pledge allegiance to a certain company and stay there for 30 years and retire to a blissful lifestyle at the age of 62.  When I got my first coding job, my manager and mentor, Lila, told me she knew she wouldn't be able to keep me but she wanted to give me an opportunity.  And I am so thankful she did.  There are other Lila's out there who are willing to train you so they can have a hand in training the future workforce as a whole - not just at their own institution.  I think if more people adopted this mentality, the future of the coding field would be bright indeed.

Myth 4: No one is willing to train on the job
So it turns out Lila was right.  I worked for her for three years before taking a job as her peer coding supervisor at a sister hospital.  And then she moved on for another career opportunity outside our hospital system.  That was 15 years ago.  Recently our paths crossed again when Lila took a management position with one of my clients.  Last fall I got to travel with her during a training trip and it was so much fun to be back in the company of that person who first gave me a start.  And I was dying to ask her: if you could do it all over again, in today's climate of EMRs and code-based reimbursement, would you hire a green coder like I was back in the day?  And she said yes.  Here it is almost 20 years since she gave me a chance and so much has changed with coding and HIM and she still feels the same way about training and mentoring.  God bless Lila and every coding manager like her.  We also have a hospital system in Colorado that recently opened their own coding school in preparation for ICD-10 and they are accepting people with baseline coding class experience and placing them into coding positions at the end.  People are willing to train, you just have to find them.

Myth 5: Experienced coders know more
Okay, so this may be where I lose some loyal blog readers and for that I apologize.  I will start by saying that I know some really smart, terrific coders who can code like nobody's business.  And as a coding trainer, I also know a lot of "experienced" coders who don't know as much as they think they do.  At Haugen Consulting Group, we actually have a training program for experienced coders about coding basics or fundamentals where we get them back to the coding guidelines.  Because they forget.  They get so caught up in the details that they can't see the forest between the trees.  And it's not really their fault.  My point is, new coders may have an advantage here - we are trying to get coders back to the guidelines and most students know nothing but those guidelines.  They are also "closer to the books" when it comes to things like anatomy and physiology.  And I cannot stress enough How.  Very.  Important. This. Will.  Be. For. ICD-10.  No coder knows everything - it's impossible.  I learn more about coding every day and I teach the darn stuff.  That's actually what I love about it.

Myth 6: Coding students can't get hands-on experience because of EMRs
There is some truth to this.  I hate that word "can't," though.  When I did my internship I reported to the hospital every day for 3 weeks like it was my job.  There was a coding unit and all the coders sat together.  I understand that that hospital no longer has a coding unit.  The coders all work from home by accessing the electronic medical record (EMR).  And that's how most hospitals are these days.  It's not impossible for students to get hands on experience, but it is challenging.  The main road block here is HIPAA.  The Health Insurance Portability and Accountability Act of 1996 allows for electronic submission of health information and as HIM professionals, we understand the confidentiality and security issues surrounding protected health information (PHI).  As HIM professionals, we have a duty to keep this data confidential but we also have the duty to train new professionals.  We are trying to find ways to bust this excuse, but our first commitment is to the patient and protecting their data.  That's just something to think about when you complain about the background check you need to go through to get access to a system as a student.  How would you feel if it was your medical record?

Myth 7: There are not enough coding jobs for students
Bologna.  I've said it before and I'll say it again.  There may not be a bunch of jobs for "coder," but there are tons of jobs that are coding related.  Stop searching for coding positions in HIM departments and ending your search there.  Start looking for jobs that have ICD-9-CM and CPT embedded in their job descriptions.  You will learn more than you think just by being around codes.  Plus, if you can get a job in billing, this is a great place to see coding reimbursement in action.

Wow, this is already way longer than I intended, so I will leave you with this.  I love that Ms. Chavis's article was the cover story.  I think this is the most critical issue facing our industry today (even more so that ICD-10!). But I don't want you to walk away from this article thinking that a future in coding is futile.  Get out there and network!  People give jobs to people they know, so go out there and get known!

If you haven't found a job in coding, ask yourself if you've exhausted every option.  I meet all kinds of people who want to be coders for all kinds of different reasons.  If you want to be a coder only because you want to work from home, stop now.  You won't be successful.  But if you want to be a coder because you love the detective work you have to do to pull documentation together to get those codes, then there should be nothing on this earth that will stop you.  I see a lot of people making excuses about why they aren't getting coding jobs, but I firmly believe that if you want it badly enough, you will get there.  I'm no stranger to excuses myself - mostly when it comes to living a healthy lifestyle.  So lately, I've been carrying around this quote as a reminder any time I catch myself making an excuse and falling into the role of victim:

"Ninety-nine percent of the failures come from people who have the habit of making excuses."
-George Washington Carver

I am willing to work with my colleagues to remove the excuses about why we can't train and mentor.  Are you willing remove excuses for any of your own roadblocks that you've put up?

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/.   

Opportunity Happens: ICD-10 is Mine

To quote my recent Facebook posting, "Ever notice that amazing opportunities are followed by boatloads of work?" That's my excuse for where I've been: opportunities and their resulting heavy workload. For me, opportunity is cleverly disguised as ICD-10. What is your opportunity?

Just to catch you up, I recently accepted a senior consulting position with a new consulting firm. Haugen Consulting Group is based locally in Denver and while I will be pretty much doing what I've been doing - coding consulting and education - I will also be working with a team of amazing consultants as we lead our clients through the ICD-10 implementation.

I am also chairing the Colorado Health Information Management Association's ICD-10 Task Force, which is gaining momentum each month. For the last month I've visited two of Colorado's three regional HIM associations and also had the opportunity to speak on ICD-10 and HIPAA 5010 implementation last month in Montana and do an audio conference on the new leg revascularization CPT codes for HCPro. Later this month I will present at CHIMA's spring meeting on the importance of mentoring our future workforce (I'm going to bat for all of you!) and will also moderate an ICD-10 panel. These speaking engagements lead to more speaking engagements, which is what I love to do. And sometimes the speaking engagements lead to contracts, writing opportunities, and other networking opportunities.

While I've been working on some exciting prospects of my own, some of the people I've been mentoring have also received some opportunities. I recently got a call from a recruiter asking about one such candidate and another recent grad got a part-time position in an HIM department based on her work there as a volunteer. And my advice to them now that they have their feet in the door is to work hard to keep those opportunities coming.

So if you've completed a coding or HIM program and are having trouble finding work, here's a reminder of some of the things I recommend for getting your start:

• Network! I've received jobs from 4 people I knew or worked with in the past. And I've hired people I've worked with in volunteer organizations. Who you know matters!
• View everything as a learning experience. Work is work, no matter how much you enjoy what you do. There are days when you won't like the tasks that have been assigned, but there may come a day when you need to tap into that experience.
• Find a workplace mentor. Once you get your foot in the door, find someone you can go to with questions. This doesn't have to be a manager - it can be a lead, a person who has worked there "forever" or even a team of people.
  
• Keep a positive attitude. No one wants to work with someone who is negative and miserable. A positive attitude goes a long way in any industry.
• Don't give up - because opportunity happens!
  

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!

New Year, New Attitude

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

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

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

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

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

Not Sure What to do? Do Something.

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

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

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

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

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

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

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

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

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

· Love/Belonging – friendship, family, intimacy

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

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

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

Basic Needs and a Coding/HIM Career

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

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

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

Ready to go Viral?

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

And the world includes potential employers.

And they read these sites.

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

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

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

Matchmaking for the Professional

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

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

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.

Why Wait?

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

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

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

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

The Shortcut to Being a Coding Professional

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What Are You Going to do About It?

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

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

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

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

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

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

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

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