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.

How Volunteering Can Open Doors to HIM and Coding

Here is a link to my latest post on the HI Careers blog: http://hicareers.com/Blog/BlogArticle.aspx?Id=92.

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!
  

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 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!

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.

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.

Getting Involved

As Past President of the Northern Colorado Health Information Management Association (NCHIMA), I am currently in possession of the association’s archives dating back to 1960. On August 7, I was asked to give a presentation chronicling our association’s history. I’m sure that many people would look at 40 years of archives (which had been neatly thinned and organized by a former board member) as tedious and intimidating, but I found the process enthralling. The issues of the day, the speakers’ topics, and the sense of community as well as seeing the names of “new” professionals in the meeting minutes who would later become industry leaders and mentors, left me so excited I was, at times, actually shaking with enthusiasm (this is a common side effect of being a super-coder-geek!). On more than one occasion, I picked up the phone and called my mom, a veteran HIM-er, and told her about all the treasured tidbits I had found.

But with all my enthusiasm, I was worried. Worried that only a geek like me would find that information interesting. Worried that the presentation was lacking of my usual fervor to use pictures and other visual aids. Worried that no one would make the 2-hour drive north of Denver for the presentation and I would be left presenting to anyone at the hospital who would listen. Worried that my Power Point was too purple (this is a big problem with me, given that purple is my favorite color)!

My fears were completely unfounded, though. I had recently spent time “yearbooking myself” on the website www.yearbookyourself.com (this picture is of me in "1960" - check out the website for yourself and see how you would look!), where I could upload a picture of myself and see how I would have looked with various trendy hairstyles from 1950 through 2000 and those pictures ended up in my presentation. The once nauseatingly purple Power Point presentation became a soothing shade of blue and I was excited to be the one to present this information to what happened to be a decent size group of about 20 people. And they were excited about the information. And I again felt that sense of community.

What’s my point? Well, we all need community because that’s how we get “discovered.” Very few movie stars are discovered sitting in a coffee shop minding their own business. Most work hard to get the roles that get them noticed and a well-prepared audition is often the career-launching vehicle they’ve been waiting for. A single man isn’t likely to find the woman of his dreams by spending all his time playing ball with the guys – he has to go where the women are. Likewise, novice coders are not likely to get hired without being noticed and in order to get noticed, you have to go where the professionals are.

Get Connected

Imagine meeting rooms filled with a dozens, or even hundreds, of coding professionals. And imagine that during such a conference, time is set aside for networking. It’s not fiction. It happens all the time. And all you have to do to get started is join one or both of coding’s premier national organizations: the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Let’s face it, in every business, who you know is almost as important as what you know. When I was going to school, we were strongly encouraged to join AHIMA. The great thing about AHIMA is that you automatically also become a member of the state component association for the state in which you live. So by joining AHIMA, I was also a member of the Colorado Health Information Management Association. I will never forget attending my first CHIMA meeting with my mother, who introduced me to all of her contacts. She stressed the importance of getting to know people and at the time I didn’t fully understand why. Years later, I became certified through the AAPC and it functions much like AHIMA in that as an AAPC member, you are an automatic member of your local chapter. And most local chapter meetings are free.

I cannot stress enough the importance of networking with the coding community. When I graduated, I was offered two jobs: one from the woman who gave my mom her first job and the other from the hospital where I had interned during my final year of college. I have received job offers and inquiries from many people who have crossed my path along the years – my current position included. And it is these networks that I have tapped into in spreading the word about The Coder Coach and am working to increase in an effort to help the wanna-be coders of the world get placed in positions.

AHIMA vs. AAPC

I get asked this question a lot: which organization should I join, AHIMA or AAPC? I am not here to promote one organization over the other. I happen to belong to both, so I will try to give you an objective response. In general, AHIMA credentials are more recognized by hospitals whereas AAPC credentials are more widely recognized by physician practices. Having said that, I will tell you this: these are the only two major accrediting bodies for coders. Beware of getting credentials outside of these two organizations.

I am not saying that all other coding credentials are bogus, but I have seen people get coding credentials that no one in the industry has ever heard of. There are some specialty credentials, such as the Radiology Certified Coder (RCC) that are also of good repute and are accepted by coding professionals. If you are looking into a coding credential that is not affiliated with AHIMA or AAPC and would like to know if it is well recognized, I would be happy to answer any questions you have via email (codercoach@gmail.com).

The statement I made above about AHIMA being for hospitals and AAPC being for physician practices is not a hard and fast rule. The lines between the two organizations are becoming a bit blurred as many professional coders get dually credentialed through both. Both organizations offer credentials in both hospital and physician coding. And I have seen many AAPC certified coders working in hospitals. But if you want to find an easier time getting hired, I recommend getting certified with the organization most widely associated with the type of coding you prefer. Better yet – check local job listings for coders and see which credentials they require. You will likely find that they require at least one of the following popular credentials. Please note that with the exception of the RHIA and RHIT credentials, college degrees are not required for certification.

AHIMA

• Registered Health Information Administrator (RHIA) – bachelor’s degree in health information management with completion of board examination covering HIM topics as well as coding
• Registered Health Information Technician (RHIT) – associate’s degree in health information management with completion of board examination covering HIM topics as well as coding
• Certified Coding Specialist (CCS) – demonstrates excellence in coding hospital inpatient and outpatient records; recommended for people with at least 3 years’ coding experience
• Certified Coding Specialist (CCS-P) – demonstrates excellence in coding physician records; recommended for people with at least 3 years’ coding experience
• Certified Coding Associate (CCA) – demonstrates competency and general knowledge of coding rules and guidelines; eligible for entry level position
  
  

AAPC

• Certified Professional Coder (CPC) – demonstrates on-the-job experience and proficiency in physician coding
• Certified Professional Coder – Hospital (CPC-H) – demonstrates on-the-job experience and proficiency in hospital coding
• Certified Professional Coder – Payer (CPC-P) - demonstrates proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective
• Certified Interventional Radiology Cardiovascular Coder (CIRCC) – demonstrates proficiency in coding of interventional radiology and cardiovascular coding
• In addition, AAPC offers various specialty credentials certifying the coders’ proficiency in coding for certain medical specialties

• Apprentice credentials (denoted with the suffix “-A” following credential) are given to coders who pass the examination but lack the required experience for a full credential

Worth the Money

So if you are in school for coding, or trying to get a job, you need to join up. There are annual dues associated with these associations that can seem daunting – especially if you are a student on a budget. But check out the student membership rates and remember that the cost of the membership pays for itself when you land your first coding job. Best of luck and I hope to see you soon at a coder convention through AHIMA or the AAPC!