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.

It's Coding Season!

I'm sometimes asked if there's a busy time of year for coders or if it's pretty much status quo. As a matter of fact, there is a busy time of year for coders and this is it!

Every year, we gear up for all the upcoming year's coding changes. That means letting coders know which codes have been deleted, expanded, and added and letting coders, physicians, administrators, and revenue cycle personnel know how code-based reimbursement will be affected in the coming year. This may seem rather straightforward, but since we work with more than one code set with different implementation dates, fourth quarter of each year can be pretty crazy!

ICD-9-CM Codes
The ICD-9-CM diagnosis and procedure codes are updated annually with the Center for Medicare and Medicaid Services' (CMS) fiscal year (FY), which begins October 1. These codes are used to report diagnoses for all health care settings and procedures for hospital inpatients. Right now, you will find coders acquiring their FY 2011 ICD-9-CM code books and attending seminars on the code updates. Some of this year's highlights include:

Diagnosis Codes:

• A new code for obesity hypoventilation syndrome
• Expansion of fluid overload code to differentiate between transfusion-associated fluid overload and other causes
  
• Expansion of the avian flu codes to include manifestations of the disease
• Expansion of the blood transfusion incompatibility codes to differentiate between ABO and Rh incompatibility
• Additional personal history codes
• Expansion of the body mass index (BMI) codes up to allow for classification of BMI in varying increments up to 70 and over
• A new section of V codes to report retained foreign body fragments
• A new section of V codes to report the number of placentae associated with multiple fetal gestations

ICD-9-CM diagnosis codes are within the public domain and the 2011 revisions can be found on the National Center for Health Statistics' (NCHS) website.

Procedure Codes:

• New code for placement of a central venous catheter under imaging guidance
• New codes for carotid sinus stimulation components and devices

Changes to the ICD-9-CM procedure codes are within the public domain and are available on CMS' website.

IPPS and MS-DRGs
The inpatient prospective payment system (IPPS), the system used for Medicare payments for inpatient hospitalizations, is also updated each year on October 1. This includes recalibration of the relative weights for the classification system used under IPPS - the Medicare severity diagnosis related groups (MS-DRGs). This year, the major changes to the MS-DRGs include:

• A documentation and coding adjustment of -2.9%, wherein CMS will discount payments in FY 2011 to hospitals by 2.9% in order to remain budget neutral. The attempt to remain budget neutral is to counteract the financial impact of implementing a severity-based DRG system 3 years ago.
• The addition of 12 new quality measures to be reported by hospitals under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program.
• A revamping of Medicare's 3-day rule, which bundles payment for outpatient services provided within 3 days of inpatient admission into the inpatient payment.

Changes to the IPPS and MS-DRGs are available in the public domain through CMS' website as well as the Federal Register.

CPT Codes
Changes to CPT codes become effective with each calendar year on January 1. These codes are used to report procedures and services for physicians and hospital outpatients. Because CPT codes are owned and maintained by the American Medical Association (AMA), they are not available in the public domain. As such, finding a list of upcoming CPT code changes is often a closely guarded secret until the CPT book is published, generally around November or December each year.

The best way to get updates on upcoming CPT codes is to attend either the AHIMA's Annual Clinical Coding Meeting (September 25 and 26, 2010 in Orlando) for the national code update or the AMA's CPT and RBRVS Symposium (November 10-12, 2010 in Chicago). After the AMA's Symposium, it's common to see articles appearing in coding journals and publications discussing the upcoming coding changes.

HCPCS Codes
HCPCS codes are developed and maintained by CMS to report services, supplies, and procedures that are not found in CPT. They are utilized by physicians and hospital outpatient reporting. HCPCS codes are potentially updated quarterly, although an update isn't always required that frequently. HCPCS codebooks may be purchased on an annual basis with the calendar year and quarterly updates are found on CMS' website. HCPCS codes are in the public domain and general information about their use can also be found on CMS' website.

OPPS and APCs
The outpatient prospective payment system (OPPS) is the payment system utilized by Medicare to pay for hospital outpatient claims. This is updated on January 1 each year, along with the CPT and HCPCS codes. The proposed rule was published in the Federal Register on August 3 and CMS accepted public comment on that proposed rule through August 31. CMS will review the comments, make final determinations, and finalize the rule by November 1.

OPPS changes include recalibration of the relative weights for ambulatory payment classifications (APCs), the categories used to group similar procedures for payment.

Some highlights of the proposed rule include:

• Two areas that have undergone frequent changes or requested changes will remain static for 2011: drug and substance administration and hospital outpatient evaluation and management visit guidelines
• Establishment of a list of services that must be performed under physician supervision
• Removal of three orthopedic codes from the inpatient-only list, making them reimbursable as outpatients under Medicare
• A new method of paying for separately payable drugs
  

Information about OPPS and APCs can be found on CMS' website.

Physician Fee Schedule and RVUs
Physician payment, as outlined in the physician fee schedule, is updated annually on January 1 by Medicare. The proposed rule was published in the Federal Register on July 13 and the comment period ended on August 24. The physician fee schedule outlines the relative value units (RVUs) for each CPT code based on the amount of work the physician performs. Information on the Medicare physician fee schedule and RVUs is within the public domain and can be found on Medicare's website.

Too Much Information?
It sounds like an awful lot of information, but remember this - not every coding professional needs to learn the ins and outs of every coding and payment system. Because I work with hospital clients, I will be focusing on everything but the physician fee schedule. And those who work in physician offices will focus on ICD-9-CM diagnosis code changes, CPT/HCPCS code changes, and the physician fee schedule only. Even so, it's enough of an impact to call fourth quarter "coding season!"

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.

Getting Through an Operative Report - Without Crying

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

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

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

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

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

Deciphering the Operative Report
I am often asked to explain how to decipher an operative report. Well, it depends on the procedure, really. And if you are a new coder and you ever have the opportunity to go to a seminar where they will present case studies, this is the best way to learn. I've taught dozens of classes and nothing drives home my point more than walking through the cases and coding them. But I will give you some basic elements here to get you started. While these rules don't apply to all specialties (e.g., interventional radiology has "special" rules that drive the even the most experienced coders - that would be me - batty!), this should get you started on some of those basic surgical reports.

• Rule 1 - Doctors Lie: Admit it, you watch House and have heard him say on more than one occasion that patients lie. Well, Dr. House, I would like to point out that doctors lie too. They will state the procedure one way in the title and then proceed to describe a completely different procedure in the body of the report. For example, the doctor may state a left heart catheterization was done, but after reviewing the report, the catheter never made it all the way to the heart - only to the coronary arteries. So keeping this in mind, you should never believe what you read in the procedure title. Honestly, I rarely even read the procedure title anymore - it's often fiction. As for Dr. House, I would love to see a strong-willed coder have it out with him on the show about his documentation, which I'm sure is a mess.
  

• Rule 2 - Get a Medical Dictionary: There's no excuse anymore. When I learned how to code, we were still using Windows 3.1, so there was no way the hospital was using the internet. But even without online resources, I had a medical dictionary on my shelf. And it was used often. How will you know if something is important if you don't even know what it means? While you're at it, make sure you also have access to an English dictionary. I know it's a novelty, but you will also find complex nonmedical words in the operative report (or even in your code descriptions). If you don't know what it means, look it up. Tedious, I know, but you will learn. Of course, you might feel like Billie Dawn from Born Yesterday, but you will learn. (Don't understand the movie reference? Look it up!).

• Rule 3 - Just Like Ragu, It's Probably in There: In school we hear terms like "it's bundled" or "separate procedure" but what does that really mean? Well, it means it's integral to the main procedure and don't code it out separate. What's included? Well, pretty much anything that has to be done in order to accomplish the main procedure. Taking out an appendix? Well, then the incision (or creation of ports for laparascopic instruments) is included. So is the closure at the end of the procedure. I don't know about you, but if I have my appendix taken out I sure hope the physician remembers to suture me closed at the end. All those things are like regular ingredients in Ragu pasta sauce - tomatoes, oregano, garlic. It's in there! So don't code each component out separately. Now, had they decided to do a liver biopsy while in there, that's different. That's like throwing a banana in the pasta sauce. So it gets coded separately.
  

• Rule 4 - You Will Only Use 10-20% of the Operative Report: Don't feel like you need to use every word in the operative report to code the case. The fact is, the operative report isn't about you, it's about the patient and it's a communication tool for clinicians. It just happens to double nicely as a recording of everything that happened to the patient and can substantiate coding and billing. It's up to you to determine what's important in the documentation. There's a reason we use coding for billing - your codes actually fit on a 1-page claim form so the insurance company doesn't have to read through every single medical record.
  

• Rule 5 - Know the Procedure: Okay, maybe I should have led off with that one. Medical terminology is, quite literally a foreign language. In fact, it's at least two foreign languages: Latin and Greek. So when you say "it's Greek to me," you're being quite literal. A really good medical terminology class will solve a lot of problems. You may think esophagogastroduodenoscopy is a really big word until you break it down and realize it's visualization (scopy) of the esophagus (esophago), stomach (gastric), and part of the small intestine (duodeno). You also need to know your anatomy. You need to know when they operate on a structure that's part of a bigger structure (e.g., mesentary of the intestines) vs. a different organ altogether (like in the appendix/liver example above). After you learn medical terminology and anatomy and physiology, that's half the battle. The rest of the battle can typically be solved with Google. Come to think of it, there are few things that can't be solved with Google. I'm pretty sure there will be a support group some day for Google-aholics, but in the mean time, I highly encourage you to google a procedure if you don't know what it is. I never remember what a Whipple procedure is. But I can google it in about 10 seconds. Just be careful which website you select from your Google search list - something from the Mayo Clinic is probably more reliable than lazy-Dan-explains-medical-procedures.com.

• Rule 6 - There is Crying in Coding, Just Don't Let Anyone See It: Oh, how I wish I could tell you I had that one down. But I'm pretty transparent when it comes to being frustrated. And I've had students cry in frustration when trying to code case studies. But try to minimize your public displays of tearful frustration and remember this - we've all been there and this is hard. It's okay to not know all the answers all the time.
  

I hope this at least gets you moving in the right direction. When people ask me how I learned everything I know I, 1) laugh, because I know there is so much more for me to learn, and 2) tell them how the rules above worked for me.

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.

Do You Want to Be a Coder?

A few months ago I held a forum for wanna-be coders and much of my presentation was devoted to hospital versus physician coding. By the time I was done, I had several people asking me how to choose between the two. This is an excellent question and one that you need to decide right off because how you proceed with joining organizations and networking will be impacted. First off, not everyone has the skill it takes to be a coder. I have, unfortunately, met and attempted to train a lot of people who just “don’t get it.” Coding requires a great deal of attention to detail that can be tedious to a lot of people. It’s also detective work – once you have all the details, then you need to be able to assemble them and make sense of them. And because these details come from medical record documentation, coders must understand medical terminology, anatomy and physiology, and disease process.

What Makes a Good Coder?

The first question to ask yourself is, do I meet the following criteria?

· Strong medical terminology, anatomy and physiology, and disease process knowledge,

· Ability to piece together clues logically,

· Strong attention to detail,

· Ability to work a full day in front of the computer without a lot of peer interaction,

· Common sense,

· Ability to research and seek out answers to questions,

· And good written and verbal communication skills for those times when you get to escape from your desk.

If you answered yes to most or all of these questions, then you are on your way. If you answered no to most of these, then you should reevaluate becoming a coder. Some things, of course, can be taught, such as medical terminology, anatomy and physiology, and disease process. Other things, like the strong attention to detail cannot be taught.

Hospital vs. Physician

Once you’ve determined that you want to be a coder, you need to decide which healthcare setting best suits you. There are coders for every healthcare setting, but the two major ones are hospital and physician. If you’ve never coded before, you may be wondering what the difference is. After all, there are only a few codebooks (ICD-9-CM, CPT, and HCPCS), so all you have to know is which book to look in right? Wrong.

Besides the coding systems, there are other differences. In a hospital, you are coding for the hospital resources, which include hospital overhead, staffing, supplies, medications, and anything else you can think of that a hospital provides to a patient that costs money. And remember: in most situations, doctors are affiliated with hospitals, not employed by them. On the physician coding side, you are coding for the physician’s time and effort as well as his office overhead. If the physician owns a surgery suite or otherwise utilizes supplies and medications, he may also bill for these items. He cannot, however, code or bill for items that were supplied by a hospital or surgical center where he performed a procedure. What it comes down to is, whoever paid for the item can code for it – this is where common sense comes in!

You may hear experienced coders and billers talk about professional versus technical coding. Professional services are those provided by the physician. So coders working for physicians are always billing the professional component. Technical services are those provided by hospitals or other facilities (e.g., ambulatory surgery centers, rehabilitation hospitals). There are some instances, however, in which a provider (hospital or physician) may bill for both the technical and professional component. For example, there are some physicians who are employed by hospitals. In these instances, the hospital can bill for both the technical and professional components and the physician is paid a salary by the hospital. Another example is of a physician who owns his own surgery center.

Another difference between hospital and physician coding is the information that is coded. In a hospital, the patient’s record is evaluated for the entire visit and all documentation is reviewed including physician reports and progress notes, orders, therapy records, operative reports, labs, and x-rays. In the physician coding setting, the coder is looking only at a particular physician and coding his part in the patient’s case. For example, although a patient may have been in ABC Hospital from June 4-10, if Dr. Smith saw the patient in consultation only on June 5, his coder can only code from his June 5 consultation notes.

The size of the practice or hospital also makes a difference. In physician offices, the coder is also the biller and, as such, must become very familiar with insurance billing regulations. Physician coders are generally also the ones to process and correct insurance denials.

In a hospital, coders are usually part of the health information management (HIM) department where they have easy access to the medical records. In addition to HIM coders there is a computerized system for assigning certain codes on outpatient cases automatically when charges are entered into the hospital’s computer system. These codes are linked to charges using a database that contains all of the hospital’s charges for every department. This enormous database is called the charge description master (CDM), or simply charge master, and codes assigned using the CDM are said to be hard coded. In contrast, the codes that are manually assigned by HIM coders are said to be soft coded. Hard and soft codes come together on the patient bill in the billing department, which is generally separate from coding. If there are any problems with the codes, the billers will send them back to the coders for correction. Once billed, the billers process the denials. So in the hospital, HIM coders are less likely to be familiar with the various insurance billing guidelines.

Finally, coding rules themselves can be different depending on the healthcare setting. One example is the application of the Official Guidelines for Coding and Reporting, which states that the first-listed (principal) diagnosis for a hospital inpatient is the reason established, after study, found to be responsible for occasioning the admission of the patient to the hospital. For physicians, though, the first-listed diagnosis is the reason for which he saw the patient for that episode. Another difference in coding guidelines is for the assignment of evaluation and management (E/M) codes. E/M codes were developed to report physician time and effort in examining a patient and determining the plan of care. Hospitals use E/M codes for outpatient cases, but have adapted the definition to be able to report hospital costs associated with patient care that are not separately reported with a procedure code.

What Type of Coding Setting Suits You?

So you need to determine the type of coding that best suits you. Do you want to work in a small office where you have control over the entire coding and billing process? Maybe physician coding is for you. Would you like work as part of a revenue cycle team and be able to view the patient’s visit episode as a whole rather than just one piece of it? Then maybe hospital coding is right for you. I can’t say which one is better, because I’ve found that people are inherently one or the other. I liken it to being either a cat person or a dog person – neither is wrong or right, it’s just what fits the individual. Can you be both? I think you can be both a hospital and physician coder, but I have yet to meet anyone who is really proficient at all areas of hospital and physician coding – there is so much out there! But that’s part of what I really like about coding… endless opportunities to learn.

Live in Colorado and want to know more? I will be soon announcing an August date for networking. We will meet in “pod forums” with three facilitators demonstrating how to code for physicians, hospital outpatient, and hospital inpatient. This is a great opportunity to see which setting is for you and network with the pros. This event will be FREE so stay tuned…