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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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!

The Shortcut to Being a Coding Professional

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Yes, Coding is Hard

I was recently perusing some online message boards and came across several postings with a resounding theme: Is coding really that hard? In a word, yes. If coding was easy, it would be easy to get a job. You wouldn’t need those 2 years of experience just to get your foot in the door. And although I want to maintain a positive can-do attitude to anyone pursuing a career in coding, I sometimes forget to exercise a little tough love and make sure that people understand exactly what they are getting themselves into and what will be expected of them.

First of all, not everyone can be a coder. Yes, there is training involved, but some people, even with years of training, will never be successful coders. So often we hear someone trying out for American Idol who has no business singing in public and we may wonder, “What made him think he could sing?” Well, the same applies to coding, albeit, in a different way. Some people aren’t detail oriented enough or don’t like medical terminology enough or can’t cope with frequent guideline changes from payers. When I hear potential coders complaining about such things, I wonder why they want to be coders.

Secondly, many people enter into coding so they can work from home. When I ask someone why he wants to be a coder and his first words are, “I want to work from home,” I usually probe a little deeper. I want to know how potential coders feel about working long hours in front of a computer with little human interaction. I want to know how well they can concentrate on their work and how detail oriented they are. I want to know if they are willing to put in weeks, months, or even years at a hospital or clinic before being released to work from home. I want to know if they are in love with coding or just the idea of coding.

Being a coder means knowing a lot of medical terminology, anatomy and physiology, disease process, and being able to read a medical record and piece together the patient’s clinical picture and translate them into codes. It’s about “peeling the onion” – that is, consistently learning more and being okay with the fact that you will never know it all. If that doesn’t sound like fun to you then coding isn’t for you.

So if you decided on a career in coding because the pay sounded good or it would allow you to work from home, I ask you to pose some hard questions to yourself. Are you willing to put in the time and effort to get the career you think you want? If you are, then let me be the first to welcome you to a rewarding career in coding. If you’re not, I encourage you to find a career you will be passionate about.

Get Your Paint Brush

I've been painting a lot lately. I recently had the intense urge to splash bold color on my bathroom walls. And I have to say, that while I love making drastic changes to a room and gazing admiringly at the finished product, the actual process of getting there drives me a bit nuts. While I was prepping and painting, it gave me a lot of time to think about... well, everything - including coding, mentoring, and blogging. And it struck me how much painting is like coding.

Maybe you don't paint the way I do, but as a typical perfectionist coder-type, I'm pretty picky about the end result. I always tell people that should this coding thing not work out for me, I'll go into interior design (LOL!). Finally, I've found a way to tie two of my passions together! At any rate, I hope you enjoy the analogy.

It's All in the Prep Work
First of all, I hate blue tape. Not because I have an aversion to the color blue, but it stands in the way of what I'm really looking forward to - the transformation that comes with brushing and rolling a new color onto the walls. And in an effort to paint the wall a dark purple with bright white trim while avoiding getting paint on the floor, it meant either a very steady hand or the use of blue tape.

While I was taping, my mind wandered to the people I've talked to who are trying to get into the coding field and how I often hear complaints about the education piece of coding. I liken taping off a room to getting a coding education. No one is going to recommend my painting skills if there is paint slopped all over the place. Likewise, no one is going to recommend me as a coder if I'm not educated.

Do You Have the Right Paint Supplies?
I wish I could say that my project took only one trip to the store to get the paint and the few supplies I needed (since I have the desire to paint something every year or two) -but it took three. The first trip resulted in a gallon of purple paint, ceiling paint, a tarp, blue tape (!), and a couple of other essentials that I couldn't remember if I had or not. The second trip garnered me a few more paint brushes for trim.

I thought I was set.

If only. At 6:00 pm on Sunday, I started going through paint cans of redecorating sessions past trying to remember which subtle shade of white was the right one for the trim. When I eventually found it, I opened the can and it was dried solid (when did I paint last anyway?!). I thought of using another white for trim, but while it wasn't dried out, it was in a sad state and ready to be retired. I thought about forgetting it and worrying about it next weekend. But I know me - it would probably never get done. So I headed back out for one last trip to get some trim paint.

Then I was set with another decision - which color of white should I get? If you've ever chosen white paint, you know there are about 5000 different shades of white. The old colors I had previously used were either a little two yellow or a little too green. So I selected a shade in the same color family as the purple and soon I was back home, painting the trim.

So how is this like coding? Well, if the prep work is the education, then your supplies are the educational institution you select. A higher quality institution means a higher quality you. I could have painted the trim with the yucky, rotten back up paint, but it wasn't the shade of white I really wanted and I knew the end result would not hold up to my standards. You can select an education based on cost, time, or promises the institution makes to you. But is it really a quality institution? There's a reason some educational institutions are more expensive. The only real answer to this is to get references from people in the industry. If you are working with a school, ask them to provide references from graduates. Make sure that the education you're seeking will set you up for the job you want, which means preparing you for the right certifications.

If you select the wrong educational institution only to find out later that it's an issue with hiring managers, be prepared to go back. Trust me. I was not happy that I had to go back to the paint store. But I am very happy with the end result. If you can't get anywhere with the education you received previously, find out what you need to do to get the education that will get you somewhere.

Don't Forget to Accessorize
Since I have fantasies of making a living transforming people's living spaces, for me no room is complete until it's been redesigned down to the last accessory. I've had this bathroom remodel planned for months, inspired by some personal stationary. I searched in stores and online for the perfect (and affordable) shower curtain, wall hangings, light fixture, and other room accessories. The end result was a complete cosmetic overhaul - the only thing I kept in the room besides the existing plumbing fixtures were the towel bars and soap dispenser. These final touches make all the difference. Let's face it - without them, this room is just a giant grape.

I always recommend that people accessorize their coding careers by picking up a specialty (or two). It's going to make the difference between you as a coder and you as a highly skilled coder. Specialties such as interventional radiology, cardiac catheterization, pain management, and radiation oncology are very difficult areas in coding. If you can code any of those specialties - and keep up with the frequent changing in coding rules and regulations - you will be highly marketable. But be careful. Unless you are willing to relocate to get a job, make sure you are seeking a specialty that is in demand in your geographic area.

When is the Painting Done?
I would like to tell you that the bathroom is done and it's beautiful and I will never change it. The truth is, I still need to replace the broken light fixture, hang the vanity mirror, and do a couple of touch ups. In another few years I will probably be sick of the color and want to change it again.

Likewise, once you complete your coding education, you won't be done. Coding requires continuous education to maintain your certification and keep up with medical technologies. And just when you get that most difficult area of coding down, Medicare will change the rules and you'll have to learn it all over again.

So keep up those painting skills and best of luck on your career remodel!

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.

Code Words for Getting Your Foot in the Door

It's the question I am asked most often as a mentor. "How do I get experience if no one will hire me without experience?" The unfortunate reality is that many employers aren't ready to assume the time, effort, and risk associated with hiring a newbie coder. But that doesn't mean that getting a job as a coder is impossible.

If you begin by looking at the job postings in your area for coders and then take a look around your live or virtual classroom at the number of students who will be looking for coding positions at the same time you will be, you can see that it just doesn't add up. In most markets there simply aren't enough coding positions for every coding student. But that doesn't mean there aren't other positions that will allow you to use and cultivate your skills and potentially align you for that coding position.

It can be especially tricky to make your way into a coding position in a hospital if you have no practical experience. The reasons for this are varied: some hospitals don't hire "newbie" coders, some hospitals have so many coding positions open that there are limited entry-level positions available, and some hospitals receive many resumes from both experienced and novice coders and subsequently hire the experienced coders. But this doesn't mean that the door is permanently closed - you just need to know how to nudge it open.

Consider HIM Positions
In the hospital setting, coding is often part of the health information management (HIM) department. While it can be difficult to get a coding position right out of school, it might be easier to get an entry-level position into an HIM department. This may mean assembling or scanning medical record documents, analyzing medical records for missing documentation, abstracting data for core measures and other hospital reporting needs, birth certificate completion, transcribing medical record reports, and working with registries (e.g., cancer, trauma, cardiac).

Many HIM departments promote coders from within when they show promise. Once you have your foot in the HIM department and are working solidly within one of these non-coding positions, though, it is no time to get lazy. Offering to do projects and work on teams that will expose you to coding and coded data is crucial. If you are interested in a coding position, you should never be shy about letting your supervisor know that that is your goal. If a coding position opens up, you need to make sure that HIM and coding management are aware of your interest.

The bonus to a position within HIM is that should a coding position become available, you will already be working for the managers responsible for hiring. You may also be exposed to other areas of health information and data management that you may otherwise miss if you follow the coding track only. The downside to a non-coding position within HIM is that you may still be overlooked for advancement to a coding position if an experienced, qualified external candidate applies for a coding job at your hospital. The dynamics of internal vs. external hires is very organization-specific, though, and there are always exceptions to the rule.

Try Billing On For Size
If you are interested in the billing side of coding, there may be opportunities in the billing (or patient financial services) department within a hospital. Look for positions that require coding skill by reading through the necessary skills. Dead giveaways include positions that require ICD-9-CM or CPT/HCPCS coding experience or "familiarity." Positions requiring "familiarity" with coding typically translate to entry-level positions. This may include working billing edit reports, processing insurance claims, or following up on insurance claim denials.

The benefits of working the billing end of coding are that you will become very familiar with the edit process and what won't be paid based on codes. This could potentially move into other billing-related positions including charge master maintenance. A disadvantage of working in billing is that should you be seeking a position as a coder within HIM, you won't be working for HIM's hiring managers and it could be more difficult to get the position you ultimately desire.

Develop a Plan
Whichever path you decide to explore, you should always take the time to develop a planned career path - even if that path deviates from your career map. Employers want to know what kind of position you are interested in so that they can assess your skill, how to get you where you want to go, and ensure that your career goals are in line with the organization. So take the time to develop a simply laid-out map of where you plan to be professionally within 1, 5, and 10 years.

Whatever path you decide to take, follow it with confidence and commit to learning as much as you possibly can in that position. It will take time to become skilled as a coder and like to many other worthwhile careers, you will get out of it what you put into it. Best of luck to you all!

Coding Sure Isn't What I Thought it Was Going to be!

When I enrolled in HIM school, I never envisioned my career would end up the way it has. For those of you keeping score at home, let me briefly outline how it has turned out. I am a senior consultant - and the only coding professional - for a small consulting firm that specializes in hospital revenue cycle management and electronic medical record conversions. I do project-based work that involves improving coding and charging accuracy with our clients. Right now that means working closely with cardiac catheterization and interventional radiology coders and auditors. In the coming months and years it means hours of developing ICD-10 training materials and helping the coding workforce get ready for the switch in 2013.

Well obviously as a child I didn't think "I want to grow up to be a coding professional" but even once I selected an area of study and was taking classes, I was having trouble visualizing what my days would be like - which is pretty sad considering my mother had been in the business for about 20 years and all my stuffed animals had medical records when I was a kid. I knew about the HIM field, but I didn't really know about it. I guess I imagined that some day I would go to work as a manager in an HIM department like my mom, but I couldn't really figure out how to get there or if it was right for me.

"I Don't Want to be a Coder"

When I took my first coding class I hated it! I didn't understand it and the statements the instructor gave us to code were confusing. I constantly arrived at the wrong code and sometimes didn't even know what to look for. And unfortunately at that time, I never wanted to ask questions because I didn't want to feel stupid. When they handed me an inpatient medical record for the first time I wanted to cry. How was I supposed to put it all together and come up with the right codes - the ones everyone else in the class seemed to have no trouble getting? I vowed that I would never be a coder and rebelled by not renewing my free updates for codebooks for the coming year. And then I decided I would follow my mom's path and go into the operations side of HIM, focused on legal health information issues, completion of medical records, and the general management of health information.

And then it happened. Enlightenment. Divine intervention. My aha moment. Or whatever you want to call it. I went to do an internship at a local hospital and they started me out on emergency room records. All of a sudden it started to make sense. Practical application of coding was something I excelled at. Instead of being given statements to code, I was given (small and manageable) medical records that represented real people with real problems and it was my job to translate those problems into a set of codes. That excited me.

Don't get me wrong. I coded a lot of things wrong in the beginning and that initial feeling of looking at an operative report and wanting to cry didn't go away quickly. When I was assigned a senior coder to check my work, I was amazed that I could get so many wrong and she still thought I had potential. And now, nearly 15 years later and with substantial experience in the training and education of coders, I understand what she saw. I was only there three weeks, but I learned so much and by the end of the internship I knew I was meant to be a coder. My internship supervisor thought so too. Within a month of graduation, she had another coding position approved and I had my first job as an outpatient coder.

Why Don't Employers Want to Train Inexperienced Coders?

It's a long road from learning coding in school and applying it in the real world. I receive emails from wanna-be coders across the country asking me why it's so hard to get a job as a coder and this last week I had another epiphany as I presented an intro to diagnosis related groups (DRGs) to a group of coding students at one of my Coder Coach events. It was the first time I had deconstructed a complex topic like DRGs and presented it in an "introductory" format to coding students. And as I listened to their questions and watched the look of awe on their faces as the complexity of code-based reimbursement started to sink in, I was reminded how much I've learned and how hard it is to explain that coding isn't just looking up a code in a book.

The long and the short of it is this: health care providers are being scrutinized from every angle and the best way to prevent increased scrutiny is to decrease risk. The best way to decrease risk is to ensure that staff is well educated and experienced. Unfortunately, our industry isn't doing a very good job of replenishing the ranks as coders move on to advanced coding-related jobs in other departments or with other companies. There are coding jobs to be had, but trying to get one as an inexperienced coder is really tough. So what you have to know how to do is convince your future employer that you are the right choice.

What Your Future Employer Needs to Know About You

As health care dollars become tighter and patient premiums rise, provider budgets are being slashed. The first thing to typically be cut from any budget is education dollars. Ten years ago it was much more common to find an employer willing to pay to maintain dues for professional organizations or to send employees to regular educational seminars or classes than it is today. So the first thing your employer needs to know is that you are so committed to this profession that you will pay for your own education.

But here's the best part - so much of what's out there to learn is free. It just takes time to acquire it. If you want to be a coder so bad you can taste it, this will be a labor of love for you. If you are reading this now thinking I'm nuts ("how dare she suggest my employer not pay!"), then maybe coding isn't for you. Like any career profession, what you get out of coding will be relative to what you decide to commit to it. So if you want to be an inpatient hospital coder, now is the time to start learning about DRGs. At least learn the lingo. If you go into an interview for an inpatient coding position and they are asking you about CCs and MCCs and decreasing case mix and you have no idea what they are talking about, your chances of getting the job aren't good. So let your employer know what you will do for them to expedite the training process.

What You Need to Know About Your Future Employer

I've worked with a lot of coding students over the years and there have been some stars and there have been some duds - and it doesn't take long to spot the difference. The stars haven't always been perfect, but they have an enthusiasm and skill that can't be taught in a classroom. Some of the duds just didn't have the skill. And if you don't have the skill to be a coder, trying to force your way into it is like trying to fit a square peg in a round hole.

Are you wondering if you have the skill and if it's recognizable? If so, work on getting that interview and once you get the interview, ask to take a coding test for the employer. A good coding test, even if "failed" as far as percentages go, can show a prospective employer if you have the skill to be a great coder once trained.

Of course, many people wonder why someone would hire an inexperienced coder when they could have an experienced one. That was what I wondered when I graduated and here is what my mentor/first employer told me: experienced coders have picked up bad habits along the way; hiring someone with the skill to be a good coder means the employer can train them the way they want. There are no bad habits to erase.

Use Your Employer - and Let Them Use You

Okay, that sounds less than appealing, but I mean it in the most positive way. The best jobs I've had have been the ones where there has been "mutual using" of each other. The employer takes advantage of the employee's strengths and willingness to learn and in return, the employee gets the most wanted commodity: experience. No matter how mundane a project may seem, there is probably a wealth of experience to be gained by taking the project. You won't really know how much you've learned until people start coming to you for advice or you find yourself knowing exactly how to handle a situation because of your previous work. This might mean sitting on an inter-departmental committee, working claim denials, or reading up on a Medicare memorandum about how they will (and won't) pay for certain services based on documentation and coding.

Keep an Open Mind

Whatever you decide to do or wherever you work, remember to keep an open mind. My career sure didn't turn out the way I thought it would - it turned out better than I ever imagined! If you put yourself into a boxed category you will stifle your growth, but if you believe in limitless possibilities, you just might soar! So be bold and good luck!