Upcoming Speaking Engagements

It's conference season! This means I have a lot of speaking engagements coming up. Here's a list of what's on tap for me over the next several months and links to more information. If you have any questions or would like more information, email me at codercoach@gmail.com. If you're in the area, I'd love to meet any and all of you!

March

• Tuesday, March 22 - Coder Coach Event, Emily Griffith Opportunity School, Denver, CO. Topic: "Overview of Health Information Management" (speaker)
  

April

• Friday, April 15 - NCHIMA Spring Meeting, Bella Sera Event Center, Brighton, CO. Topic: "Confessions of a Dyslexic Coder - What it's Really Like to Learn ICD-10-CM" (speaker)
  
• Thursday, April 21 - Montana HFMA 2011 Spring Conference, Bozeman, MT. Topic: ICD-10 and HIPAA 5010 Preparation (speaker)
  
• Thursday, April 28 - HCPro audio conference. Topic: "Cardiac Catheterization and Peripheral Revascularization: 2011 CPT Coding Changes Explained" (co-presenter)
  

May

• Tuesday, May 24 - Coder Coach Event, Emily Griffith Opportunity School, Denver, CO. Topic: "Introduction to ICD-10-CM (Diagnosis) Coding" (speaker)
  
• Wednesday, May 25 - CHIMA Spring Meeting, Denver Marriott West, Denver, CO. Topics: "ICD-10 Implementation Panel" (panelist) and "Mentoring the Future Workforce" (speaker)
  

July

• Tuesday, July 12 - Denver chapter AAPC meeting, VA Medical Center, Denver, CO. Topic: "The Importance of Networking in Coding" (speaker)

October

• Saturday, October 1 - 2011 AHIMA Convention & Exhibit, Salt Lake City, UT. Topic: "The Cardiac Cath Coding/Charging Crossover" (speaker)

Two Track Mind: ICD-10 and Vascular CPT Coding

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

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

CPT Code Changes

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

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

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

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

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

ICD-10-CM and ICD-10-PCS

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

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

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

Prepare for Your Challenge

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

Back Away from the Keyboard...

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

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

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

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

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

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

Happy networking!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What the Heck is a DRG? And Why Should I Care About Case Mix?

So you want to be a coder. And not just that, you want to be a hospital coder because, on average, they make more money than physician coders. And you don't just want to be a hospital coder, you want to be an inpatient hospital coder because then you get to look at the whole chart and piece together the patient's clinical picture. If this is your goal, then everything you need to know you will not learn in school. And that's mainly because there is so much to learn and practical experience is key.

Most of all, if you want to be an inpatient coder, you need to know diagnosis-related groups (DRGs) because in hospitals, it's all about DRGs and case mix - and compliance. If you have no idea what I'm talking about, fear not - here's a primer on DRGs! I wish I could say I cover it all here, but this is just a beginning!

What is a DRG?
The ICD-9-CM coding system contains about 16,000 diagnosis codes and ICD-10-CM contains over 68,000 codes. Imagine trying to determine a payment amount for each individual condition. And that doesn't include accounting for procedures. The most logical solution is to create a system that allows for broader classification of conditions and services for easier comparison and assignment into payment categories. DRGs were created for this purpose. I look at DRGs as a way to "organize the junk drawer" where patients are grouped into different categories based on similar conditions and cost to treat the patient.

History
DRGs were first developed at Yale University in 1975 for the purpose of grouping together patients with similar treatments and conditions for comparative studies. On October 1, 1983, DRGs were adopted by Medicare as a basis of payment for inpatient hospital services in order to attempt to control hospital costs. Since then, the original DRG system has been changed and advanced by various companies and agencies and represents a rather generic term. These days, we have various DRG systems in use - some proprietary and some a matter of public record - all of which group patients in different ways. Two of the main DRG systems currently in use are the Medicare Severity DRG (MS-DRGs) and 3M's All Patient Refined DRGs (APR-DRGs). Different DRG systems are used by different payers.

How to Get a DRG
All DRG systems are a little different, but the basic premise is the same. DRGs are based on codes. In effect, DRGs are codes made up of codes. The following elements are taken into consideration when grouping a DRG:

• ICD-9-CM diagnosis codes
• ICD-9-CM procedure codes
• Discharge disposition
• Patient gender
• Patient age
• Coding definitions as defined by the Uniform Hospital Discharge Data Set (UHDDS) - in other words, the sequence of codes on the claim

Back in the 80s, DRGs were grouped manually using decision trees. These days, DRGs are grouped with the touch of a button and DRG groupers are a big part of encoding software. But I would be doing you a disservice if I didn't at least give you an idea of the grouper logic. As I mentioned, there are different DRG systems and probably the most popular is the MS-DRG system, so I will explain how MS-DRG grouper logic works.

MS-DRG Grouper Logic
The first step in assigning an MS-DRG is to classify the case into one of the 25 major diagnostic categories (MDC). These MDCs are based on the principal (first) diagnosis and, with a few exceptions, are based on body systems, such as the female reproductive system. Five MDCs are not based on body systems (injuries, poison and toxic effect of drugs; burns; factors influencing health status (V codes); multiple significant trauma; and human immunodeficiency virus infection). Organ transplant cases are not assigned to MDCs, but are immediately classified based on procedure, rather than diagnosis. These are called pre-MDC DRGs.

Once a case has been assigned into an MDC (with the exception of the transplant pre-MDCs), it is determined to be either medical or surgical. Surgical cases require more resource consumption (that's industry speak for "costs more!"), so they must be separated from the medical cases. If there are no procedure codes on the case (e.g., a patient with pneumonia may have no procedure codes), then it's simple - it's a medical case. But if the patient had a procedure, that procedure may or may not be considered surgical. For example, an appendectomy is quite clearly a surgical procedure. But something like suturing a laceration is not. It's all based on resource consumption - the cost of performing the procedure. In general, anything requiring an operating room is surgical.

Quick sidebar here - this is why skin debridement is such a hot topic in the world of coding compliance. Nonexcisional debridement (code 86.28) groups as a medical case. However, excisional debridement (code 86.22) groups as a surgical case and the change in reimbursement is rather drastic.

Okay, so now that we have our MDC and a designation as medical or surgical, we need to look at the other diagnoses on the claim. Right now, Medicare is able to process the first 9 diagnoses on the claim (even though 18 are reportable). These other diagnoses, depending on their severity, may be designated as complications and comorbidities (CCs) or major complications and comorbidities (MCCs). Medicare maintains lists of CCs and MCCs and updates them annually. CCs and MCCs are conditions that have been identified as significantly impacting hospital costs for treating patient with those conditions. For example, it's been determined that congestive heart failure without further specification does not significantly impact costs and it is not a CC/MCC. However, patients with chronic systolic or diastolic heart failure do have slightly higher costs, so those conditions are CCs. More so, patients with acute systolic or diastolic heart failure have even higher costs, so they are designated as MCCs. Are you beginning to see how slight changes in a physician's diagnostic statement impact coding and thus payment?

DRG Weights
Okay, so we know the MDC, whether the case is medical or surgical, and whether or not there are any CCs or MCCs. How does that translate into reimbursement? Well, if you're using an encoder (and if you code for a hospital, you will), you hit a button and presto! You have a DRG with a relative weight. Now if only you knew what that relative weight meant. The DRG relative weight is the average amount of resources it takes to treat a patient in that DRG. Huh?

Let me demonstrate. The baseline relative weight is 1 and represents average resource consumption for all patients. Anything less than 1 uses less than average resources. Anything above 1 uses more than average resources. So let's compare some respiratory MS-DRGs:

• MS-DRG for lung transplant has a relative weight of 9.3350
• MS-DRG for simple pneumonia (no CC/MCC) has a relative weight of 0.7096
• MS-DRG for chronic obstructive pulmonary disease with an MCC has a weight of 1.1924

You can see how different combinations of codes lead to different MS-DRGs with different relative weights. In order to convert that into monetary terms, we multiply the relative weight by the hospital base rate. Now I'm sure you want to know how to get that hospital base rate. Me too. Well, up to a point. The base rate is exclusive to each hospital and takes a lot of historical, facility-specific data into account, like what they've been paid in the past, whether or not they are an urban or rural hospital, and how much the hospital pays out in wages. That's just more math than my poor little head can comprehend! So for the purposes of this exercise, let's pretend like this hospital - we'll call it Happyville Hospital - has a base rate of $5000. So if we multiply the relative weights above by $5000, our reimbursement for those cases, respectively, is $46,675, $3,548, and $5,962.

Case Mix
You just might be asked in an interview if you understand case mix. It's a good indication of whether or not someone really understands DRGs. And I have to admit, in my sometimes sadistic manner, I like seeing that look of glazed-over confusion on someone's face when I bring up case mix. But case mix is simple. It's the average relative weight for a hospital. So get out a big piece of paper for your hospital and start writing down the relative weights for every single case and then divide to get your average. Okay, so it's computerized now. But that's all case mix is - an average.

In the industry, we officially refer to case mix as the type of patients a hospital treats. Let's say at Happyville, we have a high volume of transplant cases plus a trauma center and a well-renowned cardiac program. These are all highly weighted types of cases and our overall case mix will be higher than say, Anytown Hospital down the street that has no trauma center, no transplant program, and basic cardiac services (they transfer all their serious cardiac cases to Happyville!). Happyville's case mix will be higher than Anytown's.

As a coder, you don't need to know what your specific hospital's case mix is at any given time. But knowing what impacts case mix is an indication that you know your stuff. First and foremost, case mix fluctuates. Most hospitals monitor case mix on a monthly basis because changes in case mix are a precursor to changes in reimbursement. Of course your CFO wants case mix to continue to rise, but that could be a red flag. And he certainly doesn't want case mix to fall. If case mix begins to decrease, the first place hospital administration usually looks is coding - after all, case mix is based on DRGs, which are based on codes. But there are lots of things that can impact case mix and many of them have nothing to do with coding, such as:

• The addition or removal of a heavy admitting physician - especially specialty surgeons
• Opening or closing a specialty unit
• Changes in a facility's trauma level designation
• Movement of cases from the inpatient setting to outpatient, and
• Anything else that impacts the type of services the hospital provides

Your Life as an Inpatient Coder
As an inpatient coder your job is to make sure you get all the codes on the claim in the correct order so that the accurate DRG is assigned and the hospital gets paid appropriately. When I put it that way, it sounds so easy! The reality is, with more and more patients being treated as outpatients, those who are admitted as inpatients are sicker than they've ever been. And sicker means harder to code. For instance, the patient comes in with shortness of breath and the final diagnosis is acute exacerbation of COPD, stapholococcal pneumonia, and respiratory failure. How you code and sequence the case will determine the appropriate DRG and reimbursement. The good news is, you'll have an encoder to help you model the DRGs and see what pays what. The bad news is, you have to paw through the medical record to determine the true underlying cause of that shortness of breath.

So are you ready for the challenge? Are you ready to apply DRGs?

New Year, New Attitude

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

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

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

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

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

Recovering Encoderaholic

Most coding students spend semesters learning to navigate ICD-9-CM and CPT code books and maybe a little class time plus internship experience learning how to code using an encoder. And then they graduate and, if they move on to a position at a hospital, they start using an encoder almost exclusively. In fact, many hospitals don't purchase code books for their coders because they pump so much money into encoders. The result can be coders who forget how to use their code books all together.

In case you aren't familiar, encoders are software programs that automate the code book. This makes coding faster for the coder and also allows for inclusion of coding and billing edits and coding guidelines and advice. Not to mention, it helps us remember to put fifth digits on all those diagnosis codes! There are two types of encoders: logic-based and book-based. Logic-based encoders are probably the most popular. They ask the coder a series of questions that ultimately lead to code assignment. Book-based encoders are computerized code books in which the coder looks up codes just like in a hard copy book with a few enhancements. Both types tend to include crosswalks from ICD-9-CM to CPT and vice versa.

Sounds great, right? What could possible go wrong?

Well, a lot, actually. And I speak from experience as a recovering encoderaholic.

Don't get me wrong, I like encoders - love them, actually - and can't do my job efficiently or completely without them. But even when I have my encoder up and running, my code books are at my finger tips. And when I teach, I prefer to teach from the book. This was a hard won lesson for me. I remember a coding auditor coming to audit my coworkers and me and, in her exit interview, she made an example of me. She asked me how I came up with a CPT code and my response was "the encoder took me there" and she asked me where my CPT book was and I pointed to the enclosed bin over my desk. And she read me the riot act for not having my CPT book on my desk - and I was coding day surgeries. She then told me what I tell the coders I audit now - "the encoder took me there" is not a valid excuse.

If you're wondering why you have to spend so much time becoming familiar with using the code book, it's because it's the fundamental of coding. If your elementary learning experience was like mine, you had to learn how to do long division before using a calculator and you had to learn to tell time on a clock face before you got a digital watch. Learning to use the code book is important because you need to know the logic behind the encoding programs in order to "check your work" - to steal a phrase from math class! How will you know the encoder led you wrong if you don't know the logic?

If that's not a good enough reason for you, then chew on this. Many people are not passing coding certification exams these days and it's not because they don't know how to code. Many of them have been coding for years - with encoders. And since they have to use books on the test and they aren't efficient in looking up codes in the book, they are unable to finish the test.
You may be asking if encoders will replace the need for coders and many industry experts agree that while there is some limited application to computer-assisted coding (e.g., radiology), the skill of reading a medical record and translating it into code is a subjective skill that requires a human. So don't worry about there being no future in coding due to computerization; just worry about how you will use coding software to enhance, not replace, your coding knowledge.