Thursday, May 13, 2010
Interesting Article About What You Might be Doing Wrong in the Hiring Process
I came across this article that I thought would be beneficial to newbie coders seeking jobs. So many of the people I talk to are concerned about the coding skills and experience but it's important that we don't lose sight of the basics. Check out this link: 7 Little-Known Reasons You're Not Getting Hired.
Monday, May 10, 2010
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.
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.
My Upcoming Speaking Engagements
As of today, here are my planned speaking engagements. I hope to see some of you there!
- Thursday, June 17, 2010 - "Cardiac Catheterization Coding" and "The Importance of Networking in Coding", Colorado Springs Chapter of AAPC, Colorado Springs, CO
- Tuesday, July 13, 2010 - "Taking the Shock out of Electrophysiology Coding" - Denver Chapter of AAPC, Denver, CO
- Thursday, July 15, 2010 - "Vascular Interventional Radiology Primer" - Loveland Chapter of AAPC, Loveland, CO
- Thursday, September 2, 2010 - "FY 2011 CMS IPPS Update" - AHIMA Audio Conference
Kristi
Next Event - May 25 - Cardiac Catheterization
When: May 25, 2010, 6:00-8:00 pm
Where: Emily Griffith Opportunity School - Rooms 403/405
1250 Welton Street Denver, CO
What: Cardiac catheterization coding has been deemed one of the most difficult areas of coding. Coding cardiac catheterization and percutaneous cardiac interventions (PCI) can prove to be a very lucrative career track, but first you need to know more than basic CPT coding. This event will provide an overview of cardiac anatomy along with coding guidelines for diagnostic heart catheterization and PCI procedures.
The presenter will also discuss documentation requirements and present actual cardiac catheterization reports for extra practice.
A basic knowledge of CPT is recommended for attendees. All attendees are encouraged to bring a 2009 or 2010 CPT codebook for coding case studies.
About the Speaker:
Kristi Stanton, RHIT, CCS, CPC is the Senior Consultant of Training & Education with The Wilshire Group Associates, LLC, based in Los Angeles, CA. She has 7 years experience with coding education, with a focus on interventional radiology, cardiac catheterization, hospital-based inpatient and outpatient coding, APCs, and DRGs. She is the founder and facilitator of The Coder Coach group and blog and is dedicated to mentoring new coding professionals.
Where: Emily Griffith Opportunity School - Rooms 403/405
1250 Welton Street Denver, CO
What: Cardiac catheterization coding has been deemed one of the most difficult areas of coding. Coding cardiac catheterization and percutaneous cardiac interventions (PCI) can prove to be a very lucrative career track, but first you need to know more than basic CPT coding. This event will provide an overview of cardiac anatomy along with coding guidelines for diagnostic heart catheterization and PCI procedures.
The presenter will also discuss documentation requirements and present actual cardiac catheterization reports for extra practice.
A basic knowledge of CPT is recommended for attendees. All attendees are encouraged to bring a 2009 or 2010 CPT codebook for coding case studies.
About the Speaker:
Kristi Stanton, RHIT, CCS, CPC is the Senior Consultant of Training & Education with The Wilshire Group Associates, LLC, based in Los Angeles, CA. She has 7 years experience with coding education, with a focus on interventional radiology, cardiac catheterization, hospital-based inpatient and outpatient coding, APCs, and DRGs. She is the founder and facilitator of The Coder Coach group and blog and is dedicated to mentoring new coding professionals.
Thursday, March 11, 2010
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!
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!
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You can find me on Twitter through codercoach@gmail.com. I will be posting blog updates and other information as I have it.
Tuesday, February 16, 2010
Coding is Just Looking up a Code in a Book…
…or is it?
When I was taking coding classes on Thursday evenings in the mid-90s, everyone in my class – including the instructor – had the same dilemma. There was a great new show on TV called “ER.” And it was on during coding class. Bearing mind that DVR didn’t exist at the time, sometimes we were able to talk our instructor into letting us go early and she would joke with us and tell us she’d give us extra credit if we went home and coded “ER,” that is, translate the conditions of the patients of the week into codes. I don’t know if anyone actually did. I certainly didn’t because I was just trying to understand the clinical lingo and decide what was important and what wasn’t. So now it’s your turn – how would you code this hospital inpatient scenario?
“CC: Pt adm w/ c/o CP, SOB, fever, weakness. PMH: CHF, HTN, DM type 2. Findings: Temp 102. BP: 100/65. CXR w/ infiltrates. Labs: WBC 40,000, sputum (-), BC (-). Assessment: sepsis, pna. Plan: IV abx, IVF, repeat BC.”
Statements such as these are a reality and before you can look up a code in a book, you first have to know what to look up. It often reminds me of my elementary school teachers telling me if I didn’t know how to spell a word to look it up in the dictionary. I remember thinking, “How do I look it up in the dictionary if I can’t spell it?!” Of course, we all learned to sound out the word and attempt to look it up in the dictionary. But coding is a little trickier because physician short hand is difficult to decipher if you don’t have any clinical knowledge. And before you can translate a clinical statement into codes, you first have to translate it into English!
Have you figured out the scenario above? Here’s the answer:
-038.9 Unspecified septicemia
-995.91 Sepsis
-486 Pneumonia, organism unspecified
-428.0 Congestive heart failure, unspecified
-401.9 Unspecified essential hypertension
-250.00 Diabetes mellitus, without mention of complication, Type II or unspecified
But how do you get there? That’s the question. So I will break down the coder’s thought process as he/she reads the statement and determines what to code.
Step 1: Translate the clinical shorthand into English.
The statement above, if written out long hand, would read as follows: “Chief complaint: patient admitted with complaints of chest pain, shortness of breath, fever, and weakness. Past medical history: congestive heart failure, hypertension, type 2 diabetes mellitus. Findings: Temperature 102 degrees. Blood pressure: 100/65. Chest x-ray with infiltrates. Labs: white blood count 40,000, negative sputum culture, negative blood cultures. Assessment: sepsis, pneumonia. Plan: intravenous antibiotics, intravenous fluids, repeat blood cultures.”
Step 2: Determine what brought the patient to the hospital and the underlying cause of that problem.
The patient had several complaints: chest pain (CP), shortness of breath (SOB), fever, and weakness. The patient’s fever was high and blood pressure was low. Tests showed infiltrates on chest x-ray, which is indicative of pneumonia and labs showed a high white blood cell (WBC) count, which is indicative of infection and blood and sputum (respiratory secretions) cultures did not grow any bacteria – but if the patient was on antibiotics before the cultures were taken, they may not grow any bacteria. The final assessment was sepsis and pneumonia. Symptoms of sepsis are weakness, fever, hypotension (low blood pressure), and high WBC count. Symptoms of pneumonia are chest pain, shortness of breath, fever, high WBC count, and weakness.
Step 3: Assign codes for the reason that brought the patient to the hospital.
Knowing that we don’t code symptoms when an established associated condition is present, we can narrow the final coding down to the sepsis and pneumonia. Coding rules tell us that coding for sepsis requires two codes: 038.9 and 995.91 and pneumonia without further specification is coded to 486. Of course, if this were a real hospital, we hopefully would have more specific documentation telling us the causative organism of both the sepsis and the pneumonia. That would require more digging through the record.
Step 4: Determine if there are other conditions that should also be reported.
In this case, the patient has a past medical history of congestive heart failure (CHF), hypertension, and type 2 diabetes mellitus. All of these are chronic conditions that impact the care of the patient and should therefore be coded. We can then add codes 428.0, 401.9, and 250.00. We can’t assume a cause and effect relationship between the CHF and hypertension because it’s not documented by the physician and we would want to look for documentation of a specific type of congestive heart failure (e.g., acute on chronic diastolic heart failure) and any diabetic complications.
So coding is just looking up a code in a book. At least that’s the tangible part of it. The rest of it is the thought process that goes behind it and explains why, if you watch coders work, you will see them spend most of their time staring at a computer screen or flipping through a medical record. I often compare coding to doing a word search: you have to sort through all the gobbledygook (i.e., pages of clinical mumbo jumbo) to find the right word to look up in the codebook.
You either found this explanation horribly boring or oddly fascinating. If you belong in the latter category, welcome to the wonderful world of coding. You're going to love it.
When I was taking coding classes on Thursday evenings in the mid-90s, everyone in my class – including the instructor – had the same dilemma. There was a great new show on TV called “ER.” And it was on during coding class. Bearing mind that DVR didn’t exist at the time, sometimes we were able to talk our instructor into letting us go early and she would joke with us and tell us she’d give us extra credit if we went home and coded “ER,” that is, translate the conditions of the patients of the week into codes. I don’t know if anyone actually did. I certainly didn’t because I was just trying to understand the clinical lingo and decide what was important and what wasn’t. So now it’s your turn – how would you code this hospital inpatient scenario?
“CC: Pt adm w/ c/o CP, SOB, fever, weakness. PMH: CHF, HTN, DM type 2. Findings: Temp 102. BP: 100/65. CXR w/ infiltrates. Labs: WBC 40,000, sputum (-), BC (-). Assessment: sepsis, pna. Plan: IV abx, IVF, repeat BC.”
Statements such as these are a reality and before you can look up a code in a book, you first have to know what to look up. It often reminds me of my elementary school teachers telling me if I didn’t know how to spell a word to look it up in the dictionary. I remember thinking, “How do I look it up in the dictionary if I can’t spell it?!” Of course, we all learned to sound out the word and attempt to look it up in the dictionary. But coding is a little trickier because physician short hand is difficult to decipher if you don’t have any clinical knowledge. And before you can translate a clinical statement into codes, you first have to translate it into English!
Have you figured out the scenario above? Here’s the answer:
-038.9 Unspecified septicemia
-995.91 Sepsis
-486 Pneumonia, organism unspecified
-428.0 Congestive heart failure, unspecified
-401.9 Unspecified essential hypertension
-250.00 Diabetes mellitus, without mention of complication, Type II or unspecified
But how do you get there? That’s the question. So I will break down the coder’s thought process as he/she reads the statement and determines what to code.
Step 1: Translate the clinical shorthand into English.
The statement above, if written out long hand, would read as follows: “Chief complaint: patient admitted with complaints of chest pain, shortness of breath, fever, and weakness. Past medical history: congestive heart failure, hypertension, type 2 diabetes mellitus. Findings: Temperature 102 degrees. Blood pressure: 100/65. Chest x-ray with infiltrates. Labs: white blood count 40,000, negative sputum culture, negative blood cultures. Assessment: sepsis, pneumonia. Plan: intravenous antibiotics, intravenous fluids, repeat blood cultures.”
Step 2: Determine what brought the patient to the hospital and the underlying cause of that problem.
The patient had several complaints: chest pain (CP), shortness of breath (SOB), fever, and weakness. The patient’s fever was high and blood pressure was low. Tests showed infiltrates on chest x-ray, which is indicative of pneumonia and labs showed a high white blood cell (WBC) count, which is indicative of infection and blood and sputum (respiratory secretions) cultures did not grow any bacteria – but if the patient was on antibiotics before the cultures were taken, they may not grow any bacteria. The final assessment was sepsis and pneumonia. Symptoms of sepsis are weakness, fever, hypotension (low blood pressure), and high WBC count. Symptoms of pneumonia are chest pain, shortness of breath, fever, high WBC count, and weakness.
Step 3: Assign codes for the reason that brought the patient to the hospital.
Knowing that we don’t code symptoms when an established associated condition is present, we can narrow the final coding down to the sepsis and pneumonia. Coding rules tell us that coding for sepsis requires two codes: 038.9 and 995.91 and pneumonia without further specification is coded to 486. Of course, if this were a real hospital, we hopefully would have more specific documentation telling us the causative organism of both the sepsis and the pneumonia. That would require more digging through the record.
Step 4: Determine if there are other conditions that should also be reported.
In this case, the patient has a past medical history of congestive heart failure (CHF), hypertension, and type 2 diabetes mellitus. All of these are chronic conditions that impact the care of the patient and should therefore be coded. We can then add codes 428.0, 401.9, and 250.00. We can’t assume a cause and effect relationship between the CHF and hypertension because it’s not documented by the physician and we would want to look for documentation of a specific type of congestive heart failure (e.g., acute on chronic diastolic heart failure) and any diabetic complications.
So coding is just looking up a code in a book. At least that’s the tangible part of it. The rest of it is the thought process that goes behind it and explains why, if you watch coders work, you will see them spend most of their time staring at a computer screen or flipping through a medical record. I often compare coding to doing a word search: you have to sort through all the gobbledygook (i.e., pages of clinical mumbo jumbo) to find the right word to look up in the codebook.
You either found this explanation horribly boring or oddly fascinating. If you belong in the latter category, welcome to the wonderful world of coding. You're going to love it.
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