I recently looked over my past blog postings to see what material I haven't covered. Well, there's a lot. And I realize my last few posts have been very heavy on ICD-10 - mainly because that's what I'm working on most of the time. It got me thinking, though - have I strayed from the initial intent of this blog? Who is my audience - current coders or future coders?
I have a friend and avid blogger (who's blog I am sorely behind in reading!) whom I consulted before I started the Coder Coach blog and I asked her, "What do I blog about?" She said, "Whatever you want!" Perfect! Because if I can't write about something I truly want to write about, what's the point of having a blog?! And today it really hit home - my audience has expanded.
I started the Coder Coach group and blog about 2 years ago because I identified an alarming trend. Schools are turning out coding professionals by the dozens and many of them are becoming certified. They spend a lot of time, money, and effort to get the training they will need to land them in a lucrative career only to have the doors of employers slammed in their faces because they lack experience. I've talked to my peers and we're all under regulatory pressures that make it difficult for us to train new employees. But can we ever really expect to hire someone who can truly hit the ground running without any training?
The Coder Coach isn't just this blog, it's also a Facebook group (where I post links to this blog and others) and it's a group of curious individuals in the Denver area who get together every couple of months to learn something about coding from a pro (not always me!) that goes above and beyond classroom learning. In my mind, the Coder Coach is helping to fill that big gap between school and experience.
But as I mentioned, my audience is growing. The unknown isn't just limited to coding students and new grads right now. The coding field is about to undergo a monster transition and at the same time, health information management (HIM) professionals are struggling with implementation of electronic health records (EHRs), health information exchanges (HIEs), and meaningful use standards. As an HIM professional and coder, I see and talk to many people who are paving the way for the future of these professions. My mother is a retired RHIT who was before her time - she retired about 10 years ago and before her retirement was really excited about the future of EHRs. When I tell her about what's going on in the field right now, she is in awe - we are just starting to realize what she had a vision for 15 years ago.
And as I've toured the state of Colorado, conducting outreach through our ICD-10 Task Force, I've had many HIM practitioners asking me questions that coding students ask me. Should they consider a change from the operational side of HIM to coding and what's the best way to do it? So I will try to give a good balance in my blog postings of basic things I think anyone interested in a coding career should know now along with what everyone seems to need - a little insight into what it will be like as an ICD-10 coder.
Happy evolving to all of us!
Thursday, July 21, 2011
Wednesday, July 20, 2011
31 Flavors of Ice Cream, 31 Root Operations in ICD-10-PCS
Sunday I decided to give up ice cream. Not forever, just for a few weeks or so while I try to kick what has become a rather troublesome sugar addiction. It turns out Sunday was not a good day to give up ice cream because that was National Ice Cream Day. How that very important holiday was omitted from my Outlook calendar when I imported all the US holidays, I'll never know, so I will have to be more watchful next year. I am proud, albeit unsatisfied, to tell you I stuck to my guns and didn't celebrate National Ice Cream Day this year. There's always 2012!
You might be laughing right now, but ice cream is a very serious matter to me. When asked what my favorite ice cream is, I will inevitably ask you "from where?" and then launch into a tirade about how the manufacturer is key in determining what flavor to eat and continue with a discussion about proper chocolate-to-ice-cream ratio that would make Sally Allbright from When Harry Met Sally proud. I consider myself a bit if a connoisseur, which my mother tells me goes all the way back to that first ice cream cone I "shared" with her. The words "death grip" come to mind when I think of her telling the story. In short, she didn't get any ice cream that day and so began my love affair with the creamy treat.
Monday morning, ice cream ban still in full swing, and ready to start another work week, I shuffled into ICD-10 Central (aka, my office), where it's quite obvious there is some serious ICD-10 work going on: the two large flipchart posters on the wall listing the root operations, stacks of ICD-10 books from current and past years, and a hot pink post-it stuck to my July (national ice cream month!) calendar stating quite simply: "31 Flavors of ice cream - 31 Root Operations."
The ice cream post-it is the only way I can remember how many root operations there are in ICD-10-PCS. I heard a speaker once tell the audience to take a root operation a month and study it in preparation for ICD-10-PCS and then she said there weren't enough months before implementation. And sure enough, here we are in July 2011 and the October 1, 2013 deadline is looming ever closer - only a couple years away.
When I tried to relay that story to one of my audiences, I decided it was pathetic I couldn't tell anyone off the top of my head how many root operations there were. So thank you, Baskin Robbins, for helping me out with this one and loaning me your 31 Flavors terminology. Even though at last count there were more than 31 flavors behind your counter. And even though, in my mind, there is only one flavor of Baskin Robbins ice cream (accolades for proper chocolate-to-ice-cream ratio!).
So there you have it. There are 31 root operations in ICD-10-PCS that hospital inpatient coders must become familiar with. It will be quite impossible to code without knowing the root operations. For ease of use as I have sat down with medical records and began coding my little ICD-10 heart out, I posted the wall charts right in front of my desk, arranged in categories I wish I could take credit for creating:
Root operations that take out some or all of a body part:
of part of a body part while resection is removal of the entire body part. That contradicts the way we code today where excision is a complete removal.
But don't worry - this alien new coding system comes with its own set of guidelines that define these root operations and tell you when to code out separate components of a procedure. For example, there is a hierarchy for spinal fusions that utilize bone graft, internal fixation, and cages so you only end up with a single code. On the other hand, placement of a completely embedded vascular infusion device requires two codes: one for catheterizing the vessel, and one for placement of a subcutaneous port.
If you're wondering how to get a leg up on ICD-10, don't bother learning to code it right now. We've all heard that, right? You will forget it unless you use it every day. But you can and should start reading the coding guidelines and become familiar with the table format of ICD-10-PCS. It's different for everyone who codes now (that was spy code for all you novices looking for a level playing field!). ICD-10-PCS coding will identify a whole new population of coders with the skill to properly categorize root operations. It will mean knowing not only the name of the procedure, but what that procedure is trying to accomplish and how it's performed. So brushing up on surgical procedures is a great way to bide your time until it is time to get moving with hands-on training.
So are you ready to test out those 31 flavors of root operations? I will start posting some teasers for you and you can test your ability to name that root operation. If you would like to download the latest version (2012) of ICD-10-PCS, the files are free at CMS' website - guidelines included! Check it out here at: http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOfPage. While you start reading, I am going to go hide my car keys and my Ben and Jerry's pint cozy. I suddenly have a craving for ice cream. Weird.
You might be laughing right now, but ice cream is a very serious matter to me. When asked what my favorite ice cream is, I will inevitably ask you "from where?" and then launch into a tirade about how the manufacturer is key in determining what flavor to eat and continue with a discussion about proper chocolate-to-ice-cream ratio that would make Sally Allbright from When Harry Met Sally proud. I consider myself a bit if a connoisseur, which my mother tells me goes all the way back to that first ice cream cone I "shared" with her. The words "death grip" come to mind when I think of her telling the story. In short, she didn't get any ice cream that day and so began my love affair with the creamy treat.
Monday morning, ice cream ban still in full swing, and ready to start another work week, I shuffled into ICD-10 Central (aka, my office), where it's quite obvious there is some serious ICD-10 work going on: the two large flipchart posters on the wall listing the root operations, stacks of ICD-10 books from current and past years, and a hot pink post-it stuck to my July (national ice cream month!) calendar stating quite simply: "31 Flavors of ice cream - 31 Root Operations."The ice cream post-it is the only way I can remember how many root operations there are in ICD-10-PCS. I heard a speaker once tell the audience to take a root operation a month and study it in preparation for ICD-10-PCS and then she said there weren't enough months before implementation. And sure enough, here we are in July 2011 and the October 1, 2013 deadline is looming ever closer - only a couple years away.
When I tried to relay that story to one of my audiences, I decided it was pathetic I couldn't tell anyone off the top of my head how many root operations there were. So thank you, Baskin Robbins, for helping me out with this one and loaning me your 31 Flavors terminology. Even though at last count there were more than 31 flavors behind your counter. And even though, in my mind, there is only one flavor of Baskin Robbins ice cream (accolades for proper chocolate-to-ice-cream ratio!).
So there you have it. There are 31 root operations in ICD-10-PCS that hospital inpatient coders must become familiar with. It will be quite impossible to code without knowing the root operations. For ease of use as I have sat down with medical records and began coding my little ICD-10 heart out, I posted the wall charts right in front of my desk, arranged in categories I wish I could take credit for creating:
Root operations that take out some or all of a body part:
- Excision
- Resection
- Detachment
- Destruction
- Extraction
- Drainage
- Extirpation
- Fragmentation
- Division
- Release
- Transplantation
- Reattachment
- Transfer
- Reposition
- Restriction
- Occlusion
- Dilation
- Bypass
- Insertion
- Replacement
- Supplement
- Change
- Removal
- Revision
- Inspection
- Map
- Control
- Repair
- Fusion
- Alteration
- Creation
of part of a body part while resection is removal of the entire body part. That contradicts the way we code today where excision is a complete removal.But don't worry - this alien new coding system comes with its own set of guidelines that define these root operations and tell you when to code out separate components of a procedure. For example, there is a hierarchy for spinal fusions that utilize bone graft, internal fixation, and cages so you only end up with a single code. On the other hand, placement of a completely embedded vascular infusion device requires two codes: one for catheterizing the vessel, and one for placement of a subcutaneous port.
If you're wondering how to get a leg up on ICD-10, don't bother learning to code it right now. We've all heard that, right? You will forget it unless you use it every day. But you can and should start reading the coding guidelines and become familiar with the table format of ICD-10-PCS. It's different for everyone who codes now (that was spy code for all you novices looking for a level playing field!). ICD-10-PCS coding will identify a whole new population of coders with the skill to properly categorize root operations. It will mean knowing not only the name of the procedure, but what that procedure is trying to accomplish and how it's performed. So brushing up on surgical procedures is a great way to bide your time until it is time to get moving with hands-on training.
So are you ready to test out those 31 flavors of root operations? I will start posting some teasers for you and you can test your ability to name that root operation. If you would like to download the latest version (2012) of ICD-10-PCS, the files are free at CMS' website - guidelines included! Check it out here at: http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOfPage. While you start reading, I am going to go hide my car keys and my Ben and Jerry's pint cozy. I suddenly have a craving for ice cream. Weird.
Wednesday, July 13, 2011
Evolution of the Coder
When I started the HIM program at the local community college in... ahem, a few years ago (sly smile), I split my time working as a file clerk in a doctor's office and a catch-all clerk in a physician's billing office. The doctor's office was a family practice managed by the owner of the billing office, which was located just next door. I remember my coworkers asking me why I was going to school to learn about medical records because I was already a file clerk. I also remember hearing one of the billers grumble about an insurance company denying claims for a male patient with pelvic pain and "can't men have pelvic pain?!"
Well, it didn't take me long to realize that the HIM field was more than filing - especially these days as hospitals and physicians move to electronic health records. And it didn't take me long to learn that, at least in the eyes of ICD-9-CM, men can't have pelvic pain - at least not the kind classified to code 625.9, Unspecified symptom associated with female genital organs (as evidenced by the word "female" in the code description and the little female symbol next to the code).
That was a long time ago and a lot has changed in the coding (and HIM) field since then. As a consultant, I work with hospitals to identify areas for coding education and then develop a curriculum and deliver training. It used to be as simple as telling my client to have all their coders at the training at a specific time and date. But not anymore. You see, the coders in a hospital aren't just sitting in the coding unit (physical or virtual) anymore. There could be coders all across a hospital. There could be people coding who don't even know they're coding. There could be nurses working with doctors to improve their documentation to ensure proper code-based reimbursement. There could be clinic coders coding the professional side for physicians working in hospital-based clinics. Finding coders in a facility is a challenge!
In short, coding has evolved.
And this is a great thing - this means that if you have the skill to be a coder - and it is a skill - there are many directions your career path can take you. So what's your passion? Do you relate to transactional work? Are you production oriented? Do you like the clinical puzzle involved in coding and secretly harbor fantasies of being Dr. Gregory House and solving the diagnostic dilemma in front of you? Do you like finance? Are you a data hound? Do you love to do research? If you answered yes to any of the above, there's a niche for you in coding.
The Transactional/Production Coder
I'll be honest. As a coder, my production, in general, stinks. At least it did the last time I did it. Some days I could concentrate very well and knock out a bunch of records. Some days it was like ADD kicked in and I just couldn't concentrate on the documentation in front of me. But there is a group of very special people who are production-based and enjoy transactional work. These are the people who are a coding manager's dream. They come to work, know how many accounts they need to code for the day, and they get it done. I have a lot of respect for those people. I wish that was me!
The Dr. House Coder
I use the TV show, House, a lot in my training sessions and blogs. I watch it and see if I can diagnose the patient before Dr. House. Usually not. But it's fun to try! Physicians and nurses alike are often surprised when they talk to coders to learn how much coders know about clinical practice and disease process. If you read enough medical records in your lifetime and see the treatment plans, it starts to rub off! If you love the clinical stuff like me, there's a lot of opportunity. Clinical documentation improvement (CDI) programs are popping up all over hospitals. The point: get the physician to document as specific as possible to ensure proper reimbursement for the hospital. Clinical documentation specialist (CDSs) are on the floor, looking at charts while the patient is in-house and talking directly with physicians. This is a job that can be done by a nurse or a coder who has been given proper clinical training. Some hospitals employ both coders and nurses as CDSs for a collaborative effort. I don't really have a desire to go back to working for a hospital, but if I did, I think I would like to be a CDS.
The Code-Based Reimbursement Coder
More and more I see coders being placed in the billing departments of hospitals. Or certified coders being given the role of charge description master (CDM) analyst. As Medicare and other code-based payers get really sticky with their billing requirements, it gets more difficult to get a clean claim out the door. Coders working on the revenue side are typically ensuring hospital systems that incorporate the use of codes are updated and interfacing/functioning properly.
A CDM analyst maintains the hospitals list of charges. If you're looking for a picture of what a CDM looks like, it's a massive spreadsheet for each department in the hospital with a line item for everything they could possibly charge for along with prices for those services and supplies. And some of those line items are attached to codes. CDM analysts work with clinical department heads to make sure charges are set up for all their services and supplies. They also make sure CPT and HCPCS codes in the CDM are updated according to regulatory standards. They might be called into a clinical department to assist in training personnel who are responsible for charging.
For lack of a better title, the code-based reimbursement analyst (an aptly named title I borrowed from a former employer where I was responsible for training code-based reimbursement analysts), is a catch-all before a claim goes out the door. Or someone who audits claims and makes corrections. This person may be responsible for working NCCI edits to get claims through the hospital scrubber and may also work closely with the coders, educating them on the latest Medicare reimbursement changes.
Code-based reimbursement analysts may also be placed in departments prone to frequent coding and charging errors, like interventional radiology, wound care, or injections and infusions. These specialty coders often work not only with documentation, but also with nurses entering charges and physicians regarding their documentation. They may also have a link to billing so they can see how their coding is translating to claim denials and errors.
If you like the revenue and compliance side of coding, there are lots of opportunities for you. Students and recent grads interested in this area often ask me where they can get training or certification for this type of job. Well, there really isn't a specific type of training for it. The best thing you can do is try to get your foot in the door and learn on the job. The coding piece of this is probably the hardest - the rest you learn from your employer. Revenue cycle is part of what I do as a consultant and I like it. I particularly like trying to figure out the complex changes Medicare has put into effect and walking that tightrope between ensuring the provider is getting paid as much as possible while maintaining revenue compliance. Let's just call this code-based coder the "Goldilocks" coder - don't code too much, don't code too little, code just right!
The Data Coder
Maybe you like analyzing data. I for one, find it dull after about 15 minutes. But I've had the joy of working with people who love doing that so we can leverage our skills for the greater good. There are many opportunities for the data-oriented coder. Of course, we should all be concerned about data integrity and coding what was done. But there are positions for people who want to slice and dice and interpret coded data. Registry programs (e.g., cancer, trauma, cardiac) often incorporate the use of codes and then some. The plus to being a registrar is that you usually become an expert in one particular area. For example, I know a cancer registrar who has been to enough tumor board meetings where cancer cases are discussed among physicians, she can effectively diagnose skin cancers most of the time (of course, the real diagnosis comes from a physician!).
Coded data is used by many - health departments, clearinghouses, universities, state hospital associations - and the list goes on. As the government becomes more concerned about outcomes of care and pay-for-performance in hospitals, there is a heavier reliance on accurate coded data. Independent companies like HealthGrades rely on coded data to compare the quality of healthcare among providers and report it to consumers. Someone is behind that data ensuring it's accuracy and interpreting it's impact and meaning. That could be you!
The "Why" Coder
I saved the best for last - well, in my opinion anyway. The "why" coder is the one who loves research and wants to know why. Why will Medicare not pay for a biopsy and an excision of a lesion done at the same time? Why does Medicare pay less for certain patients who have been discharged to a nursing home rather than home? What's the difference between two codes that at first glance appear to have identical code descriptions? Why can't men have pelvic pain?! And this is why I have trouble being a production coder. It's hard to produce when you keep asking why. Luckily, I am able to put my investigative skills to work and do research to build training materials for other coders - like production coders - so they can do their jobs efficiently. The best thing about the "why" coder is that it's free. You can learn just about anything you ever wanted to know about Medicare and their why's and not pay a cent. Of course, the price for accessing public domain information is the sheer amount of information you need to paw through to answer a single question - it can be several hundred pages.
So what's your passion? What kind of coder will you be? The opportunities are endless and we need all kinds!
Well, it didn't take me long to realize that the HIM field was more than filing - especially these days as hospitals and physicians move to electronic health records. And it didn't take me long to learn that, at least in the eyes of ICD-9-CM, men can't have pelvic pain - at least not the kind classified to code 625.9, Unspecified symptom associated with female genital organs (as evidenced by the word "female" in the code description and the little female symbol next to the code).
That was a long time ago and a lot has changed in the coding (and HIM) field since then. As a consultant, I work with hospitals to identify areas for coding education and then develop a curriculum and deliver training. It used to be as simple as telling my client to have all their coders at the training at a specific time and date. But not anymore. You see, the coders in a hospital aren't just sitting in the coding unit (physical or virtual) anymore. There could be coders all across a hospital. There could be people coding who don't even know they're coding. There could be nurses working with doctors to improve their documentation to ensure proper code-based reimbursement. There could be clinic coders coding the professional side for physicians working in hospital-based clinics. Finding coders in a facility is a challenge!
In short, coding has evolved.
And this is a great thing - this means that if you have the skill to be a coder - and it is a skill - there are many directions your career path can take you. So what's your passion? Do you relate to transactional work? Are you production oriented? Do you like the clinical puzzle involved in coding and secretly harbor fantasies of being Dr. Gregory House and solving the diagnostic dilemma in front of you? Do you like finance? Are you a data hound? Do you love to do research? If you answered yes to any of the above, there's a niche for you in coding.
The Transactional/Production Coder
I'll be honest. As a coder, my production, in general, stinks. At least it did the last time I did it. Some days I could concentrate very well and knock out a bunch of records. Some days it was like ADD kicked in and I just couldn't concentrate on the documentation in front of me. But there is a group of very special people who are production-based and enjoy transactional work. These are the people who are a coding manager's dream. They come to work, know how many accounts they need to code for the day, and they get it done. I have a lot of respect for those people. I wish that was me!
The Dr. House Coder
I use the TV show, House, a lot in my training sessions and blogs. I watch it and see if I can diagnose the patient before Dr. House. Usually not. But it's fun to try! Physicians and nurses alike are often surprised when they talk to coders to learn how much coders know about clinical practice and disease process. If you read enough medical records in your lifetime and see the treatment plans, it starts to rub off! If you love the clinical stuff like me, there's a lot of opportunity. Clinical documentation improvement (CDI) programs are popping up all over hospitals. The point: get the physician to document as specific as possible to ensure proper reimbursement for the hospital. Clinical documentation specialist (CDSs) are on the floor, looking at charts while the patient is in-house and talking directly with physicians. This is a job that can be done by a nurse or a coder who has been given proper clinical training. Some hospitals employ both coders and nurses as CDSs for a collaborative effort. I don't really have a desire to go back to working for a hospital, but if I did, I think I would like to be a CDS.
The Code-Based Reimbursement Coder
More and more I see coders being placed in the billing departments of hospitals. Or certified coders being given the role of charge description master (CDM) analyst. As Medicare and other code-based payers get really sticky with their billing requirements, it gets more difficult to get a clean claim out the door. Coders working on the revenue side are typically ensuring hospital systems that incorporate the use of codes are updated and interfacing/functioning properly.
A CDM analyst maintains the hospitals list of charges. If you're looking for a picture of what a CDM looks like, it's a massive spreadsheet for each department in the hospital with a line item for everything they could possibly charge for along with prices for those services and supplies. And some of those line items are attached to codes. CDM analysts work with clinical department heads to make sure charges are set up for all their services and supplies. They also make sure CPT and HCPCS codes in the CDM are updated according to regulatory standards. They might be called into a clinical department to assist in training personnel who are responsible for charging.
For lack of a better title, the code-based reimbursement analyst (an aptly named title I borrowed from a former employer where I was responsible for training code-based reimbursement analysts), is a catch-all before a claim goes out the door. Or someone who audits claims and makes corrections. This person may be responsible for working NCCI edits to get claims through the hospital scrubber and may also work closely with the coders, educating them on the latest Medicare reimbursement changes.
Code-based reimbursement analysts may also be placed in departments prone to frequent coding and charging errors, like interventional radiology, wound care, or injections and infusions. These specialty coders often work not only with documentation, but also with nurses entering charges and physicians regarding their documentation. They may also have a link to billing so they can see how their coding is translating to claim denials and errors.
If you like the revenue and compliance side of coding, there are lots of opportunities for you. Students and recent grads interested in this area often ask me where they can get training or certification for this type of job. Well, there really isn't a specific type of training for it. The best thing you can do is try to get your foot in the door and learn on the job. The coding piece of this is probably the hardest - the rest you learn from your employer. Revenue cycle is part of what I do as a consultant and I like it. I particularly like trying to figure out the complex changes Medicare has put into effect and walking that tightrope between ensuring the provider is getting paid as much as possible while maintaining revenue compliance. Let's just call this code-based coder the "Goldilocks" coder - don't code too much, don't code too little, code just right!
The Data Coder
Maybe you like analyzing data. I for one, find it dull after about 15 minutes. But I've had the joy of working with people who love doing that so we can leverage our skills for the greater good. There are many opportunities for the data-oriented coder. Of course, we should all be concerned about data integrity and coding what was done. But there are positions for people who want to slice and dice and interpret coded data. Registry programs (e.g., cancer, trauma, cardiac) often incorporate the use of codes and then some. The plus to being a registrar is that you usually become an expert in one particular area. For example, I know a cancer registrar who has been to enough tumor board meetings where cancer cases are discussed among physicians, she can effectively diagnose skin cancers most of the time (of course, the real diagnosis comes from a physician!).
Coded data is used by many - health departments, clearinghouses, universities, state hospital associations - and the list goes on. As the government becomes more concerned about outcomes of care and pay-for-performance in hospitals, there is a heavier reliance on accurate coded data. Independent companies like HealthGrades rely on coded data to compare the quality of healthcare among providers and report it to consumers. Someone is behind that data ensuring it's accuracy and interpreting it's impact and meaning. That could be you!
The "Why" Coder
I saved the best for last - well, in my opinion anyway. The "why" coder is the one who loves research and wants to know why. Why will Medicare not pay for a biopsy and an excision of a lesion done at the same time? Why does Medicare pay less for certain patients who have been discharged to a nursing home rather than home? What's the difference between two codes that at first glance appear to have identical code descriptions? Why can't men have pelvic pain?! And this is why I have trouble being a production coder. It's hard to produce when you keep asking why. Luckily, I am able to put my investigative skills to work and do research to build training materials for other coders - like production coders - so they can do their jobs efficiently. The best thing about the "why" coder is that it's free. You can learn just about anything you ever wanted to know about Medicare and their why's and not pay a cent. Of course, the price for accessing public domain information is the sheer amount of information you need to paw through to answer a single question - it can be several hundred pages.
So what's your passion? What kind of coder will you be? The opportunities are endless and we need all kinds!
Wednesday, May 18, 2011
It's HIPAA, not HIPPA
Just for the record, it's HIPAA, not HIPPA. The actual legislation is called the Health Insurance Portability and Accountability Act of 1996 (HIPAA), not the Health Information Patient Privacy Act (HIPPA). I can't tell you how many times I've seen the latter referred to. As a matter of fact, a colleague of mine once emailed a company after seeing HIPPA repeatedly displayed on their website. Once she educated them, they offered her a job!
Privacy and Security
It's true - when most of us think HIPAA, we think privacy of health information. And that's a huge part of it. We may even think, as coders, that we are only impacted by HIPAA when it comes to keeping the medical record information we read during the coding process confidential. But HIPAA is much bigger than keeping health information from falling into the wrong hands. The true intent of the law was the make sure people retained insurance coverage as they changed jobs. It includes several provisions for sharing data electronically and in order to enact this sharing of information, it was prudent that privacy and security provisions be built into the infrastructure of HIPAA.
As coders, we will likely be required to sign confidentiality agreements with employers. We will be subjected to criminal background checks and possibly credit checks. We will be forbidden from discussing that interesting ER case in the elevator. We won't be able to look up medical record information for friends and family. Well, I suppose you could, but make no mistake - there is very little to no tolerance for HIPAA violations. I've seen people dismissed immediately for violating patient confidentiality. I saw this most at a celebrity-frequented hospital where people tweeted or posted on Facebook when someone famous was admitted or they released specific protected health information (PHI). In this day and age, it's not uncommon for employers to have a social networking policy that addresses Facebook and Twitter.
And while privacy of PHI is a coder's concern, there are other provisions within HIPAA that impact us. I meet a lot of people who want to code so they can work from home. But setting up a home office as a coder means more than getting a computer and internet connection. Along with ensuring patient privacy comes security of PHI as well. The home workstation must be secure from breaches including hacking of computer systems and stolen computers. It's a natural concern when setting up a home office - who will have access to the work computer and if there are multiple people living in the household, what provisions are being taken to ensure that the workstation is secure? Some home coders may be subjected to a home evaluation by an employer to ensure the workspace is secure.
HIPAA-Defined Code Sets
Still not convinced that HIPAA impacts you greatly as a coder? How about the codes you use? Those are also intertwined into HIPAA legislation. Electronic exchange of information between two different parties requires specific transactions. For example, the submission of an insurance claim by a provider to a payer is one such HIPAA transaction. There is another for communication from the payer back to the provider about what was paid on each account. These HIPAA transactions require a common language between the parties. And that language is often codes. As such, HIPAA defines which code sets are approved for reporting diagnoses and procedures in order to ensure uniformity.
There are six code sets approved for various uses and time periods as defined by HIPAA:
Most coders and coding students are aware of the massive effort currently under way to migrate from ICD-9 to ICD-10 in 2013. Many are not aware, though, of the updates to the HIPAA transactions that must occur in order to make ICD-10 data electronically exchangeable. We currently operate under the HIPAA version 4010 and as of January 1, 2012, we will use HIPAA version 5010. This upgrade includes many other updates besides those to get us ready for ICD-10. The impact of 5010 implementation is currently being felt by payers and providers as they gear up for testing these new transactions beginning in July. As of January 1 of next year, CMS will not accept any electronic data in the old format. And that means failure to comply will hold up claims submission and payment.
The 5010 upgrade is probably invisible to most coders in an organization. It's very much an information technology (IT) initiative and involves inventorying systems and working with vendors and payers to ensure everyone has updated to the 5010 standard. In addition to updating the number of bytes available to report ICD codes and allowing for alpha-numeric entry (instead of mostly numeric with ICD-9), it also includes updates to allow for reporting the present on admission indicator, eliminates the release of superfluous PHI for insurance certification and verification, and eliminates numerous other inefficiencies in reporting data electronically.
So keep an eye out for the acronym HIPAA - it will come into play a lot in your career as a coder. As for HIPPA, I still can't figure out what that is. There is no Health Information Patient Privacy Act, so as best as I can tell, a hippa is a baby hippo!
Privacy and Security
It's true - when most of us think HIPAA, we think privacy of health information. And that's a huge part of it. We may even think, as coders, that we are only impacted by HIPAA when it comes to keeping the medical record information we read during the coding process confidential. But HIPAA is much bigger than keeping health information from falling into the wrong hands. The true intent of the law was the make sure people retained insurance coverage as they changed jobs. It includes several provisions for sharing data electronically and in order to enact this sharing of information, it was prudent that privacy and security provisions be built into the infrastructure of HIPAA.
As coders, we will likely be required to sign confidentiality agreements with employers. We will be subjected to criminal background checks and possibly credit checks. We will be forbidden from discussing that interesting ER case in the elevator. We won't be able to look up medical record information for friends and family. Well, I suppose you could, but make no mistake - there is very little to no tolerance for HIPAA violations. I've seen people dismissed immediately for violating patient confidentiality. I saw this most at a celebrity-frequented hospital where people tweeted or posted on Facebook when someone famous was admitted or they released specific protected health information (PHI). In this day and age, it's not uncommon for employers to have a social networking policy that addresses Facebook and Twitter.
And while privacy of PHI is a coder's concern, there are other provisions within HIPAA that impact us. I meet a lot of people who want to code so they can work from home. But setting up a home office as a coder means more than getting a computer and internet connection. Along with ensuring patient privacy comes security of PHI as well. The home workstation must be secure from breaches including hacking of computer systems and stolen computers. It's a natural concern when setting up a home office - who will have access to the work computer and if there are multiple people living in the household, what provisions are being taken to ensure that the workstation is secure? Some home coders may be subjected to a home evaluation by an employer to ensure the workspace is secure.
HIPAA-Defined Code Sets
Still not convinced that HIPAA impacts you greatly as a coder? How about the codes you use? Those are also intertwined into HIPAA legislation. Electronic exchange of information between two different parties requires specific transactions. For example, the submission of an insurance claim by a provider to a payer is one such HIPAA transaction. There is another for communication from the payer back to the provider about what was paid on each account. These HIPAA transactions require a common language between the parties. And that language is often codes. As such, HIPAA defines which code sets are approved for reporting diagnoses and procedures in order to ensure uniformity.
There are six code sets approved for various uses and time periods as defined by HIPAA:
- HCPCS (Healthcare Common Procedural Coding System, Level II)for ancillary services and procedures
- CPT-4 (Current Procedural Terminology) for hospital outpatient and physician services
- CDT (Current Dental Terminology) for dental services
- NDC (National Drug Codes) for over-the-counter and prescription medications
- ICD-9 (International Classification of Diseases, 9th Revision) for diagnoses and hospital inpatient procedures - currently used
- ICD-10 (International Classification of Diseases, 10th Revision) for diagnoses and hospital inpatient procedures - effective October 1, 2013
Most coders and coding students are aware of the massive effort currently under way to migrate from ICD-9 to ICD-10 in 2013. Many are not aware, though, of the updates to the HIPAA transactions that must occur in order to make ICD-10 data electronically exchangeable. We currently operate under the HIPAA version 4010 and as of January 1, 2012, we will use HIPAA version 5010. This upgrade includes many other updates besides those to get us ready for ICD-10. The impact of 5010 implementation is currently being felt by payers and providers as they gear up for testing these new transactions beginning in July. As of January 1 of next year, CMS will not accept any electronic data in the old format. And that means failure to comply will hold up claims submission and payment.
The 5010 upgrade is probably invisible to most coders in an organization. It's very much an information technology (IT) initiative and involves inventorying systems and working with vendors and payers to ensure everyone has updated to the 5010 standard. In addition to updating the number of bytes available to report ICD codes and allowing for alpha-numeric entry (instead of mostly numeric with ICD-9), it also includes updates to allow for reporting the present on admission indicator, eliminates the release of superfluous PHI for insurance certification and verification, and eliminates numerous other inefficiencies in reporting data electronically.
So keep an eye out for the acronym HIPAA - it will come into play a lot in your career as a coder. As for HIPPA, I still can't figure out what that is. There is no Health Information Patient Privacy Act, so as best as I can tell, a hippa is a baby hippo!
Monday, May 9, 2011
Opportunity Happens: ICD-10 is Mine
To quote my recent Facebook posting, "Ever notice that amazing opportunities are followed by boatloads of work?" That's my excuse for where I've been: opportunities and their resulting heavy workload. For me, opportunity is cleverly disguised as ICD-10. What is your opportunity?
Just to catch you up, I recently accepted a senior consulting position with a new consulting firm. Haugen Consulting Group is based locally in Denver and while I will be pretty much doing what I've been doing - coding consulting and education - I will also be working with a team of amazing consultants as we lead our clients through the ICD-10 implementation.
I am also chairing the Colorado Health Information Management Association's ICD-10 Task Force, which is gaining momentum each month. For the last month I've visited two of Colorado's three regional HIM associations and also had the opportunity to speak on ICD-10 and HIPAA 5010 implementation last month in Montana and do an audio conference on the new leg revascularization CPT codes for HCPro. Later this month I will present at CHIMA's spring meeting on the importance of mentoring our future workforce (I'm going to bat for all of you!) and will also moderate an ICD-10 panel. These speaking engagements lead to more speaking engagements, which is what I love to do. And sometimes the speaking engagements lead to contracts, writing opportunities, and other networking opportunities.
While I've been working on some exciting prospects of my own, some of the people I've been mentoring have also received some opportunities. I recently got a call from a recruiter asking about one such candidate and another recent grad got a part-time position in an HIM department based on her work there as a volunteer. And my advice to them now that they have their feet in the door is to work hard to keep those opportunities coming.
So if you've completed a coding or HIM program and are having trouble finding work, here's a reminder of some of the things I recommend for getting your start:
Just to catch you up, I recently accepted a senior consulting position with a new consulting firm. Haugen Consulting Group is based locally in Denver and while I will be pretty much doing what I've been doing - coding consulting and education - I will also be working with a team of amazing consultants as we lead our clients through the ICD-10 implementation.
I am also chairing the Colorado Health Information Management Association's ICD-10 Task Force, which is gaining momentum each month. For the last month I've visited two of Colorado's three regional HIM associations and also had the opportunity to speak on ICD-10 and HIPAA 5010 implementation last month in Montana and do an audio conference on the new leg revascularization CPT codes for HCPro. Later this month I will present at CHIMA's spring meeting on the importance of mentoring our future workforce (I'm going to bat for all of you!) and will also moderate an ICD-10 panel. These speaking engagements lead to more speaking engagements, which is what I love to do. And sometimes the speaking engagements lead to contracts, writing opportunities, and other networking opportunities.
While I've been working on some exciting prospects of my own, some of the people I've been mentoring have also received some opportunities. I recently got a call from a recruiter asking about one such candidate and another recent grad got a part-time position in an HIM department based on her work there as a volunteer. And my advice to them now that they have their feet in the door is to work hard to keep those opportunities coming.
So if you've completed a coding or HIM program and are having trouble finding work, here's a reminder of some of the things I recommend for getting your start:
- Network! I've received jobs from 4 people I knew or worked with in the past. And I've hired people I've worked with in volunteer organizations. Who you know matters!
- View everything as a learning experience. Work is work, no matter how much you enjoy what you do. There are days when you won't like the tasks that have been assigned, but there may come a day when you need to tap into that experience.
- Find a workplace mentor. Once you get your foot in the door, find someone you can go to with questions. This doesn't have to be a manager - it can be a lead, a person who has worked there "forever" or even a team of people.
- Keep a positive attitude. No one wants to work with someone who is negative and miserable. A positive attitude goes a long way in any industry.
- Don't give up - because opportunity happens!
Wednesday, March 16, 2011
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
March
- Tuesday, March 22 - Coder Coach Event, Emily Griffith Opportunity School, Denver, CO. Topic: "Overview of Health Information Management" (speaker)
- 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)
- 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)
- Tuesday, July 12 - Denver chapter AAPC meeting, VA Medical Center, Denver, CO. Topic: "The Importance of Networking in Coding" (speaker)
- Saturday, October 1 - 2011 AHIMA Convention & Exhibit, Salt Lake City, UT. Topic: "The Cardiac Cath Coding/Charging Crossover" (speaker)
Tuesday, March 8, 2011
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 t
asks 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.
asks 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.
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.
Subscribe to:
Posts (Atom)