Monday, August 31, 2009
So what should be on your reading list? Let’s start with the basics for the job. Of course you need the latest version of any and all of the codebooks for the health care setting in which you work. For most of us, this list includes ICD-9-CM, CPT, and HCPCS Level II. And yes, you need the current year. While not all of the codes change annually, some of the changes can be significant enough to render the previous year’s codebook useless.
ICD-9-CM codes are effective October 1 of each year and if you don’t have an employer who provides this book for you and you’re responsible for ordering your own, be careful to order the right one. While ICD-9-CM has various publishers (e.g., Ingenix, Channel), the content is the same. However, you can choose the format you like best, for example, some publishers offer color codebooks, others may have illustrations. The format is not important, but if you are working in a hospital, be sure to get all three volumes (I, II, and III). If you are a physician coder, the “professional” edition, or one that contains only volumes I and II, is sufficient since volume III codes are not used in doctors’ offices.
CPT codes are effective each year on January 1 and are published only by the AMA, although you can usually order them through other publishers as well, or even through the AAPC at a discounted rate if you are a member (are you seeing the benefits of joining coding organizations yet?!). HCPCS Level II is another story. While the book is published annually with the calendar year, the Centers for Medicare and Medicaid Services (CMS) adds to the list quarterly and these updates are posted on their website. HCPCS Level II books can also be ordered from any codebook publisher and may be offered in various formats.
Once you have your codebooks on the shelf, you need some clinical references on hand. First off, this means an anatomy book. You also need to know how all those anatomical parts work – or physiology. So you if you haven’t invested in an anatomy and physiology book, this is a wise investment. Other clinical references that come in handy are a pathophysiology book, medical dictionary, and book of acronyms. The pathophysiology (or disease process) book will help you connect the dots while you code. This is what will tell you that hypotension and fever are common symptoms of sepsis. The medical dictionary is a given – I still use one even after taking 2 semesters of medical terminology and coding for nearly 15 years. And the acronym list, well, should be self-explanatory if you’ve ever looked at a medical record (for example: “45 yo WM c/o CP and SOB x24 hrs” = “45-year-old white male complaining of chest pain and shortness of breath for 24 hours”). If you want to go a step further and like to study, invest in a medical terminology book. Medical terminology books are not just medical dictionaries; they will often take the Greek or Latin root of a word and expand from there. Once you know basic Greek and Latin roots, the medical dictionary is not needed as much.
But wait! There’s more!
Remember how I said that coding was dynamic? Well, it’s so dynamic, in fact, that the annual and sometimes quarterly code revisions are sometimes outdated by the time the ink is dry, so you will need to invest in periodicals discussing the latest and greatest in the world of coding. If you joined AHIMA or the AAPC, or both (and I highly recommend you do; see my blog post titled “Getting Involved” for more details) you will start to receive publications from them on a monthly basis. Read them. AHIMA publishes the Journal of the American Health Information Management Association and various other publications including e-newsletters. You can control what you receive and how by managing your profile on AHIMA’s website once you are a member. The AAPC publishes Coding Edge and it’s nothing but coding information from cover to cover. They also send out e-newsletters on a regular basis. Looking for more? Another industry standard is Advance for Health Information Management, a **free** publication that includes a regular column titled “CCS Prep,” which discusses scenarios to prep coders for the AHIMA examination. Did I mention it’s free?! And there are job postings in the back of the publication. That means there are no excuses not to be reading it. Another good magazine is For the Record, which is free for AAPC members and people residing in certain states.
Want to know more about coding as it relates to reimbursement? To delve into the world of MS-DRGs, APCs, fee schedules, and prospective payment systems, visit CMS’ website and start browsing the listings. You can also sign up for listservs to receive updates. Be careful, though, and don’t sign up for everything. Do you have any idea how much CMS is working on at any given moment? You don’t want to overwhelm yourself! If you are a newbie, try out Medicare’s Learning Network. If you want to know where all those government billing guidelines are written, try out the manuals section.
If you are a beginner coder or CMS’ website is too intimidating for you (and don’t feel bad if it is– some days it still freaks me out a little and I use it nearly every day!), I recommend getting on the mailing lists of some of those consulting companies who offer free e-newsletters. Sometimes they will explain the coding and reimbursement for a topic in a way that is way less confusing than government speak! HCPro offers a laundry list of e-newsletters – some are free and some are not. Integrated Revenue Management, Inc. offers a free monthly e-newsletter called “Net Revenue Matters” that has general information about health care revenue cycle updates, but usually has at least one coding article.
And finally, never underestimate the power of Google! While it is true there is a lot of junk on the internet and you need to be careful where you get official coding and reimbursement advice, Google can sometimes get you to a website that will get you to another website that will get you an answer. If you are searching for clinical information, Health Finder is a search engine developed by the US government and all of the sites listed have been verified as legitimate. Emedicine has some great articles authored by physicians that can help with learning about particular diseases and procedures.
From "Born Yesterday" to Seasoned Professional
So get ready to read up and don’t feel discouraged if it sounds like Greek at first. My mother always told me that knowledge isn’t what you know, it’s whether or not you know where to find the answer and the resources listed here should get you started on finding answers. If you need to look up or google every other word or phrase, don’t fret. I’ve been there. Have you ever seen the movie “Born Yesterday” (originally made in 1950 starring Judy Holliday and William Holden and then remade in 1993 starring Melanie Griffith and Don Johnson)? In the movie, Billie (played first by Holliday and then by Griffith) is learning to read difficult books and always has a dictionary next to her. There are days when coding feels like this, but then by the end of the day you feel maybe just a little bit smarter!
Advance for HIM
For the Record
Integrated Revenue Management, Inc.
Monday, August 24, 2009
As Past President of the Northern Colorado Health Information Management Association (NCHIMA), I am currently in possession of the association’s archives dating back to 1960. On August 7, I was asked to give a presentation chronicling our association’s history. I’m sure that many people would look at 40 years of archives (which had been neatly thinned and organized by a former board member) as tedious and intimidating, but I found the process enthralling. The issues of the day, the speakers’ topics, and the sense of community as well as seeing the names of “new” professionals in the meeting minutes who would later become industry leaders and mentors, left me so excited I was, at times, actually shaking with enthusiasm (this is a common side effect of being a super-coder-geek!). On more than one occasion, I picked up the phone and called my mom, a veteran HIM-er, and told her about all the treasured tidbits I had found.
But with all my enthusiasm, I was worried. Worried that only a geek like me would find that information interesting. Worried that the presentation was lacking of my usual fervor to use pictures and other visual aids. Worried that no one would make the 2-hour drive north of Denver for the presentation and I would be left presenting to anyone at the hospital who would listen. Worried that my Power Point was too purple (this is a big problem with me, given that purple is my favorite color)!
My fears were completely unfounded, though. I had recently spent time “yearbooking myself” on the website www.yearbookyourself.com (this picture is of me in "1960" - check out the website for yourself and see how you would look!), where I could upload a picture of myself and see how I would have looked with various trendy hairstyles from 1950 through 2000 and those pictures ended up in my presentation. The once nauseatingly purple Power Point presentation became a soothing shade of blue and I was excited to be the one to present this information to what happened to be a decent size group of about 20 people. And they were excited about the information. And I again felt that sense of community.
What’s my point? Well, we all need community because that’s how we get “discovered.” Very few movie stars are discovered sitting in a coffee shop minding their own business. Most work hard to get the roles that get them noticed and a well-prepared audition is often the career-launching vehicle they’ve been waiting for. A single man isn’t likely to find the woman of his dreams by spending all his time playing ball with the guys – he has to go where the women are. Likewise, novice coders are not likely to get hired without being noticed and in order to get noticed, you have to go where the professionals are.
Imagine meeting rooms filled with a dozens, or even hundreds, of coding professionals. And imagine that during such a conference, time is set aside for networking. It’s not fiction. It happens all the time. And all you have to do to get started is join one or both of coding’s premier national organizations: the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Let’s face it, in every business, who you know is almost as important as what you know. When I was going to school, we were strongly encouraged to join AHIMA. The great thing about AHIMA is that you automatically also become a member of the state component association for the state in which you live. So by joining AHIMA, I was also a member of the Colorado Health Information Management Association. I will never forget attending my first CHIMA meeting with my mother, who introduced me to all of her contacts. She stressed the importance of getting to know people and at the time I didn’t fully understand why. Years later, I became certified through the AAPC and it functions much like AHIMA in that as an AAPC member, you are an automatic member of your local chapter. And most local chapter meetings are free.
I cannot stress enough the importance of networking with the coding community. When I graduated, I was offered two jobs: one from the woman who gave my mom her first job and the other from the hospital where I had interned during my final year of college. I have received job offers and inquiries from many people who have crossed my path along the years – my current position included. And it is these networks that I have tapped into in spreading the word about The Coder Coach and am working to increase in an effort to help the wanna-be coders of the world get placed in positions.
AHIMA vs. AAPC
I get asked this question a lot: which organization should I join, AHIMA or AAPC? I am not here to promote one organization over the other. I happen to belong to both, so I will try to give you an objective response. In general, AHIMA credentials are more recognized by hospitals whereas AAPC credentials are more widely recognized by physician practices. Having said that, I will tell you this: these are the only two major accrediting bodies for coders. Beware of getting credentials outside of these two organizations.
I am not saying that all other coding credentials are bogus, but I have seen people get coding credentials that no one in the industry has ever heard of. There are some specialty credentials, such as the Radiology Certified Coder (RCC) that are also of good repute and are accepted by coding professionals. If you are looking into a coding credential that is not affiliated with AHIMA or AAPC and would like to know if it is well recognized, I would be happy to answer any questions you have via email (firstname.lastname@example.org).
The statement I made above about AHIMA being for hospitals and AAPC being for physician practices is not a hard and fast rule. The lines between the two organizations are becoming a bit blurred as many professional coders get dually credentialed through both. Both organizations offer credentials in both hospital and physician coding. And I have seen many AAPC certified coders working in hospitals. But if you want to find an easier time getting hired, I recommend getting certified with the organization most widely associated with the type of coding you prefer. Better yet – check local job listings for coders and see which credentials they require. You will likely find that they require at least one of the following popular credentials. Please note that with the exception of the RHIA and RHIT credentials, college degrees are not required for certification.AHIMA
- Registered Health Information Administrator (RHIA) – bachelor’s degree in health information management with completion of board examination covering HIM topics as well as coding
- Registered Health Information Technician (RHIT) – associate’s degree in health information management with completion of board examination covering HIM topics as well as coding
- Certified Coding Specialist (CCS) – demonstrates excellence in coding hospital inpatient and outpatient records; recommended for people with at least 3 years’ coding experience
- Certified Coding Specialist (CCS-P) – demonstrates excellence in coding physician records; recommended for people with at least 3 years’ coding experience
- Certified Coding Associate (CCA) – demonstrates competency and general knowledge of coding rules and guidelines; eligible for entry level position
- Certified Professional Coder (CPC) – demonstrates on-the-job experience and proficiency in physician coding
- Certified Professional Coder – Hospital (CPC-H) – demonstrates on-the-job experience and proficiency in hospital coding
- Certified Professional Coder – Payer (CPC-P) - demonstrates proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective
- Certified Interventional Radiology Cardiovascular Coder (CIRCC) – demonstrates proficiency in coding of interventional radiology and cardiovascular coding
- In addition, AAPC offers various specialty credentials certifying the coders’ proficiency in coding for certain medical specialties
- Apprentice credentials (denoted with the suffix “-A” following credential) are given to coders who pass the examination but lack the required experience for a full credential
Worth the Money
So if you are in school for coding, or trying to get a job, you need to join up. There are annual dues associated with these associations that can seem daunting – especially if you are a student on a budget. But check out the student membership rates and remember that the cost of the membership pays for itself when you land your first coding job. Best of luck and I hope to see you soon at a coder convention through AHIMA or the AAPC!