Monday, August 15, 2011

Spotlight on Certification: The Certified Coding Associate (CCA)

I get a lot of questions from interested individuals about coding certifications. Like it or not, employers are looking more and more to credentialed coders to staff the workforce. It's almost impossible to get hired without a coding certification -but which one is right for you? What do the different certifications say about your qualifications? And what will you have to do to maintain your certifications?

I thought I would help out by spotlighting different coding credentials. There are two main organizations I will focus on and there are a lot of certifications. So be patient - I will get to all of the AHIMA and AAPC credentials eventually! And remember - I hold certifications with both organizations, so I'm not here to sell you on any single credential. If you plan to work in hospitals, AHIMA credentials are more widely recognized whereas physician offices usually require AAPC certifications. Before you decide which organization to join, do your homework and find out what credentials they require where you want to work.

I'd like to start with the newest AHIMA credential, the Certified Coding Associate (CCA).

I've never taken the CCA exam because when it came out, I was already certified as a Certified Coding Specialist (CCS). And while many aspire to be a CCS, AHIMA doesn't recommend taking that exam until one has at least 2-3 years of experience as a hospital inpatient and outpatient coder. But what about those people who have taken coding classes and want to prove they know a thing or two so they can land an entry-level coding position? Enter, the CCA credential.

AHIMA created the CCA credential to demonstrate one's "coding competency in any setting, including both hospitals and physician practices." In essence, it lets your future employer know you've taken the core coding and HIM classes. When I talk to people who are trying to begin coding careers, I often hear them say something along the lines of, "Why should I waste my time with an introductory credential?" or, "It's a waste of money."

Well, from my perspective, if you have taken the time and effort to take the CCA exam, it tells me one big thing: you're serious about coding as a career because you took the initiative to study for an exam. And if I were hiring, that is something I would definitely take into account. Coding certifications cost money - it's an occupational hazard. But being without a coding credential most likely means not having a career as a coder. Which do you want more?

CCA Specs
The CCA credential, as mentioned, is available through AHIMA. It costs $199 for AHIMA members to take the test. If you aren't a member of AHIMA and plan to work as a hospital-based coder, I highly recommend joining. Again, another cost that is important to your career if you're serious about working as a coder. If you aren't a member of AHIMA, the cost is $299. The CCA credential is the only HIM credential worldwide that is accredited by the National Commission for Certifying Agencies (NCCA), although I've heard AHIMA is seeking the same approval for other credentials.

As for content, it's not just coding. And I think this surprises a lot of people who take the test. It also tests for HIM-related competencies. That's something to keep in mind when you're studying for it. There are six domains that make up the CCA test:
  1. Health Records and Data Content (20%)
  2. Health Information Requirements and Standards (14%)
  3. Clinical Classification Systems (36%)
  4. Reimbursement Methodologies (10%)
  5. Information and Communication Technologies (6%)
  6. Privacy, Confidentiality, Legal, and Ethical Issues (14%)
The tasks for each domain are outlined on AHIMA's website along with FAQs and other important exam information. If you plan to take the CCA exam, I recommend spending a lot of time on the CCA page.

CCA Jobs
The CCA credential is still relatively new for those of us who have been around for a decade or so. And I admit, as a profession, we're a little slow to accept new ideas sometimes. Job postings may not state the CCA credential as one that is accepted. My general rule is, if the job calls for a CCS and you have the CCA, apply for it. The employer may not get enough job applications from qualified individuals. And if it was me, I would certainly look at a CCA with more interest than someone without any certification. The credential is catching on, though, and I'm starting to see it in job postings. So, do I think it's a credential worth getting? If you don't have any other certifications, then yes. Absolutely!

Curious about whether or not to take the CCA if you have an RHIT? If so, check out this past blog of mine on the HICareers website: "Should There be a CCA After RHIT in Your Title?"

ICD-10-PCS Code Me This - Root Operation #10b

Okay comrades in coding, here's root operation #10b (since I cheated and gave you the root operation Excision twice!). Are you ready for a new procedure? Here it is.... replacement of a PEG tube. I'll give you time to look up that acronym in case you aren't familiar.

By the way, if you don't have a medical abbreviations book, I recommend purchasing one. You can google a lot of abbreviations and acronyms, but I find it more convenient to have a book at my fingertips. My personal fave is Medical Abbreviations: 32,000 Conveniences at the Expense of Communication and Safety by Neil M. Davis. You can purchase a copy on Amazon for less than $25. I think the title pretty much says it all when it comes to why the publication is so important...

Bonus Points: Mmmmmm, ice cream. I still have not partaken in one of my favorite foods since I began this blog series on root operations (and ice cream). And I admit, it is a bit tricky to come up with a different flavor of ice cream every day. So let's do something a little different. In my opinion, there are two flavors that, while incredible mixed together, have no place in ice cream. Any guesses? Here's a hint.... these two flavors together bring back memories of fun TV commercials from the 80s...

ICD-10-PCS: Answer to Root Operation #10

I realize it's been well over a week since I last made a blog posting -I hope you weren't missing the root operation posts too much! I took a brief hiatus to focus on, of all things, work. I wanted to get at least a couple posts in this week before taking a little time off for some R&R!

The last procedure I posted was a decompressive laminectomy of the cervical spine for spinal stenosis. What did you go with for the root operation on this - release? Excision? Well, this one is actually a repeat of a root operation already presented. Although the laminectomy is done for a release, it is actually a partial removal of a body part. Therefore, the root operation is:

Excision: Cutting out or off, without replacement, a portion of a body part.

The code for decompressive laminectomy of the cervical spine is 0RB10ZZ:
Extra Credit: As for the other non-chocolate Haagen Dazs flavor? That would be butter pecan and it always reminds me of my grandmother, who shares my love of ice cream!

Thursday, August 4, 2011

ICD-10-PCS: Code Me This - Root Operation #10

Today's procedure is decompressive laminectomy of the cervical spine for spinal stenosis. What is the root operation?

Bonus Points: What is the other Haagen Dasz non-chocolate choice?

ICD-10-PCS: Answer to Root Operation #9

Yesterday's operation was radiofrequency neurolysis for trigeminal neuralgia. Here's a little background. The trigeminal nerve, or cranial nerve V (as in 5), is the largest of the 12 cranial nerves. It is responsible for most of the sensation felt in the face. Trigeminal neuralgia is a stabbing face pain that comes and goes and can be very disruptive to the patient's life. It can be brought on by simple daily activities, such as washing one's face or brushing one's teeth. Radiofrequency coagulation is a procedure in which the trigeminal nerve is burned, or destroyed, thereby relieving pain. Thus, the root operation for this procedure is:

Destruction: Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent.

Radiofrequency coagulation of tigeminal nerve is commonly done percutaneously (without incision). This leads to ICD-10-PCS code 005K3ZZ:


Extra Credit: Okay, so if I'm not in the mood for chocolate and want ice cream, one non-choclate choice is Haagen Dasz strawberry ice cream. Besides being delicious, I figure it's healthy because it has fruit in it! It's especially good with rainbow sprinkles - as long as they don't have any chocolate sprinkles mixed in. I never was a fan of fruit mixed with chocolate. (The two separate from each other are totally okay, though!).

Wednesday, August 3, 2011

ICD-10-PCS: Code Me This - Root Operation #9

Today's procedure is a fun one - radiofrequency neurolysis for trigeminal neuralgia. If you're new to coding, I'll give you time to go google those words! What is the root operation?

Bonus Points: Up until now I've talked a lot about ice cream and the proper chocolate-to-ice-cream ratio. But what happens when I want ice cream but am not in the mood for chocolate? Yes, it's possible. What should I reach for from the freezer case?!

ICD-10-PCS: Answer to Root Operation #8

Yesterday's root operation was open reduction with internal fixation (ORIF) of a right distal radius fracture. In ICD-9-CM, we would look this up under main term Reduction. We can also find the main term Reduction in the ICD-10-PCS index, but it refers us to the root operation:

Reposition: Moving to its normal location or other suitable location all or a portion of a body part.

ORIF of a right distal radius fracture, then is reported with ICD-10-PCS code 0PSH04Z:


Now let me mention that this is a partial table - I only copied the portions that reference the radius. This table actually spans a couple of pages in in my ICD-10-PCS book to cover many specific body parts of the upper bones. You will also notice that the right radius body part appears in multiple rows. The difference for each row is the device character. So there are lots of options for reducing a fracture - that means we as coders need to know what these procedures are and how to tell the difference!

Extra Credit: Mmmmmm Coldstone.... When I go to Coldstone, I become Sally Allbright! I never order off their menu with the pre-prescribed mix-ins because that's a little too busy for me. My choice is impacted by the specific mix-ins. Coffee ice cream with mini chocolate chips and chocolate sprinkles is my first choice. If they don't have mini chocolate chips, though, regular ones won't do (you guessed it, it messes up the chocolate-to-ice-cream ratio!) and I just have to go with chocolate sprinkles. Sometimes I will mix it up with my mix-ins and have them throw in some white chocolate chips (this does not mess with the chocolate-to-ice-cream ratio!).


Tuesday, August 2, 2011

ICD-10-PCS: Code Me This - Root Operation #8

Today's procedure is an open reduction internal fixation of the right distal radius. What is the root operation?

Bonus Points: Okay, this one could be tricky because there are so many choices. What is the best thing to order at Coldstone Creamery? (in my opinion anyway!)

ICD-10-PCS: Answer to Root Operation #7

Yesterday's procedure was breast augmentation with saline implants. What is the root operation?

All reconstructive (i.e., plastic surgery) procedures fall under the root operation:

Alteration: Modifying the anatomic structure of a body part without affecting the function of the body part.

A bilateral breast augmentation with saline implants is reported with code 0H0V0JZ. This table shows how the code is assigned from the 0H0 table.


Extra Credit:
My local favorite for Italian ice cream (aka gelato)? Gelazzi Gelato has been spotlighted on the Food Network's show "Unwrapped" for their Gelatinis. I have never had one, but I have sampled their gelato. Yum! It tastes amazing and really it's just fun to go look at all the fun colors in the case - Gelazzi gets my vote for most colorful ice cream parlor!

Monday, August 1, 2011

ICD-10-PCS: Code Me This - Root Operation #7

Here we are already on root operation #7. That means I am only 24 more blog postings away from enjoying ice cream again!

Today's procedure is breast augmentation with saline implants. What is the root operation?

Bonus Points: I realize these ice cream references are probably close to impossible for most people to guess, but here I go anyway. This place gets kudos for its Italian ice cream and has been featured on the Food Network. Even better, unlike Farrell's, it's close by right here in Colorado. Any guesses?

ICD-10-PCS Answer to Root Operation #6

Sorry if I left you feeling a little let down on Friday, but I'm back in full force today and ready to pick up where we left off. Did you get the root operation for a right total hip replacement? Are you wondering if this is a trick question?

Well, it's not. I figured I taxed your brain enough last week with the excision vs. resection and partial vs. total body part values so I thought I would cut you an end of the week break. The root operation for total hip replacement is:

Replacement: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.

Total hip replacements involve cutting out a portion of the femur and removing the femoral head (the ball portion of this ball and socket joint) and replacing it with a ball made of ceramic or metal. The hollowed portion of the pelvic bone (acetabulum) is fitted with a prosthetic device made of metal, ceramic, or polyethylene (plastic) to create a smooth surface for the new femoral head to rotate in.

A right total hip replacement without further specification of the materials used, is coded to code 0SR90JZ:

Sneak Peak: for 2012, there will be changes to coding for hip replacements to enable reporting of cemented vs. uncemented hip replacements.

Extra Credit: Best childhood ice cream memory? Farrell's Clown Sundae. I think Farrell's moved out of Colorado before I became a teenager but I remember lots of birthday parties and a candy counter with lollipops bigger than my head! And the treat of choice there was always a clown sundae - an ice cream scoop head with whipped cream for hair and a cone hat. I recently stumbled upon Farrell's on Facebook and I see they have some stores in California and still have the clown sundae. I need to get out there - after this ice cream, ban, of course!

I Love ICD-9-CM - What if I Don't Feel the Same Way About ICD-10?


I think there are a lot of students out there learning ICD-9-CM right now who are feeling a certain apprehension about the ICD-10 implementation. It's a tricky time to be educated in coding right now - you may decide you love ICD-9-CM only to have it ripped from your grip in 2013 and replaced by something that doesn't closely resemble your new found love. So maybe you've been reconsidering a field in coding.

Well, let's not overreact! First of all, let's look at what it is you like about coding, what will be changing, and then decide if it's time to overreact!

First of all, ICD-9-CM, Volumes 1 and 2 (the diagnosis codes) are being replaced by ICD-10-CM. And although there are some tricky areas and all of the code numbers are different, the overall feel and use of ICD-10-CM is not that dissimilar to what we're used to today. Yes, it will be more difficult to roll codes off the top of our heads like many of us can now with ICD-9-CM, but it will not be impossible (after a week coding in ICD-10, I found it was not difficult to memorize frequently used codes. The major changes? We have extensions now to indicate the episode of care for patients with injuries and we have codes for underdosing of medications - something that's completely foreign. And although in ICD-10 there are two types of excludes notes instead of one (not coded here vs. not coded in addition), that's a nice change that most coders are happy about.

ICD-10-PCS on the other hand, is very different from Volume 3 of ICD-9-CM, which includes procedures. In fact, ICD-10-PCS is very different from anything we've ever used for coding. The fact that there are no inclusion and exclusion notes - no tabular listing, in fact - only pages of tables, makes it seem daunting. This will be a huge impact, no doubt.

But should you worry about it? Remember - ICD-10-PCS has limited application. It is only required for billing on hospital inpatient claims. So if you work for a physician - or plan to - you will not have to learn ICD-10-PCS. If you code outpatients in a hospital, the jury is still out. Many hospitals still collect ICD-9-CM procedure codes for outpatients so they can use the data internally (remember - coding is about data collection too, not just billing). There is much discussion in the industry on the productivity impact of having coders code in both ICD-10-PCS and CPT for hospital outpatient services.

CPT is not at all affected by ICD-10 implementation. If you code for a physician, you will continue to use CPT to code and bill for his services and procedures.

Of course, if you find you have an affinity for ICD-10-PCS, perhaps this will help you determine your career path and you can look for opportunities to code in a hospital. Inpatient coding is usually a higher level coding position, so it may take time to get promoted up, but if you have the skill for ICD-10-PCS, it's my belief that you will be in demand. I think some current inpatient coders may decide they don't care for ICD-10-PCS at all and make some changes in their career paths.