Coder Coach

I Bet You're Wondering What I've Been Up To...

2011-11-10T09:00:00.011-07:00

Oh wow, has this been a crazy fall! Up until this year, "Rocktober" was a term we used in Colorado whenever our beloved Colorado Rockies made it to the playoffs. This year Rocktober took on a whole new meaning for me. And while it was a great month, I am so happy to say it's over and now I can concentrate on the less busy holiday season. Yes, October was that busy!

As you saw from some of my blog postings, I kicked off October in true coder fashion by attending the AHIMA Convention and Exhibit in Salt Lake City. What a great opportunity to learn the newest, latest, and greatest from some of the nation's best HIM and coding minds and get in some serious networking as well. This year was particularly busy at convention as I was honored with an AHIMA Triumph Award for mentoring, mainly due to my efforts with the Coder Coach blog and some of the networking and educational events I've hosted over the last couple of years. It was an incredible honor and to help commemorate the occasion, I took my personal and professional mentor - my mom (pictured here with me) - along with me. It's hard to tell who was more excited about my award!

This was also the first year that I was chosen to speak at the national level. I presented an outpatient track at the coding meeting on the overlap between coding and charging in the cardiac cath lab. As if that wasn't enough, I just couldn't say no when another Triumph Award recipient and fellow Coloradan, Dee Johnson, asked me to be a part of the Student Academy. Dee is a student at Arapahoe Community College, my alma mater here in Colorado, and was a key planner in this year's Student Academy. The academy is a free event for students in AHIMA programs at the convention each year. I was a part of the mentor lightning rounds where several established professionals spent a few minutes with each group of students to share our experience and answer questions. All of that and Apolo Anton Ohno too! The Olympic athlete and Dancing with the Stars champion was our closing keynote speaker and he had an inspiring message about giving it your all.

Once I was back at home, there was no rest for the weary as I delved into not one, not two, but FIVE client trainings. For those who aren't aware, training sessions take about 4-5 times as long to prepare as they do to present but the work is always well worth it when I get to training. That is my favorite part of my job because it combines two of my great talents: coding and talking! My last week of training involved three training sessions, work-related road travel, a snow storm, and, of course, that inevitable sinus infection as a result of a crazy month. I would love to tell you that following that last training on October 28 I headed out for happy hour with my friends, but truth be told, I had a nice evening vegging out on the sofa and catching up on all my DVR'd shows!

So here we are in November and I'm trying to wrap a few things up before the holidays. Last weekend I met with a fantastic group of super coder geeks (birds of a feather!) who were so amazing to not only spend their own time coding some records in ICD-10, but to also give up a Saturday to come together and talk about the results. This is a project that the Colorado Health Information Management Association's (CHIMA) ICD-10 Task Force has undertaken to assess documentation readiness for ICD-10. I have had a great year chairing this task force and working with an enthusiastic group who is making great strides as a clearinghouse for ICD-10 information in the state of Colorado.

Last week I was interviewed by ICD-10 Watch, a terrific resource for anyone interested in ICD-10. We specifically chatted about the fantastic opportunities that await coders as we transition to ICD-10. The interview is recounted in the blog posting How ICD-10 can create opportunities for medical coders.

Whew, I think I need to take a nap now that I've recounted the previous month's events! I plan to get back to the ICD-10-PCS series in another week or two, but bear with me - November's calendar is starting to fill up, so it might be 2012 before I can give the series the attention it deserves. In the meantime, I hope everyone has a terrific holiday season.

ICD-11 is Coming...

2011-10-04T13:40:00.001-06:00

That was a key message this morning in a presentation by Dr. T.B. Ustun from the World Health Organization (WHO) at the AHIMA convention general session. Yes we are still on track for implementing ICD-10 in the US on October 1, 2013 (just under 2 years for those of you keeping score at home) but while the US works to catch up with the rest of the industrialized countries who have been using ICD-10 for several years, the WHO is already looking at ICD-11. Does that worry you as a current or future coding professional?

I know a few current students are concerned about learning ICD-9 in school and then trying to get a position as a coder using ICD-10. Should they go ahead and start working now using ICD-9 or wait until 2013 and use ICD-10? Well, from my perspective, the critical thinking skills that make a coder a good coder will not change even though the codes themselves do. And yes, ICD-10 - especially from the procedure perspective (ICD-10-PCS) requires more anatomy and physiology, medical terminology, and procedural knowledge but you can learn that over the next couple of years as you code in ICD-9-CM. Plus, most employers have plans for training their workforce and getting a coding position now gives you a starting point for learning ICD-10.

So go ahead and go for that open coding position now. Do whatever you can to position yourself for the transition and get ready for a career of continuing education. Not only will you need to book continuing education units to maintain any coding credentials you have, the codes change at least annually, so change is constant. And be ready to adopt ICD-11....

From the Green Room at AHIMA

2011-10-03T08:36:00.001-06:00

Today is a big day as the AHIMA conference General Session kicks off. At the moment, I'm hanging out in the green room backstage with the Triumph Award recipients. I am very honored this year to have been awarded one of the Triumph Awards for mentoring for my work with the Coder Coach. This is a new experience for me - to be backstage and a part of the presentation. And I'm very excited to have one of my mentors (and favorite people in general) with me to celebrate - my mother, who is also a retired RHIT. I will post more pictures later, but here's a super secret green room photo!

Networking at the AHIMA Student Academy

2011-10-02T15:12:00.001-06:00

Today I spent a couple of hours at the AHIMA Student Academy as a mentor for their lightning rounds. AHIMA's Student Academy is a one day free event for students in AHIMA based programs. Several mentors including myself were asked to spend time giving advice on certification, career planning, volunteering, and networking - you know, a lot of the things I blog about through the Coder Coach!

It was great to network with the future of our profession and see so many people excited about their future careers.

So here's a little recap from the mentors' advice to students today:
-Follow your bliss - if a particular area interests you, pursue it, even if the pay isn't great. If you go for a job that you're passionate about, the money will follow.
-Certification is a must if you want to be taken seriously and want to excel.
-Network, network, network. Communicating and networking with current pros is key.
-Volunteer. You would be amazed at the doors that will open for you when you volunteer either with coding/HIM departments or with your local coding/HIM associations.
-Stay positive and avoid being defensive. People pick up on attitude quickly. If you are looking for a job and have been for a long time it's easy to let bitterness creep into your conversations. So be careful to keep positive and hopeful.

More from AHIMA in Salt Lake City coming soon!

Live from AHIMA Salt Lake City!

2011-10-01T11:32:00.001-06:00

Today marks the first day of AHIMA's Coding Community meeting, which kicks off the annual convention. This year we're meeting in Salt Lake City and as usual, I am like a little kid in a candy store here. Every year AHIMA is a bigger deal to me since it's a chance to reconnect with former coworkers and meet new professional contacts. And since this year my focus is heavily on workforce development, I thought it would be fun to send out reports from my experiences through my blog and maybe you can join me at AHIMA next year.

So here goes...

This afternoon I will be presenting on coding and charging in the cardiac cath lab and I'm sure my audience will find it the best presentation at this conference (tongue in cheek!). But for me, my favorite presentation happened this morning with the national coding update. Every year we have the coding gurus from AHIMA, the American Hospital Association and the AMA talking about upcoming coding changes for ICD-9-CM and CPT. I love getting that firsthand information and feel a little like I'm getting some super secret information - along with the other 500 people in the room.

More for SLC as the conference progresses... Stay tuned!

Boy, How Time Flies....

2011-09-26T12:44:00.002-06:00

Oh wow, do I realize I have dropped the ball! I know there are some folks out there waiting for the next installment of the ICD-10 root operations postings. Please be patient! This is a very busy time of year for coders - especially those of us who do a lot of education and public speaking. I've been wrapped up in coding updates, training sessions, training material development, and some local and not-so-local traveling as the fall conference season kicks off. I plan to pick back up next week after the AHIMA conference, so please hang in there!

Spotlight on Certification: The Certified Coding Associate (CCA)

2011-08-15T21:18:00.002-06:00

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:

Health Records and Data Content (20%)
Health Information Requirements and Standards (14%)
Clinical Classification Systems (36%)
Reimbursement Methodologies (10%)
Information and Communication Technologies (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

2011-08-15T20:55:00.003-06:00

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

2011-08-15T20:25:00.005-06:00

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!

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

2011-08-04T10:08:00.002-06:00

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

2011-08-04T09:27:00.004-06:00

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!).

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

2011-08-03T11:51:00.002-06:00

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

2011-08-03T11:23:00.004-06:00

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!).

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

2011-08-02T09:35:00.003-06:00

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

2011-08-02T09:15:00.004-06:00

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!

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

2011-08-01T10:37:00.003-06:00

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

2011-08-01T10:18:00.005-06:00

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?

2011-08-01T09:31:00.005-06:00

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.

ICD-10-PCS: Code Me This - Root Operation #6

2011-07-28T09:01:00.002-06:00

Are you ready or is your brain getting a little fried? Today's procedure is a right total hip replacement. What is the root operation?

Bonus Points: If you are feeling fried, try to think about ice cream! Every now and then I start feeling nostalgic and given my love affair with ice cream, I definitely have a nostalgic favorite (or two). But this is about a place that made such a huge impression with their ice cream (not to mention ambiance!) that I've found it necessary to "like it" on Facebook. Even though there isn't one within a 1000 mile radius from my house. I really need to make a trip out to California! Any guesses? What ice cream chain leaves an impression on a little girl that can last for decades?

ICD-10-PCS: Answer to Root Operation #5

2011-07-28T08:40:00.003-06:00

Yesterday's operation was right hepatectomy. This involved removing the right lobe of the liver. So what is the root operation?

I know I said that excision is complete removal of a body part and excision is the partial removal, so it seems logical that because removing just the right lobe of the liver would be a repeat of yesterday's root operation, excision, right? Unfortunately, that's wrong. Sorry, it was meant to be a trick question. Because if there is a body part value for what was removed and that body part value was completely removed, it is considered to be:

Resection: Cutting out or off, without replacement, all of a body part.

This takes us to the 0FT table where the body part values for the liver are:

Liver (total)
Liver, right lobe
Liver, left lobe

So it seems the resection vs. excision decision is not so cut and dry. But don't worry, there are ICD-10-PCS guidelines that explain all this!

Here is the table for right hepatectomy. In this case, we'll say it was done laparoscopically, therefore the code is 0FT14ZZ.

Extra Credit: Who makes the best coffee ice cream? My dad and I have had long discussions about this. When I was a kid, you could buy plain old coffee ice cream. No java. No nuts. No pieces of chocolate milling around, just plain, smooth, yummy coffee flavored ice cream. Now I have nothing against java, nuts, or chocolate (as you can tell from previous posts), but sometimes I just want simplicity. And I've found it in Haagen-Dazs coffee ice cream. You knew it wouldn't be long before I mentioned Haagen-Dasz. My grocer is shocked it took me this long to mention it because this summer I've purchased so much of it, they've been sending me coupons for free pints (that makes it so much harder to avoid ice cream!). There are other Haagen-Daz faves, but I will tell you about those another time...

ICD-10-PCS: Code Me This - Root Operation #5

2011-07-27T11:27:00.003-06:00

Okay root operation junkies, are you sufficiently hooked yet? Here is today's procedure: right hepatectomy. What is the root operation?

Bonus Points: Who makes the best coffee-flavored ice cream?

ICD-10-PCS: Answer to Root Operation #4

2011-07-27T10:44:00.004-06:00

Yesterday's procedure was a left needle core breast biopsy. Did you leap to the immediate conclusion that the root operation was biopsy only to find that biopsy is not a root operation? Now what?!

This is one of the major changes on tap for ICD-10-PCS. Currently in ICD-9-CM, biopsy is defined as partial removal whereas excision is defined as complete removal. Not anymore. We no longer use the term "biopsy" in ICD-10-PCS and excision is defined as partial removal whereas resection is complete removal. Therefore, the root operation for our procedure is:

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

This takes us to code 0HBU3ZX. The qualifier in this table indicates whether or not the procedure was diagnostic. Biopsies are diagnostic, so that's how we distinguish a biopsy from a therapeutic excision. Here is a copy of the table:Extra Credit: The best Ben and Jerry's flavor (in my opinion) is definitely chocolate chip cookie dough!

ICD-10-PCS: Code Me This - Root Operation #4

2011-07-26T11:36:00.002-06:00

Today's procedure is left breast needle core biopsy. What is the root operation?

Bonus Points for guessing what I considered to be the only flavor of Ben and Jerry's until about 4 years ago...

Check back tomorrow for the answers.

ICD-10-PCS: Answer to Root Operation #3

2011-07-26T11:08:00.004-06:00

Yesterday's root operation was placement of a urinary Foley catheter. Which root operation did you go for: insertion? Remember, the root operation describes the primary objective of the procedure. The primary objective of a Foley catheter is to drain the bladder of urine. Therefore, the root operation is:

Drainage: Taking or letting out fluids and/or gases from a body part.

If we were to code this in ICD-9-CM, we would be focusing on the main search term "Insertion" and the subterms "catheter" and "urethra" In ICD-10-PCS, the main search term is the root operation, drainage and the body part - and this is important - is bladder, not urethra. Remember, the main objective of Foley catheterization is to drain the bladder, not the urethra. The code table for urinary system drainage is shown below to get us to code 0T9B70Z.
Extra Credit: The best ice cream you probably have never heard of? That would be Graeters. I understand they have some stores in Ohio and Kentucky, but since I don't live there, I am thankful to a friend of mine for not only introducing me to it, but also pointing out I can buy it at the grocery store. This was after he naively handed me a fresh pint of Graeters and a spoon - he discovered that the words ice cream, Kristi, and sharing do not belong in the same sentence! My flavor of choice is mocha chocolate chip, but really, any flavor of Graeters with chocolate chips is amazing. The ironic thing about this ice cream is that it breaks my cardinal rule of chocolate-to-ice-cream ratio because the chocolate isn't so much present in chips and even goes beyond chunks - it's more like slabs of chocolate. Amazing soft and chewy chocolate that doesn't get brittle in the freezing process. And the ice cream itself is amazing. I had to get this one out of the way because there's no way I could describe Graeters if I was further into my ice cream ban! Run, don't walk, to your grocery store and check it out!

ICD-10-PCS: Code Me This - Root Operation #3

2011-07-25T10:46:00.004-06:00

Hopefully by now you're catching your stride and getting used to this root operation business. Remember: the root operation always coincides with the purpose of the procedure.

So today's procedure is placement of a urinary Foley catheter. What is the root operation?

Bonus Points: The ice cream ban is still in full effect for me, so I will continue to live vicariously through my blog as I continue to list off my 31 favorite ice creams as I tick off an example of each root operation. Today's bonus is a tricky one - the best ice cream you may have never heard of. Guesses?

Check back tomorrow for answers!

ICD-10-PCS: Answer to Root Operation #2

2011-07-25T10:23:00.004-06:00

Friday's quiz was to identify the root operation for tracheostomy. Give up?

Well, this one is not at all what I would call intuitive and it goes to show how coder thinking will need to change. In ICD-9-CM Volume 3, if I were to look for tracheostomy in the index, I would look under Tracheostomy (clever). Incidentally, in ICD-10-PCS I can do that to, but it directs me to the root operation:

Bypass: Altering the route of passage of the contents of a tubular body part.

I don't know about you, but I didn't see that one coming. It makes sense after reading the definition of bypass, of course, definitely not intuitive.

Want to see the rest? Assuming in this case, the tracheostomy was performed percutaneously and without the aid of a scope, the code for tracheostomy would be 0B113F4. The body part value for bypass is always the "from" and the qualifier is always the "to."

Extra credit: First choice at Dairy Queen? Oreo Cookie Blizzard, of course!

How Volunteering Can Open Doors to HIM and Coding

2011-07-25T10:07:00.002-06:00

Here is a link to my latest post on the HI Careers blog: http://hicareers.com/Blog/BlogArticle.aspx?Id=92.

DNFB, AR, Bill Hold and Other Things You Need to Know Before You Interview at a Hospital

2011-07-22T10:49:00.008-06:00

I've interviewed my share of individuals who come in with a padded resume who discredit themselves in about 5 minutes. It has nothing to do with a coding test, education, or certifications. They don't know what the DNFB is. And that is tell tale sign that they have never worked in a hospital coding department before. I can deal with inexperience and honesty. I have trouble accepting lying and deceit.

And while I can't give you all experience, I can let you in on some important coding lingo and explain why it's so important. DNFB stands for "discharged, not final billed." It means - every account held for billing for some reason. Some hospitals refer to it as AR (accounts receivable) or simply "the unbilled." The reasons for unbilled accounts are generally categorized into 3 major buckets:

Accounts within suspense (also known as the bill hold) is a facility-defined number of days in which an account will be held from billing so charges can be entered after the patient is discharged from the hospital. Any charges added after the suspense period, which typically ranges from 3-5 days, are considered late.
Accounts outside of suspense and not coded - charts awaiting coding before bill drop.
Accounts outside of suspense and not billed - charts that have been coded but are being held by billing until issues are resolved (e.g., awaiting late charges)

The concept is simple - the patient receives services, charges are entered, the record is coded and billed. The execution is complicated and the process can hit a number of hiccups before the bill gets out the door.

An informed coding manager can tell you any given day where the facility's DNFB is sitting, particularly those that fall outside suspense and have not been coded. An effective coding manager reports the DNFB to his/her coding staff on a daily basis, keeps the unbilled accounts at a dollar figure the CFO can live with, and can tell you why accounts haven't been coded.

In my experiences with DNFB cleanup as a consultant, I can tell you, it's often not a shortage of coding staff that leads to a high unbilled report. At one client, I was given unlimited coding resources, but as I looked outside my office at the empty shelves that were supposed to be filled with paper records (this was about 10 years ago), I remember telling my boss not to send me more coders but to send me people who could find charts instead. This began a major search in the hospital for medical records that never came down from the floors. Today as we pave the way for electronic health records, there are still a lot of facilities using paper that is then scanned into an electronic format, so tracking down this paper is still an issue for some.

In short, DNFB is not just every coding manager's responsibility, it's every coder's responsibility. You should be prepared to react to fluctuations in the DNFB - when it's high, you may be asked for overtime, denied time off, or taken off other projects that don't contribute to dropping bills (e.g., going to educational seminars). If you're being trained in a new area of coding but are proficient in another, you may be asked to revert to your level of experience before continuing your training.

ICD-10-PCS Code Me This - Root Operation #2

2011-07-22T10:45:00.002-06:00

Code me this:
Today's procedure is tracheostomy. What is the root operation?

Bonus Points if you can guess my first (yes, there is more than one!) choice of ice cream at Dairy Queen!

Check back Monday for the answer.

ICD-10-PCS: Answer to Root Operation #1

2011-07-22T10:13:00.004-06:00

Yesterday's question was to guess the root operation for reversal of a tubal ligation, which was performed laparoscopically with removal of Hulka clips.

How the procedure is performed:

Small incisions (ports) are made in the abdomen for placement of the laparoscopic camera and instruments.
Through these small incisions, spring loaded clips previously placed on the outside of the fallopian tubes are removed.

Hulka clip tubal ligation involves little damage to the fallopian tubes and the pregnancy success rate following clip removal is rather high.

Your first instinct, as was mine, might be to go for removal as your root operation, but we have to go back to the intent of the procedure, which is to restore function to the fallopian tubes without the insertion of any devices. Therefore, this root operation is:

Repair: Restoring, to the extent possible, a body part to its normal anatomic structure and function.

Did you get it?

In case you're curious about how to code this, once you've identified the root operation, you can start in the index with the main term Repair; Fallopian Tubes, Bilateral, which gives the first 4 characters of the code 0UQ7. From there, you can look up the table 0UQ. This snapshot shows the character selection to get the complete code 0UQ74ZZ:

Extra credit: Best Baskin Robbins ice cream is mint chocolate chip. In my mind, it's the only mint chocolate chip ice cream with the proper chocolate-to-ice-cream ratio!

Evolution of the Coder Coach

2011-07-21T11:05:00.004-06:00

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!

ICD-10-PCS: Code Me This - Root Operation #1

2011-07-21T10:20:00.003-06:00

In case you missed my last blog, you had an assignment. You were to start reading through the ICD-10-PCS Guidelines. I'm sure at least one of you did that! Now comes the real fun! I will post a new procedure each day and you get to see if you can decide the root operation. For a little added fun and to continue to the ice cream theme, I will also include 31 tidbits about my views on my favorite frozen dessert.

Need a hint? Refer to my blog entitled: "31 Flavors of Ice Cream, 31 Root Operations in ICD-10-PCS" for a list of the root procedures and their categories.

Ready?

Go!

Code Me This:
Today's procedure is reversal of a tubal ligation. The procedure was performed laparascopically with removal of bilateral Hulka clips. What is the root operation?

Bonus Points if you can guess my favorite flavor choice from Baskin Robbins.

Check back tomorrow for the answer!

31 Flavors of Ice Cream, 31 Root Operations in ICD-10-PCS

2011-07-20T14:24:00.011-06:00

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:

Excision
Resection
Detachment
Destruction
Extraction

Root operations that take out solids, fluids, or gases:

Drainage
Extirpation
Fragmentation

Root operations that involve cutting or separation:

Division
Release

Root operations that involve putting in or putting back or moving some or all of a body part:

Transplantation
Reattachment
Transfer
Reposition

Root operations that alter the diameter or route of a tubular body part:

Restriction
Occlusion
Dilation
Bypass

Root operations that always involve devices:

Insertion
Replacement
Supplement
Change
Removal
Revision

Root operations that involve examination only:

Inspection
Map

Root operations that involve other repairs:

Control
Repair

Root operations with other objectives:

Fusion
Alteration
Creation

Some root operations have very limited use: mapping is used only for cardiac electrophysiology mapping; the root operation creation has only two possible uses - gender reassignment from male to female or vice versa. Some are more commonplace: excision is removal 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.

Evolution of the Coder

2011-07-13T12:59:00.006-06:00

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!

It's HIPAA, not HIPPA

2011-05-18T08:29:00.006-06:00

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:

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

The HIPAA Version 5010 Standard
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!

Opportunity Happens: ICD-10 is Mine

2011-05-09T12:02:00.005-06:00

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:

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!

Upcoming Speaking Engagements

2011-03-16T11:52:00.005-06:00

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

March

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

April

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

May

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

July

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

October

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

Two Track Mind: ICD-10 and Vascular CPT Coding

2011-03-08T10:01:00.012-07:00

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

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

CPT Code Changes

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

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

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

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

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

ICD-10-CM and ICD-10-PCS

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

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

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

Prepare for Your Challenge

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

Back Away from the Keyboard...

2011-01-31T22:27:00.004-07:00

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

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

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

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

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

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

Happy networking!

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

2011-01-14T09:44:00.004-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-01-06T13:44:00.010-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New Year, New Attitude

2010-12-29T13:14:00.003-07:00

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

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

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

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

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

Recovering Encoderaholic

2010-12-21T13:36:00.004-07:00

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

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

Sounds great, right? What could possible go wrong?

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

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

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

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

There's No Future in Coding... or is There?

2010-12-05T09:19:00.006-07:00

When I graduated from college 15 years ago, there was a big local trend in my area to train RHITs to become utilization review (UR) case managers. In case you haven't heard of UR, they are typically nurses who review medical record documentation against criteria from insurance companies to help the doctors know when it would be best to discharge patients and they help arrange post-hospitalization care if needed. There was a local company created by an RHIT who received her first post-grad job from none other than my mom (also an RHIT) and she promised me an interview when I graduated. See? Networking is important!

Once I graduated, I called in the favor and met with her HR recruiter. The only problem was, I had just finished doing a lot of coding at an internship and I had fallen in love with it. Believe it or not, at that time there were no open coding positions. I used to joke that the only way I would get hired as a coder is if someone moved out of state or retired! So I took the interview at the UR company and it sounded okay. It sounded like something I could do and they were willing to train. They were even willing to give me raise once I passed my RHIT exam.

And then I got the call from my internship supervisor. She was excited to tell me that they had just run the numbers and decided they needed another outpatient coder. She really wanted to hire me as an inpatient coder, but this is what she could offer me to get my foot in the door. It was more money than the starting position at the UR company, but less than I would make at the UR company once I passed my RHIT. But I didn't care about the money, I wanted to code. So I took the coding job and graciously declined the UR position. And I was told by the HR recruiter at the UR company that there was no future in coding - the future was UR.

I'm sure there are still some RHITs out there doing UR, but within a few years of beginning my coding career, the coding industry exploded. We had OIG investigations and new code-based payment systems and a seemingly endless list of things to keep the job new and fresh. Now I look back on that time 15 years ago when I wondered if I was making a mistake because I followed my gut rather than looking at trends. And then I look forward at the challenges we're facing in the future of coding and can say with a resounding "hooray!" - I think I made the right decision!

Is the Future EHRs?
These days I'm starting to hear it again - "Go into electronic health records (EHRs), there's no future in coding." What?! That's absurd! I'm not here to tell you there is no future in EHRs, but don't let anyone tell you there's no future in coding either. The health information management (HIM) field has historically been divided into operations, i.e., managing patient health information, and coding.

These days the most innovative thing to hit operations is the EHR. More hospitals are moving toward EHRs that will allow for better accessibility to patient health information for continuity of care. There are programs popping up everywhere to close the education gap between HIM and information systems and the term "health informatics" is the new buzz term for the early part of the 21st century.

I have a lot of colleagues who are are firmly embedded in EHR implementations. As a matter of fact, my company is an EHR implementation company. But most of us currently working in the field know that while there is an absolute future in EHRs for any HIM professional, coding is not and never will be a dead-end career. And if you can understand how coding relates to EHRs and vice versa, you can be very marketable.

RHIT vs. RHIA
When I received my RHIT, I assumed I would go into management like my mom. She was an RHIT who had been everything from a coder in her early career to director of HIM and quality for a small psych hospital. RHITs are not typically managers, though, they are usually more ingrained in technical work. The associates program for HIM that precedes the RHIT certification exam is loaded with classes on the technical aspects of managing patient information - including coding - with a few management classes thrown in. The bachelors program that prepares one to sit for the RHIA exam is less technical and more management.

What we tell folks is, if they want to manage an HIM program, become an RHIA. If you want to be a technical worker, like a coder or cancer registrar, become an RHIT. But this isn't a hard and fast rule. I recently talked to an RHIA student who really thinks she wants to be a coder, but her fellow students are telling her there is no future in coding, the future is in managing EHR implementations. She really wants to pursue coding, though.

Follow Your Bliss
I'm not really one for corny sayings like "follow your bliss" but this is your career we're talking about. No matter what your educational background - RHIT or RHIA - if you're trying to decide between coding and EHRs, don't let anyone else influence your decision. Even if you're an RHIA who wants to be a coder or an RHIT who aspires to manage some day (it can and has been done!), go after what you want.

And don't let anyone tell you there is no future in coding or EHRs. All I see for the future of HIM is opportunity in every direction I look.

Not Sure What to do? Do Something.

2010-11-29T19:39:00.003-07:00

I know, I know. It's been a long time since I've blogged - I once again defer to my blog entitled "It's Coding Season" for my excuse! Like many I am back at work today after a long weekend - the kind of weekend that makes you forget about reality and work and you're embedded in a euphoric state of holidaydom with family and friends. But this morning it was back to the dreaded reality that I really have a lot to do. Darn it.

Like many Monday mornings, I grabbed a cup of coffee and padded into the office where stacks of virtual work awaited me. I was instantly grateful that I took the time last week before the holiday to clean off my desk and get the real stacks of paper off my credenza. But that ended once the computer was on, email was open, and my to do list was blaring at me. And so I sat here at my desk for a bit, not really knowing where to start, all the while knowing I needed to do something - no matter how seemingly small - to whittle down that to do list and make it more manageable.

By mid morning, I was starting to feel like I was accomplishing something. It reminded me of some of the students and novice coders I talk to who are so overwhelmed by prospects and job requirements that they're paralyzed by the fear of starting a new job. So if you're not sure what to do, here's my advice - do something. Eventually you will stumble onto something valuable that will help you get your foot in the door.

Does this sound familiar? The job description has a list of job requirements that you know you can do if given the chance, but you don't have experience. They call for coding experience, and you only have classroom hours. In addition to all the things you've trained for in school and basic office duties, they also want you to be a phlebotomist or rocket scientist. My point is, they probably aren't going to find a rocket scientist who can code and fix the copier, so stop focusing on what you can't bring to the table, and let them know what you can do. Are they looking for a team player? Are they looking for someone with project management skills? If your background and education (not just coding) brings additional skills to the table that they're looking for, this is the time to flaunt them. And be sure to let them know how passionate you are about learning coding too. With perseverance and hard work, by mid-morning, you might feel like you've accomplished something.

Coding From Home

2010-10-20T10:18:00.003-06:00

Wow, I've been busy - see "It's Coding Season" for details!

Maybe this link will tide you over until I can come back up for air. This is a link to my HI Careers blog about the realities of coding from home.

"FAQ: Can I work from home as a coder?"

Catch you later,
Kristi

What Maslow's Hierarchy of Basic Needs has to do With Coding

2010-10-07T10:36:00.004-06:00

By high school, we all had learned about Maslow’s hierarchy of needs, which states that if basic human needs are met, people are motivated to achieve more. And if those needs aren’t met, people can’t be expected to aim higher. I’m paraphrasing, of course, but lately I’ve witnessed a trend that seems to be upholding Maslow’s theory. The base of the Maslow hierarchy is the physiologic needs we all require to sustain life with safety following close behind. And when these two base needs are threatened, people don’t have the confidence they need to move into the self-actualization phase.

In case you need a refresher, here is Maslow’s hierarchy starting with the most basic needs:

· Physiological – breathing, food, water, sleep, homeostasis, excretion

· Safety – security of body, employment, resources, morality, family, health, and property

· Love/Belonging – friendship, family, intimacy

· Esteem – self-esteem, confidence, respect of others, respect by others

· Self-actualization – morality, creativity, problem solving, lack of prejudice, acceptance of facts

I think the best demonstration of Maslow’s needs is observing human reaction to environmental chaos – such as Hurricane Katrina. You witness people fighting for food and water and anything else they need in order to survive. It is, in my opinion, why we need the mobilization of external resources – people whose general well-being isn’t in jeopardy – to come to the rescue. Because when your basic needs are threatened, you aren’t really thinking about how to help other people.

Basic Needs and a Coding/HIM Career

By now, you may be wondering what this has to do with a career in coding. Well, although not as drastic as Katrina, the current economic environment has taken its toll on many. People have lost jobs and that has led to losing homes. People are seeking new professions and going back to school as they’ve seen their old jobs either dissolve or be outsourced to another country. And to come into a field, like coding or health information management (HIM), which has a need for workers only to find it hard to get a start, how are those people supposed to achieve the top level of self-actualization?

I’ve read message boards on coding and HIM career websites and talked to countless novices who are trying land their first job – some who are scared for their basic needs. I’ve talked to managers and debated the issue of hiring new grads. And although I’ve been accused of being a hopeless Pollyanna, I really do get it – times are tough and employers don’t always want to take a risk on a new student. From the novice perspective, it’s very difficult to understand how an industry with a need for trained workers isn’t more welcoming. From the employers’ perspective, everything we do in HIM and coding is surrounded by risk – whether related to submitting claims for reimbursement or releasing protected health information. Employers have been hit by the recession, even in health care, so they will cut dollars where they can in order to cut down on layoffs. One of the first things to go is education and training programs. The good news is there will be increased demands for HIM and coders over the next few years. The hard part is getting started.

That said – and here comes the hopeless Pollyanna part – you must be persistent. If this is what you really want to do, you will find a way to get the experience you need for the dream job you covet. I’ve blogged about it before, but it bears repeating: start networking. Who you know is so very important.

Ready to go Viral?

While you’re working hard and networking to get the recognition you deserve, here is something not to do. Don’t spill your feelings in an online forum. I see it all the time. People are frustrated and they want to lash out and vent, but an online forum isn’t the right place. You may be sitting alone in your home typing your feelings, but once you submit it online, it’s there for the world to read.

And the world includes potential employers.

And they read these sites.

And they don’t hire hot heads they think might be HR risks.

Plus, you never know when your post will go “viral.” Seemingly innocent communications can turn controversial quickly. This morning’s news was about a college student who wrote a thesis-style paper with graphs accounting her romantic encounters with other college students. And she named names. She only emailed it to three friends, but it didn’t take long for everyone on campus to see it and now that the story ran on national television, more people will read it. Do you want that kind of exposure?

Don’t get me wrong, though, I’m all for venting. Find someone you trust to spill your guts to or vent your frustrations in a private journal. I once knew someone who was under immense pressure and had to maintain a pleasant demeanor in public at all times. She coped by purchasing some juice glasses with happy faces on them and driving to a remote area with a cliff. She would scream and throw the glasses over the cliff and listen to them smash. I have the benefit of being a second generation HIM professional. Even though my mother is retired, she’s one of the best sounding boards for me in venting my professional frustrations because she understands the field.

Matchmaking for the Professional

I recently read a novel in which the heroine ran an executive recruitment company. She had a romanticized vision of her job. She saw it as a matchmaking business – except instead of matching two soul mates, it’s about matching the person to the right employer. Her colleagues thought she was shallow and nuts. I thought she was brilliant. If you think about it, interviewing is like dating, albeit a lot less personal. And the same traits that make a person a miserable dater make them a miserable interviewee. You want to come across as confident (not desperate), intelligent (but not cocky), and knowledgeable about who you are, what strengths you can bring to the relationship, and where you want to be in the future. At the same time, you don’t want to tell them everything about your history in the first meeting.

So do what you need to do to maintain your basic needs so you can find your employment soul mate – or at least the employment version of Mr./Miss-You’ll-Do-For-Now. That may mean taking a non-health care related job to make money and keep a roof over your head while you search for the job you want, but remember to take care of yourself so you can acquire the confidence you need for self-actualization – and remain positive!

Have a Smurfy Career

2010-10-06T13:42:00.003-06:00

One of my favorite cartoons as a child was the Smurfs. And although I have strong opinions on my perceived unoriginality of remakes and the making of TV shows into movies, I admit, I was oddly excited when I saw a photo of Hank Azaria donning a Gargamel costume for next year’s Smurfs movie. I then read that the Smurfs have been around for more than 50 years. I’m not good at math, but I’m good enough to realize that means Smurfs were around long before I first started watching Saturday morning cartoons. So I did what I always do when faced with a potential trivia question. I googled Smurfs.

I was surprised to find out that the Belgian creator, Peyo, was faced with two job prospects after his schooling: one in dentistry and one as an illustrator. He applied for the job at the dentist first, only to find out the job had been filled 15 minutes earlier. And to think, had Peyo gotten started earlier that morning, I would have led a Smurfless life. Devastating. Peyo began illustrating for Le Journal de Spirou in 1952, but it wasn’t until the Smurfs made their costarring appearance in Peyo’s Johan and Peewit comic in 1958 that he was launched into cartoon fame. And the world has had an obsession with these lovable little blue creatures ever since.

The obvious lesson to be learned here is that the early bird doesn’t always get the worm – something I am ever so grateful for considering my solid existence as a non-morning person. Okay, so that’s not really the lesson. I also believe in the “you snooze you lose” mentality as well. I meet a lot of aspiring coders who are looking for an “in” into the industry. And those ins are not always glamorous. Or well-paid. Even with the right credentials, you may have to take a lower paying position to get your foot in the door or take a position close to the one you really want. But who knows? With the right mix of hard work, divine intervention, planetary alignment, or just plain luck, you may find yourself on a career path you never expected. And like Peyo, it could lead you to great things.

It's Coding Season!

2010-09-07T10:00:00.007-06:00

I'm sometimes asked if there's a busy time of year for coders or if it's pretty much status quo. As a matter of fact, there is a busy time of year for coders and this is it!

Every year, we gear up for all the upcoming year's coding changes. That means letting coders know which codes have been deleted, expanded, and added and letting coders, physicians, administrators, and revenue cycle personnel know how code-based reimbursement will be affected in the coming year. This may seem rather straightforward, but since we work with more than one code set with different implementation dates, fourth quarter of each year can be pretty crazy!

ICD-9-CM Codes
The ICD-9-CM diagnosis and procedure codes are updated annually with the Center for Medicare and Medicaid Services' (CMS) fiscal year (FY), which begins October 1. These codes are used to report diagnoses for all health care settings and procedures for hospital inpatients. Right now, you will find coders acquiring their FY 2011 ICD-9-CM code books and attending seminars on the code updates. Some of this year's highlights include:

Diagnosis Codes:

A new code for obesity hypoventilation syndrome
Expansion of fluid overload code to differentiate between transfusion-associated fluid overload and other causes
Expansion of the avian flu codes to include manifestations of the disease
Expansion of the blood transfusion incompatibility codes to differentiate between ABO and Rh incompatibility
Additional personal history codes
Expansion of the body mass index (BMI) codes up to allow for classification of BMI in varying increments up to 70 and over
A new section of V codes to report retained foreign body fragments
A new section of V codes to report the number of placentae associated with multiple fetal gestations

ICD-9-CM diagnosis codes are within the public domain and the 2011 revisions can be found on the National Center for Health Statistics' (NCHS) website.

Procedure Codes:

New code for placement of a central venous catheter under imaging guidance
New codes for carotid sinus stimulation components and devices

Changes to the ICD-9-CM procedure codes are within the public domain and are available on CMS' website.

IPPS and MS-DRGs
The inpatient prospective payment system (IPPS), the system used for Medicare payments for inpatient hospitalizations, is also updated each year on October 1. This includes recalibration of the relative weights for the classification system used under IPPS - the Medicare severity diagnosis related groups (MS-DRGs). This year, the major changes to the MS-DRGs include:

A documentation and coding adjustment of -2.9%, wherein CMS will discount payments in FY 2011 to hospitals by 2.9% in order to remain budget neutral. The attempt to remain budget neutral is to counteract the financial impact of implementing a severity-based DRG system 3 years ago.
The addition of 12 new quality measures to be reported by hospitals under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program.
A revamping of Medicare's 3-day rule, which bundles payment for outpatient services provided within 3 days of inpatient admission into the inpatient payment.

Changes to the IPPS and MS-DRGs are available in the public domain through CMS' website as well as the Federal Register.

CPT Codes
Changes to CPT codes become effective with each calendar year on January 1. These codes are used to report procedures and services for physicians and hospital outpatients. Because CPT codes are owned and maintained by the American Medical Association (AMA), they are not available in the public domain. As such, finding a list of upcoming CPT code changes is often a closely guarded secret until the CPT book is published, generally around November or December each year.

The best way to get updates on upcoming CPT codes is to attend either the AHIMA's Annual Clinical Coding Meeting (September 25 and 26, 2010 in Orlando) for the national code update or the AMA's CPT and RBRVS Symposium (November 10-12, 2010 in Chicago). After the AMA's Symposium, it's common to see articles appearing in coding journals and publications discussing the upcoming coding changes.

HCPCS Codes
HCPCS codes are developed and maintained by CMS to report services, supplies, and procedures that are not found in CPT. They are utilized by physicians and hospital outpatient reporting. HCPCS codes are potentially updated quarterly, although an update isn't always required that frequently. HCPCS codebooks may be purchased on an annual basis with the calendar year and quarterly updates are found on CMS' website. HCPCS codes are in the public domain and general information about their use can also be found on CMS' website.

OPPS and APCs
The outpatient prospective payment system (OPPS) is the payment system utilized by Medicare to pay for hospital outpatient claims. This is updated on January 1 each year, along with the CPT and HCPCS codes. The proposed rule was published in the Federal Register on August 3 and CMS accepted public comment on that proposed rule through August 31. CMS will review the comments, make final determinations, and finalize the rule by November 1.

OPPS changes include recalibration of the relative weights for ambulatory payment classifications (APCs), the categories used to group similar procedures for payment.

Some highlights of the proposed rule include:

Two areas that have undergone frequent changes or requested changes will remain static for 2011: drug and substance administration and hospital outpatient evaluation and management visit guidelines
Establishment of a list of services that must be performed under physician supervision
Removal of three orthopedic codes from the inpatient-only list, making them reimbursable as outpatients under Medicare
A new method of paying for separately payable drugs

Information about OPPS and APCs can be found on CMS' website.

Physician Fee Schedule and RVUs
Physician payment, as outlined in the physician fee schedule, is updated annually on January 1 by Medicare. The proposed rule was published in the Federal Register on July 13 and the comment period ended on August 24. The physician fee schedule outlines the relative value units (RVUs) for each CPT code based on the amount of work the physician performs. Information on the Medicare physician fee schedule and RVUs is within the public domain and can be found on Medicare's website.

Too Much Information?
It sounds like an awful lot of information, but remember this - not every coding professional needs to learn the ins and outs of every coding and payment system. Because I work with hospital clients, I will be focusing on everything but the physician fee schedule. And those who work in physician offices will focus on ICD-9-CM diagnosis code changes, CPT/HCPCS code changes, and the physician fee schedule only. Even so, it's enough of an impact to call fourth quarter "coding season!"

More From the Coder Coach

2010-08-24T11:16:00.002-06:00

Need a Coder Coach fix between blog postings? I frequently post links to articles on Facebook and Twitter. On Facebook, search for the group "The Coder Coach" and on Twitter, look for @codercoach.

What Does ICD-10 Really Mean to New Coders?

2010-08-19T13:38:00.006-06:00

If you haven't heard yet, the coding system is changing on October 1, 2013 from ICD-9-CM to ICD-10-CM and ICD-10-PCS. I have told a lot of new coders and coding students that this gives them a more level playing field when it comes to getting hired on as a coder. But 2013 is still 3 years away. If you are graduating soon and will be looking for a coding position, what does ICD-10 really mean to you? Should you start training on ICD-10 now so that you are well-positioned for the coding switch?

Why ICD-10 is a Good Thing for Wanna-be Coders
I always start with the prerequisite disclaimer when I talk about coders: I am a coder, so I can poke a little fun at our idiosyncrasies. Many coders don't like change. And that's part of what makes them so successful as coders - the ability to work in a routine environment coding patient record after patient record. So to coders who really dislike change, ICD-10 is like an atomic bomb. I've heard some say they will retire or find a new line of work when ICD-10 is implemented. Add those open positions to the decreased productivity that is inevitable with the implementation of a new coding system, health care reform, and the current national coder shortage, and what we have is an awesome opportunity for new coders to enter the field.

Coders who learn ICD-10 in school will likely be called upon by their new employers to share their knowledge of the new coding system with more established coders. Getting into ICD-10 on the ground level means more opportunities for new coders in the future.

Why ICD-10 Coding Jobs Won't be Super Easy to Land
While the need for more coders trained in ICD-10 will be there in 2013 and the codes themselves will be different, the one thing that makes a coder truly special will not change: navigating the medical record, deciphering medical terminology, and applying coding guidelines. These are skills that are not easily taught in school - this is the "experience" that employers are looking for when they say they want two to three years of coding experience. And while new coders right out of school will have oodles of exposure to the ICD-10 code sets, experienced coders will have that other type of experience - the type that goes beyond looking up a code in a book. That skill will still be coveted by employers.

I talk to a lot of people who are pondering changing careers and getting into coding because of what they've heard about ICD-10 and the future need for more coders. But just because we're nearing this massive change doesn't mean that it will be any easier to get hired as a coder in 2013 than it is now. There are many considerations you need to make in determining when ICD-10 training is appropriate for you.

What Kind Of Coder Do You Want to Be?
I have been trained in ICD-10-CM and ICD-10-PCS. The only reason I am trained is because I intend to do a lot of ICD-10 training myself and those who are getting educated now are the educators. I recently had someone tell me she planned to wait a couple years to get trained in ICD-10 because she heard it was so different from ICD-9-CM and she didn't want to have to learn a dying coding system. So let's start with the first question you need to ask yourself: What kind of coder do you want to be?

This is important because ICD-10 is divided into two code sets: ICD-10-CM for diagnoses, which will be used by all health care settings, and ICD-10-PCS, which will be used only by hospitals for reporting procedures. CPT will not be impacted by ICD-10 implementation and the format of ICD-10-CM is very similar to ICD-9-CM (granted all the code numbers are different!). I see the transition from ICD-9-CM diagnoses to ICD-10-CM being relatively easy (notice I said relatively - it will still be a bear!).

ICD-10-PCS is a whole different story. The procedure portion of ICD-10 is set up like no codebook we've ever seen. There is no tabular listing - only a series of tables that allow the coder to "build a code." Furthermore, the level of detail and the coder knowledge required to code an ICD-10-PCS code as opposed to an ICD-9-CM procedure code is astronomical. For example, there is one ICD-9-CM procedure code for repair of an artery. In ICD-10-PCS, the coder will need to know which specific artery was repaired and how that repair was approached.

So when people say ICD-10 is very different from ICD-9-CM, I have to ask, which code set? While the code numbers and code format will be drastically different, the way we code will be the same for ICD-10-CM as it is now for ICD-9-CM diagnosis coding. But ICD-10-PCS is like... well, CPT on steroids. The level of detail in ICD-10-PCS coding is much more specific than what's required even by CPT standards.

Why the long explanation? Well, if you plan to code for a physician office, you won't need to learn ICD-10-PCS. So I say, go ahead and learn ICD-9-CM now because the main change for you will be the code numbers themselves (and a couple of coding guidelines). If you plan to code for a hospital, you need to be prepared for a whole new game with procedure coding when ICD-10 is implemented. The good news is, ICD-9-CM procedure coding really isn't very difficult, so I don't see anyone "wasting" time by learning it now until 2013.

Do You Want to be More Than a Coder?
Let's get one thing perfectly clear here and now. The implementation date for ICD-10 (both CM and PCS) is October 1, 2013. There will be no push on that date. Everyone will be expected to be up and running on October 1, 2013. Rumor has it that this date will get pushed back, but everything I have heard from government representatives says that there will be no push on that date. So spread the word!

Let me get something else perfectly clear: ICD-9-CM will not "die" out. There will be a need for people to know ICD-9-CM diagnosis and procedure coding after October 1, 2013. Particularly if you work in a hospital, data analysis is often performed based on codes and we often compare case loads from year to year to see which services are growing, which are waning, and which are needed in the community that aren't currently offered. In the calendar year 2013, we will have data from both ICD-9-CM and ICD-10. That means a need to be able to crosswalk between codes for data analysis. And someone within the hospital needs to understand both systems. That might be you.

Take the Next 3 Years to Get Experienced
The biggest complaint I hear from wanna-be coders is that all employers are requiring 2-3 years of experience. So if my math is correct, if you wait 3 years to learn ICD-10 and it takes another 2-3 years to get experience, you won't really be working as a coder for another 5-6 years. Why wait? While it doesn't make too much sense to get trained specifically on ICD-10 right now because you won't remember it in 3 years, it does make sense to get hired on as a coder and start positioning yourself to take on a coding position in 2013. This might mean taking an entry-level position where you are exposed to the medical record, codes, or billing. Don't wait till 2013 because there will be a mad dash and employers who have open positions in 2013 probably won't have time to train someone who is complete green. As a matter of fact, I have been encouraging facilities to make education a part of their organizational culture now to lessen the impact of ICD-10 implementation.

Now is the time to hone your skills in coder detective work - where you find information in the medical record, how the patient's symptoms come together in the disease process, anatomy and physiology, medical terminology, and pharmacology. And the good news is, learning this now means you can also apply it to ICD-9-CM now and it will make it easier to make the switch to ICD-10.

Talk to Your School
If you're enrolled in a coding or HIM program or plan to enroll in one, do your homework. Ask the program director or coding instructor what the school's plan is for the ICD-10 transition. They should be referencing timelines like the one posted on AHIMA's website. If they don't have a plan now, you should be concerned.

Don't Hurry Up and Wait
I suppose the best way to sum up this posting is to say this: think of your coding education as a journey rather than focusing on the destination. Go ahead and get trained in ICD-9-CM now - it will not be a waste of time or money. Yes, you will need to train in ICD-10, but if you're credentialed, you will have every opportunity to train through AHIMA and the AAPC. And if you're employed, your employer will be be focused on training as well. Plus, I really do believe that those coders who know both ICD-9-CM and ICD-10 and can analyze and compare data across both code sets will be hot commodities.

Why Wait?

2010-08-13T11:14:00.002-06:00

Are you currently a coding student? Are you nearing graduation? Are you waiting until you graduate to look for a job? If you answered yes to any of the above, I ask you, why wait? Start applying for coding jobs now.

We all know it can be hard to get that first coding job or even to land in an entry-level position. So if you can make it work, I recommend applying for any job now that will boost your chances of moving into a coding position. That might mean working as a file clerk or scanner (someone who scans in medical record documentation into the hospital's imaging system). Anything that will get you closer than you are today to being a coder.

If you start now you will also find that you won't be competing with your fellow graduates for the same jobs come graduation day. And for all you kinesthetic (learn-by-doing) learners out there, you may find it will help you piece together the puzzle we call health care revenue. In other words, you'll get experience!

So take this time to get a leg up on your coding career and get started! Good luck!

The Shortcut to Being a Coding Professional

2010-08-12T13:15:00.006-06:00

About 10 years ago when I was working as a coding supervisor in a hospital, I received a phone call from a woman who was asking me how she could get trained to become a DRG auditor. At that time, there weren't a lot of coding schools and the internet was just catching on, so I referred her to the local community college and their health information technology associates degree program. She went on to tell me that she had a masters degree in an unrelated field and she didn't feel an associates degree was necessary. She also didn't want to be a coder, just a DRG auditor. She had an acquaintance who became a DRG auditor without a degree in HIM, so she figured she could too. She heard there was good money in DRG auditing and she wanted to make good money. All I needed to do was tell her where to get the information.

Okay, a quick side note: DRGs are the result of the codes assigned on a single inpatient claim - adding, removing, or changing a code can potentially change the DRG. For example, I recently reviewed a record for a coder and changed just the fourth digit on one code and it changed the DRG. So wanting to know how to audit DRGs without being a coder is like wanting to perform surgery without knowing how to use a scalpel.

Anyway, at that moment, two things ran through my brain. 1) This woman wants the job I consider to be my next step in the career ladder and 2) She just insulted me by seriously underestimating what it takes to be a successful coder, let alone a successful coding auditor.

The Shortcut to Being a Coding Professional
Each week I jot down blog ideas and often the short snippets scrawled on my note pad show a common theme. This week, the theme is summed up by a quote from Randy Pausch in the Last Lecture (I'm almost finished reading!): "A lot of people want a shortcut. I find the best shortcut is the long way, which is basically two words: word hard." And last night as I watched the last night of performances on So You Think You Can Dance, I was further moved by a simple statement by judge Nigel Lythgoe: "People believe they can be a star without working hard."

Now I am not trying to discount this woman's abilities in her chosen field of study. And although I have 15 years of experience in coding, if tomorrow I decided to be a computer programmer, I wouldn't expect someone to hire me because I have 15 years of experience in an unrelated field. I would have to study and become and apprentice all over again. It's a long journey, but the shortcut really is the long way: work hard. Would there be skills I could bring from my background? Absolutely and I would advertise those skills. But if you take one thing away from this blog posting, let it be this. You could unintentionally insult your potential employer by discounting what it takes to get to their level. And insulted people don't hire the people who insult them.

Spending Time in the Trenches
I've been a consultant for over 9 years and the best compliment I receive from a client is when they tell me that they can tell I've worked in the hospital environment and understand the process and issues. It seems simple, but in health care, we do everything differently - especially the business side of health care. Hospitals and physicians have been in business for centuries treating patients. But it's only been the last few decades that it's become necessary to combine the human health care aspect with the concept of running a facility like a business. And that's due to the increase in health care costs and the attempts to try to control those costs. The result is an industry built around human care and retrofitted for finance. How many businesses do you know that operate that way?

When I took a health care finance class a few years ago I already had several years of coding experience and was well versed in how a hospital's revenue cycle works. So as our professor talked about the process, I decided to observe the other students in the class that came from other industries - in particular, an attorney. And as the professor talked about the charge master and codes coming from different departments and payer mixes, the attorney thought it was crazy and unreasonable. It was a completely foreign concept to her. And it will be a completely foreign concept to you too until you get your foot in the door and start observing.

The woman who called me about how to be a DRG auditor eventually got frustrated with me and hung up. I wasn't the first person to give her the community college answer.

Within a few years I was a DRG auditor and I have to say it was one of the hardest experiences I've ever had. We traveled in teams of auditors (safety in numbers!) with our laptops and portable printers. Each time we finished a record that had a coding or DRG change, we printed out an audit sheet and sent the record and audit sheet back to the original coder. At the end of the week, we sat down with the coders and they had the opportunity to refute our findings. It took a few exit interviews and a lot of tough skin to build my abilities as a coding auditor. The terrific thing about coders is that they will dig to find an answer until they can prove they're right. Some of the coders I audited were right. And sometimes (I like to think more often than not!) I was right. My point is, I worked hard and I have a lot of confidence now in my ability to both conduct and defend a DRG audit.

That Annoying Overqualified Coder
I'll never forget my first encounter with a coding auditor. She was very qualified. As a matter of fact, all of my coworkers thought she was overqualified. She was brought in to do an audit of our work and then do some education. We all sat around a table at our first meeting and introduced ourselves. She started. She listed off her years of experience, degrees and credentials, and a long list of states she'd visited and audited. It took her about 5 minutes. And then she turned to her left and looked at me and asked me to introduce myself. My introduction went something like this, "Uh, hi. My name is Kristi and I just graduated and will sit for my ART [now RHIT] exam in October... That's it."

I was humiliated that I didn't have the credentials this woman had. I sounded ridiculous after her 5 minute speech about her experience. Afterward, my coworkers said they found the whole thing hilarious. They were not happy about being audited and most of them thought the consultant was overbearing and way to focused on credentials. They thought my response was perfect. And they all reassured me that no one could possibly expect me to have any experience - I had just graduated!

Now I think back to that consultant. Was she overbearing? Maybe. Did she have experience? You bet. Was she good at what she did? Absolutely. She taught me 2 things: 1) even if you have an encoder, you should always have a CPT code book on your desk because, "The encoder took me there" is not a valid response to why you coded something the way you did, and 2) how to code bunionectomies. That first introduction sticks with me too because now I'm the consultant who to some may seem overqualified. But I will tell you this. It feels so good when someone asks me a question and my answer includes the phrase, "When I was... [a coder, a coding manager, etc]." And I know it gives me credence with the people I'm talking to.

The Brick Walls are There for a Reason
The Randy Pausch quotes will be with me for awhile because so often as I've read this book, I find myself pumping a fist in the air and saying, "Yeah!" I spend a lot of time on thinking and self reflection and much of what Pausch wrote is in line with my thinking. Anyway, another favorite quote is this:

"The brick walls are there for a reason. They're not there to keep us out. The brick walls are there to give us a chance to show how badly we want something."

Yes, it's a quote worth bolding. I have no doubts that if you really want to be a coder and have the skill and talent for it, you will be a coder. The question is, how hard are you willing to work to scale that brick wall? We all started somewhere. People have asked me how I got so far in such a short time frame (15 years). I think I like the answer that Randy Pausch gave whenever someone asked him how he got his tenure so early: "It's pretty simple. Call me any Friday night in my office at ten o'clock and I'll tell you."

Top Ten Reasons to be a Coding Professional

2010-08-09T08:50:00.003-06:00

I would love to take credit for making up this list of reasons to be a coder, but I can't. It's a list that came out about 15 years ago and I believe it was published in The Journal of AHIMA. This list was popular when I first started coding in the mid-90s. I have yet to see an electronic copy of it, but found a photocopied list in a scrapbook (er, chart) my coworkers gave me when I left my first coding job. This list graced my bulletin board for a long time!

Some of these are a bit dated, but most still ring pretty true and I updated Ms. Scichilone's credentials as she is still a well-respected practicing HIM professional. I hope you enjoy this little bit of levity!

Top Ten Reasons to be a Coding Professional
by Rita Scichilone, MHSA, RHIA, CCS, CCS-P, CHC

10. You love to read really small print.

9. Carrying around code books is better weight training than those cute little dumbbells you buy at the fitness store.

8. Classification systems and nomenclatures make great party conversation. "I'll bet you don't know what SNODO* is!"

7. If a patient can do it, get it, or hurt it, you can code it.

6. You love explaining what you do each day - "Oh, I typically transform sixty-five or so pages of complicated clinical information written in a foreign language (medical terminology) into numeric codes that will fit on a one-page form."

5. When you get carpal tunnel syndrome from turning those pages and burning up a computer keyboard, you'll know how to code it for your insurance company.

4. You can impress your friends by saying you'll meet them after work for some 94.38 at your favorite hangout."**

3. You are passionate about acronyms (DRG, APG, HCPCS, HCFA, HEDIS, CPT, UHDDS, ICD-9-CM, CHMIS, WEDI, UB-92)***

2. When you hear "The AR days dropped again today," you get goosebumps.

1. The eternal mysteries of ICD-9-CM and HCPCS CPT-4 are transformed at your touch into essential mastery of critical clinical data indexing that can change the health of America!

*Standard Nomenclature of Disease and Operations (SNODO) was a coding system that predated ICD-9-CM

**94.38, Supportive verbal psychotherapy

*** Ambulatory patient groups (APGs) were proposed prior to the use of ambulatory payment classifications (APCs); the Health Care Financing Administration (HCFA) was renamed the Centers for Medicare and Medicaid Services (CMS) in 2000, the uniform bill 1992 has been updated and replaced with the uniform bill 2004 (UB-04)

What Are You Going to do About It?

2010-08-04T15:01:00.002-06:00

I will be the first one to admit when I’m bad at something (like math), but as far as joke-telling goes, I think I’m actually quite good. It’s the remembering part that’s tricky. But I do have a few favorite jokes in my arsenal – a blonde joke or two (it’s okay, I’m blonde!), a couple of jokes that are only truly appreciated by kids under the age of 8, and one joke that teaches a lesson. I am going to share the latter with you now.

A damn broke uphill from a town and the entire town had to be evacuated before the eventual flooding and devastation that was going to occur. One man began to pray and asked that God protect him from the flood. The police came to his door and told him to evacuate and he said, “No thank you. I believe and have faith that the Lord will provide.” The police left. Soon the flood waters were starting to make their way into the town and the man was forced to move to the second story of his home. He prayed again and asked God to protect him. A motor boat with rescuers came by offering to take the man to safety but again he said, “No thank you. I believe and have faith that the Lord will provide.” The rescuers sighed and shook their heads and moved on. Soon after that, the flood waters were so high the man had to take refuge on his roof. He maintained his prayer for safety. In one final attempt to clear the town, rescuers came by in a helicopter but the man refused to get on board. He said, “No thank you. I believe and have faith that the Lord will provide.” Soon there was no place left to climb and the unfortunate man drowned. When he got to heaven and spoke to God he said, “Lord, I believed in you and had faith that you would save me. Why did you let me drown?” And God said to him, “I provided you with the police, a motor boat, and a helicopter. What else was I supposed to do?!”

I’ve heard the joke many times – sometimes as part of a sermon, sometimes as an anecdote to get people to realize they have more control over their lives than they think. I receive many phone calls and emails from students and novice coders who are frustrated with the hiring process. And since I’ve committed to mentoring, I try to find time to respond to each of those emails. I am always happy to give a little pep talk or give a little advice that may guide them in the right direction. But occasionally, I get an email that is a series of complaints and blame games and all I can think is: what are you going to do about it?

Don’t get me wrong. No one loves a good venting session more than me. I even have friends that I can email and rant to and they won’t take it personally. I can type a 2 page email and usually get the response, “Feel better now?” and usually I do. I am all for venting frustration. But at some point, you have to make a decision to do something about the problem or change course. Otherwise you’ll go crazy. Think of Einstein’s famous quote about the definition of insanity: “doing the same thing over and over again and expecting different results.” So if you’re stuck in venting mode or you haven’t tried a different attempt at getting what you want, it’s time to break the monotony and move on.

I recently started reading The Last Lecture by Randy Pausch with Jeffrey Zaslow. I don’t get a lot of time to read and I am by no means a speed reader, so it will probably take me at least a week to get through this “quick read.” The story, if you are unfamiliar, chronicles the last lecture given by Randy Pausch, a professor at Carnegie Mellon University before he succumbed to pancreatic cancer. He was 47-years-old and left a wife and three young children behind. His lecture entitled “Really Achieving Your Childhood Dreams” was really directed at his children (the lecture was recorded) and is so inspiring, it yielded a spotlight on a national TV news program, the book, and countless videos on YouTube.

In the book, Pausch dedicates an entire chapter to his parents and their parenting skills. One of the things his parents did for him was to encourage him to find answers to the unknown. This is something I felt I had in common with him – my parents were always telling me to “look it up” if I didn’t know an answer. In fact, my mother always told me, “Knowledge isn’t what you know; it’s whether or not you know where to find the answer.” And as much as I hated the look-it-up-response (I actually thought they were lazy), I appreciate it now because now I don’t rely on someone else to figure everything out for me.

I am at a point in my life where I am probably the happiest I’ve ever been. And I’ve noticed that as a happy person, the last people I want to be around are unhappy people. Unfortunately, I have a few in my life – friends, acquaintances – who every time I talk to them dump every last problem on me and then wait for me to speak. Sometimes I mess up and give them advice. What I’ve found to be more effective is to ask them what they plan to do about it. If all they want to do is complain about their situation and aren’t willing to do anything about it, there’s really not much else I can do other than listen and wait it out until they’re done. But every once in awhile, I see something flicker in their eyes and I can tell they haven’t really thought what they would do about it. And I sometimes suspect they’re waiting for someone to tell them what to do. My hope is that my question is a virtual slap-in-the-face to get them past the complaining stage and onto the fixing stage.

Are you one of these people? Are you waiting for the magic opportunity that will get you into the coding profession? Have you really tried everything to get into the industry? I defer again to Randy Pausch, who created a list of childhood dreams. On that list was “being in zero gravity.” His students won a contest that enabled them to experience NASA’s plane “The Weightless Wonder,” which helps astronauts get used to a zero gravity environment. Unfortunately for Pausch, no faculty was allowed. So he found a loophole and withdrew his application as faculty and resubmitted it as press (for which he had to do some additional work to get the story into the media). It worked and Pausch was able to cross one thing off his childhood to do list. So I ask you again, if you’ve tried to get a job and have failed, what are you going to do about it?

Happy Summer!

2010-08-03T17:52:00.002-06:00

You may have noticed a blatant absence of new blog posts. I've been busy with a new client and taking advantage of summer, which, I'm sad to say, is almost over (boo!). That's meant a break from my Coder Coach events and, yes, my blogging too.

But fear not! I will be posting some small blog posts to tide you over until September and I just submitted a couple of blog posts to AHIMA's HI Careers website, so you won't miss out. Be sure to check out my latest HI Careers post entitled "Experience for the Inexperienced" at www.HICareers.com and be sure to also check out the other blogs and offerings the website has to offer.

Now Blogging in Two Places!

2010-07-23T16:24:00.003-06:00

If you haven't had the chance to check out AHIMA's HI Careers website yet, you definitely should. Besides all the great information for HIM and coding job seekers, they've recently added a series of blogs from industry pros - including yours truly. I will continue with my Coder Coach blog as well - now you just get to read me in two places! Plus, you get the added benefit of hearing from others as we tackle some FAQs about getting hired in HIM.

AHIMA's HI Careers website

Even My Dad's on Facebook - Are You?

2010-07-22T23:06:00.002-06:00

Like most people these days, I'm on Facebook. Actually, I maintain a couple of Facebook accounts: one personal and one professional. It's been fun to connect with people from my past and see what they're all up to. And I have to admit, when my brain gets a little fried, it's a quick and simple distraction to see if anyone has posted anything interesting or entertaining. For over a year now, I've tried to convince my parents that they need to get on Facebook so they can reconnect with people from their past. Even so, I was shocked the day I received a friend request from my father.

I'm not one of those people who is afraid to "friend" my parents. They're actually pretty cool and I get along well with them. Plus, I subscribe to the idea that if I'm uncomfortable having my father read it, I shouldn't be posting it on Facebook to begin with. But my dad has only recently become semi-tech savvy. I received my first email from him about a year ago. So getting a Facebook request from him was major. Mom's request came in soon after his and was a little less shocking because she's into gadgets and is one of the few people I actually text.

My point (and I do have one) is this: so many people tell me they don't do Facebook because it's too much work. These people are often people who are looking for jobs. And all I can think of is, if Facebook is too much work and you want to be a coder (and potentially code from home), you are looking into the wrong business.

Let me demonstrate. I have 7 email accounts in varying states of maintenance. One personal, one for my company, one for The Coder Coach, two for clients, and the rest are accounts that were set up for miscellaneous purposes and very few people have those email addresses. I have 2 Facebook accounts, a LinkedIn account, and a Twitter account - although I only tweet professional tidbits because I personally find it a bit ridiculous to let people know what I'm up to at every moment of the day. I also have an instant messenger (IM) account, which one of my clients uses for quick questions.

And that's just "social" media. I am able to VPN into 2 of my clients in order to access their systems, which consist of a logon to the VPN, a logon to their server, a logon to the electronic medical record (EMR), a logon to their coding system, and an encoder. I also have various online memberships (e.g., AHIMA, AAPC) that require passwords to access member-only information. And frequent flier and hotel point programs. I currently maintain over 100 passwords.

In order to maintain all these accounts and passwords, I have my main work laptop, laptops from some of my clients, and an iPhone. I also have a personal laptop, which gets turned on about once every 3 or 4 months because I can't stand to be on the computer when I'm not working. I run dual monitors on my desk so I can look at applications side by side. I have 2 phone numbers, a fax number, and 2 different ways to connect to the internet. In other words, I'm well connected - at least when all the computers are working properly.

I admit - this is extreme. For the typical coder working from home, though, there will be at least a computer and 1 or 2 huge monitors for reading EMR documentation (remember, paperless means no paper - everything is online) and the login credentials to get into a VPN, remote server, and whatever systems you'll be using. When something goes wrong or doesn't work properly, you are the first line of IT defense. You can't just get an IT guy over to your house right away.

So if you want to be a coder and work from home and you aren't on Facebook because it's "too complicated," think about either changing your reason for not being connected, get connected, or find a new career that doesn't involve computers. And try to filter what you tell a potential employer about your issues with technology. As medical records move to an electronic format, you will need to be more tech savvy. After all, if my dad can do it, so can you!

Getting Through an Operative Report - Without Crying

2010-07-07T20:31:00.007-06:00

One of the things I love about the mentoring I do for students is it reminds me of what it was like to be a newbie. And I don't just mean the excitement of being on the cusp of a new career. I am also grateful to be humbled and reminded that I knew absolutely nothing when I got started. These days when I stand in front of an audience of coders or students and teach the latest and greatest on whatever topic I'm discussing for that day, it's the culmination of years of experience and hours (or weeks) of research and preparation. But you might be interested to know that in my first coding job I did come home from work on more than one occasion in tears.

I can't explain that helpless feeling when you've trained so hard - and studied and taken numerous tests and graduated, etc. etc. etc. - and you land that first job and they hand you an operative report. And you freeze. Because it's like Greek. You have no idea what to do. Where are the short coding scenarios you learned in school? What does that first paragraph really say? You know you could find the code if you could just figure out what the heck the darn report says (incidentally, I now consider myself trilingual: English, medical terminology, and coding!). You know you're qualified, but are you really?

So I sometimes forget when I'm working with new students what it was like. Of course, there are still days when I feel like crying because I keep getting myself into uncharted territory. I actually relish researching and "figuring out" things that other people may abandon because they are too foreign or "difficult." But it wasn't always that way. I used to be an overconfident novice coder who, when a chart was placed in front of her, did a lot of tap dancing to make it look like she was competent. The good news is, 15 years later, I feel competent (most of the time anyway!).

The Word Search
I've worked in coding education now for about 8 years. In that time I've been asked to work on a lot of different projects related to coding education. In addition to training coders, I've been asked to evaluate people to see if they would make good coders. And I always start with the word search test. Do you like word searches? If not, you might want to consider a different career. Because coding is one big word search. You have to decipher the medical record (or operative report) and decide which words are important and which ones you can ditch.

Bunionectomies are a Kick
The first time I was given a bunionectomy report to code, I'm pretty sure I cried. After all, the procedure title was something like "Mitchell-Chevron," which meant nothing to me. And I knew enough about coding to know I had to read the report to figure out if it really was a Mitchell-Chevron. And the report was surely about 4 pages - pretty standard for a thorough podiatrist. And when I went to a class to learn how to code bunionectomy procedures, I realized that out of the entire 4 pages, I focused on about 3 sentences. That was it. The rest was coding garbage. In case you're wondering, a Mitchell-Chevron bunionectomy involves removing the medial eminence (AKA bunion) and making an osteotomy (bone cut) into the first metatarsal (the foot bone connected to the big toe). I'm still amazed that it takes 4 pages to describe that.

Deciphering the Operative Report
I am often asked to explain how to decipher an operative report. Well, it depends on the procedure, really. And if you are a new coder and you ever have the opportunity to go to a seminar where they will present case studies, this is the best way to learn. I've taught dozens of classes and nothing drives home my point more than walking through the cases and coding them. But I will give you some basic elements here to get you started. While these rules don't apply to all specialties (e.g., interventional radiology has "special" rules that drive the even the most experienced coders - that would be me - batty!), this should get you started on some of those basic surgical reports.

Rule 1 - Doctors Lie: Admit it, you watch House and have heard him say on more than one occasion that patients lie. Well, Dr. House, I would like to point out that doctors lie too. They will state the procedure one way in the title and then proceed to describe a completely different procedure in the body of the report. For example, the doctor may state a left heart catheterization was done, but after reviewing the report, the catheter never made it all the way to the heart - only to the coronary arteries. So keeping this in mind, you should never believe what you read in the procedure title. Honestly, I rarely even read the procedure title anymore - it's often fiction. As for Dr. House, I would love to see a strong-willed coder have it out with him on the show about his documentation, which I'm sure is a mess.

Rule 2 - Get a Medical Dictionary: There's no excuse anymore. When I learned how to code, we were still using Windows 3.1, so there was no way the hospital was using the internet. But even without online resources, I had a medical dictionary on my shelf. And it was used often. How will you know if something is important if you don't even know what it means? While you're at it, make sure you also have access to an English dictionary. I know it's a novelty, but you will also find complex nonmedical words in the operative report (or even in your code descriptions). If you don't know what it means, look it up. Tedious, I know, but you will learn. Of course, you might feel like Billie Dawn from Born Yesterday, but you will learn. (Don't understand the movie reference? Look it up!).

Rule 3 - Just Like Ragu, It's Probably in There: In school we hear terms like "it's bundled" or "separate procedure" but what does that really mean? Well, it means it's integral to the main procedure and don't code it out separate. What's included? Well, pretty much anything that has to be done in order to accomplish the main procedure. Taking out an appendix? Well, then the incision (or creation of ports for laparascopic instruments) is included. So is the closure at the end of the procedure. I don't know about you, but if I have my appendix taken out I sure hope the physician remembers to suture me closed at the end. All those things are like regular ingredients in Ragu pasta sauce - tomatoes, oregano, garlic. It's in there! So don't code each component out separately. Now, had they decided to do a liver biopsy while in there, that's different. That's like throwing a banana in the pasta sauce. So it gets coded separately.

Rule 4 - You Will Only Use 10-20% of the Operative Report: Don't feel like you need to use every word in the operative report to code the case. The fact is, the operative report isn't about you, it's about the patient and it's a communication tool for clinicians. It just happens to double nicely as a recording of everything that happened to the patient and can substantiate coding and billing. It's up to you to determine what's important in the documentation. There's a reason we use coding for billing - your codes actually fit on a 1-page claim form so the insurance company doesn't have to read through every single medical record.

Rule 5 - Know the Procedure: Okay, maybe I should have led off with that one. Medical terminology is, quite literally a foreign language. In fact, it's at least two foreign languages: Latin and Greek. So when you say "it's Greek to me," you're being quite literal. A really good medical terminology class will solve a lot of problems. You may think esophagogastroduodenoscopy is a really big word until you break it down and realize it's visualization (scopy) of the esophagus (esophago), stomach (gastric), and part of the small intestine (duodeno). You also need to know your anatomy. You need to know when they operate on a structure that's part of a bigger structure (e.g., mesentary of the intestines) vs. a different organ altogether (like in the appendix/liver example above). After you learn medical terminology and anatomy and physiology, that's half the battle. The rest of the battle can typically be solved with Google. Come to think of it, there are few things that can't be solved with Google. I'm pretty sure there will be a support group some day for Google-aholics, but in the mean time, I highly encourage you to google a procedure if you don't know what it is. I never remember what a Whipple procedure is. But I can google it in about 10 seconds. Just be careful which website you select from your Google search list - something from the Mayo Clinic is probably more reliable than lazy-Dan-explains-medical-procedures.com.

Rule 6 - There is Crying in Coding, Just Don't Let Anyone See It: Oh, how I wish I could tell you I had that one down. But I'm pretty transparent when it comes to being frustrated. And I've had students cry in frustration when trying to code case studies. But try to minimize your public displays of tearful frustration and remember this - we've all been there and this is hard. It's okay to not know all the answers all the time.

I hope this at least gets you moving in the right direction. When people ask me how I learned everything I know I, 1) laugh, because I know there is so much more for me to learn, and 2) tell them how the rules above worked for me.

Yes, Coding is Hard

2010-06-30T18:01:00.001-06:00

I was recently perusing some online message boards and came across several postings with a resounding theme: Is coding really that hard? In a word, yes. If coding was easy, it would be easy to get a job. You wouldn’t need those 2 years of experience just to get your foot in the door. And although I want to maintain a positive can-do attitude to anyone pursuing a career in coding, I sometimes forget to exercise a little tough love and make sure that people understand exactly what they are getting themselves into and what will be expected of them.

First of all, not everyone can be a coder. Yes, there is training involved, but some people, even with years of training, will never be successful coders. So often we hear someone trying out for American Idol who has no business singing in public and we may wonder, “What made him think he could sing?” Well, the same applies to coding, albeit, in a different way. Some people aren’t detail oriented enough or don’t like medical terminology enough or can’t cope with frequent guideline changes from payers. When I hear potential coders complaining about such things, I wonder why they want to be coders.

Secondly, many people enter into coding so they can work from home. When I ask someone why he wants to be a coder and his first words are, “I want to work from home,” I usually probe a little deeper. I want to know how potential coders feel about working long hours in front of a computer with little human interaction. I want to know how well they can concentrate on their work and how detail oriented they are. I want to know if they are willing to put in weeks, months, or even years at a hospital or clinic before being released to work from home. I want to know if they are in love with coding or just the idea of coding.

Being a coder means knowing a lot of medical terminology, anatomy and physiology, disease process, and being able to read a medical record and piece together the patient’s clinical picture and translate them into codes. It’s about “peeling the onion” – that is, consistently learning more and being okay with the fact that you will never know it all. If that doesn’t sound like fun to you then coding isn’t for you.

So if you decided on a career in coding because the pay sounded good or it would allow you to work from home, I ask you to pose some hard questions to yourself. Are you willing to put in the time and effort to get the career you think you want? If you are, then let me be the first to welcome you to a rewarding career in coding. If you’re not, I encourage you to find a career you will be passionate about.

Keeping Keepers

2010-06-29T22:43:00.000-06:00

When I took my first job as a manager, I received a basket of "necessities" from my coworkers. I can't remember everything that was in the basket - things like Diet Pepsi and Visene and a couple other tongue-in-cheek items poking fun at the challenges of being a manager. The most memorable thing, though, was a simple manilla folder, marked with the label "Keepers." I wasn't sure what it meant and which of my coworkers would put it in there or why.

It was my mentor and first supervisor who told me that it was she who put the keeper folder in the basket and then she proceeded to tell me why. She said as a manager I would be under the microscope and there would be days when all I heard from my employees and coworkers is what I was doing wrong. And because of that harsh reality, it was even more important to maintain a keeper folder in order to keep my confidence up. So as all you novice coders out there try to break into the industry, I encourage you to start a keeper folder as well.

The purpose of the keeper folder is to fill it with notes and emails of compliments from people on things you've done well and received praise for. Think of it as a rainy day folder that you pull out and read on those days when things aren't going well for you and when it seems like you can't do anything right. It's a reminder that there are things you've done so well that someone decided it was worth mentioning it to you.

I honestly can't tell you what happened to that original folder that was given to me so long ago, but every time I start a new job, I almost immediately create a virtual folder and save emails containing compliments and praise from coworkers, clients, and my bosses. Did you receive a good grade on a paper you wrote or get an email from someone thanking you for doing something special? Or did you receive a note from someone with a compliment that came out of left field? Well, start to put them together and organize them - you may find the additional pick-me-ups are a saving grace as you try to land that first job.

How the Coder Coach Spends Her Time

2010-06-18T13:26:00.003-06:00

You’ve read the blog postings before – I am very passionate about helping folks break into the industry. And as I step on my soap box to tell novice coders to be persistent and network, someone inevitably asks me if I hire new coders. The honest answer is no, but it’s not because I wouldn’t if I had the opportunity. The truth is, as a consultant, I am working with clients who expect - and pay a premium for - experienced coding knowledge. And because I am not in a position to hire new coders, I write this blog, present monthly Coder Coach events, and tweet relevant articles I come across. When I give that answer, the next inevitable question is, “What do you do as a consultant?” So I thought I would take a moment to tell you what I’ve been up to lately – in my day job.

Because I work for a small company, we get a wide array of requests, so to many, my job may seem like a crazy schizophrenic mess. I can’t possibly put down everything I do without writing a small book! So I decided I would take the last couple of weeks and give you the rundown.

I’ve been working with a client for about a year to improve their coding and charging accuracy in the cardiac cath lab. While that may seem simple and straightforward, the client is a large teaching hospital and training the coders isn’t enough – we also need to talk to the nurses, techs, and doctors about documentation. Last week I traveled to the client and presented seven identical training sessions to the nurses and radiology techs in the cath lab on how to improve their documentation. Each presentation was two hours. And that two hour presentation took about a week to prepare for. In between training sessions, there were meetings with cath lab and HIM management and time spent one-on-one with one of the coders who had questions on some cases. I had an extra treat last week when we were invited into the cath lab to see some procedures being performed.

During the evenings last week I put the final touches on two presentations I needed to submit for this week’s AAPC chapter meeting and also met with my boss about a potential new contract that would significantly impact my summer work deadlines. After traveling home, I attended my first board meeting as a director for the Colorado Health Information Management Association where we planned our strategic initiatives for the coming year and I took a few moments to stress the importance of hiring new pros and expressing a need to get more employers on board (I just want you to know that I’m also preaching to my peers!).

This week my time was split between clients as I prepare for training a client next week on injections and infusion coding and follow-up with my cath lab client on the issues from last week and plan the next round of training. I spent several hours analyzing client data and doing a couple of chart audits. Last night I spoke at the AAPC chapter meeting and networked with some folks a bit. Today I will be pulling together the handouts for the next Coder Coach event and again preparing for next week’s training.

Over the coming weeks and months, I have several training sessions to prepare for with clients, client reports that need to be written, and client meetings that need to take place. I am also working on our company’s plan for ICD-10 training, writing white papers on ICD-10 implementation and training and presentations for two AAPC chapter meetings next month. We don't want to think about it, but fall is right around the corner and it's the busy season for consultants as we study the code changes and read the Federal Register for changes to code-based reimbursement for next year. Amid all of these tasks are a myriad of other little “to dos” and more than one project I’m not yet aware of. In my spare time (?!), I blog, network, and do other miscellaneous things for the Coder Coach group and soon will also be blogging for AHIMA's new HI Careers website.

So if you ever ask me what I do and I pause and say, “Um,” it’s because I’m trying to remember exactly what it was I did that day!

Do You Want to Be a Coding Consultant?

2010-06-18T13:20:00.002-06:00

I’ve had a few novices ask me how I like being a consultant. Well, I love it. But it’s not an easy job. And I certainly don’t recommend consulting to anyone until they have several years’ experience under their belts. So if you think you want to travel the nation (or region) or even stick locally consulting clients, make sure you have practical experience first – it’s the absolute best preparation for giving advice to clients.

Let me stress this about consulting – many people want to be consultants because of the salaries. It is true that most consulting firms pay well. But there’s a reason – it’s the price you pay to be away from home so much. If you haven’t seen the movie Up in the Air with George Clooney yet, I highly recommend it to anyone who wants to be a traveling consultant because it is an accurate depiction of what it’s like to be away from home so much. So before you offer to be a consultant, think about what it really means to be away from home 4-6 days per week.

The Coding Career Path
I had my career path all planned out in the 90s. I would be a hospital outpatient coder and then move to inpatient. Then I would become a coding supervisor and then a coding consultant. I hit all those goals by the time I was 27. I didn’t really think beyond that and I certainly didn’t think there would be a time when ADD would over take me and I wouldn’t be able to sit at a desk for 8 hours (or more) and do nothing but code.

Newbies often ask me about the career path for a coder and these days, there are so many options, I can’t think of a clear path. My best recommendation is to get your foot in the door and see what kind of opportunities await you once you’re there because I never would have dreamed I would end up where I am. And if you want to see the country and don’t mind living out of a suitcase for awhile, then by all means, be a consultant!

My First Consulting Life
My first consulting job was exactly what I thought coding consulting was and always would be. I traveled 100% of the time and spent long days as a backlog coder, interim manager, or coding auditor. In that job I learned the difference between giving my opinion versus quoting regulation and how to (most of the time) be objective with my advice. Along with that I learned a lot about traveling – how to pack a suitcase, the most efficient way to get through airport security, and probably my proudest accomplishment – how to find my way in a strange city with a map (this was before GPS really caught on!).

My New Consulting Life
That first consulting job was 7 years, 2 jobs, and about 300,000 airline miles ago. When I landed into a consulting position where I got to do coding education, everything changed. I spent more time working from home (travel was cut to 50%). I won’t bore you with the details of how I got here, I’ll just say it involved thousands of hours of research, writing thousands of pages of coding text books, and writing and presenting hundreds of Power Point presentations in person and over the web. Now I work for a small company where I have a lot of say in the projects I take on and travel only about 25%.

Paving the Way
I looked long and hard to find this job. As a matter of fact, the job didn’t really exist – it was essentially created for me when a friend and former coworker half-jokingly asked me if I wanted to be their ICD-10 trainer. Paving your own way out of the gate is not the norm, but with perseverance, hard work, and passion about your chosen career, it could be a future possibility. When I began my career, I knew I wanted to be a trainer or educator and I made that fact well known to my supervisors over the years and job opportunities have presented themselves based on that passion to teach.

So find what you’re passionate about in the coding field and make it known. It may take time to land that first coding job, but someday, you may be in the driver’s seat and you may be able to design your dream job.

Are You Locked Out of the Building?

2010-06-14T09:36:00.000-06:00

I recently threw my grandmother a 90^th birthday party celebration. By the end, it was a great party and I think everyone, especially Grandmother, had a great time. But getting there was quite the ordeal. After reserving 6-foot round tables, I was taxed with finding someone to help me haul them. My friend offered an old pick-up truck, but the truck died on the way to the rental place. So we used her minivan and rented rectangular tables instead.

Feeling good about my ability to change plans at the last minute, we arrived at the clubhouse where I proceeded to lock the clubhouse keys, our purses, and cell phones inside while we looked for something to prop the door open. The look of panic on both of our faces was immediate as I unsuccessfully tried to open the door. It was a Saturday and the management office for the clubhouse was surely closed. Luckily I lived close by. Luckily I had a spare key. Luckily I was able to reach someone at the management office. And after about 45 minutes of agonizing uncertainty, the maintenance guy came and unlocked the door for us.

While I was on the phone, my friend was scoping out the building to see if there were any windows ajar and I was trying to think of a convincing argument to tell the police to get me in the building – thankfully it didn’t come to that. I was so glad that when I’d planned the party and preparation time that I’d thought to invite several family members to help and also doubled my estimated setup time. So the setback from my annoying mistake was ultimately only a bump in the road.

Really, it never occurred to me that we would never get in. Somehow I knew we would not only get in the building but there would be enough time to set up and change from my rain-soaked sweat pants into a dress. I knew that even if the day didn’t come off completely as planned that the most important thing was to have a good time with family and friends. And that’s exactly how it came off in the end. My only regret was wasting the time of friends and family as we waited for a key.

What’s my point? My point is persistence. So often I hear people saying they can’t get coding jobs and I’ve heard of many people saying their education was a waste of time and money and they are going to stop applying for coding jobs. If this is you and you’re about to give up, I encourage you to stick it out and try another way of getting into the proverbial building. Whether it means networking with people you’ve never met before or looking for non-traditional coding jobs that still allow you to use the skills you acquired in school, you need to maintain faith that you will get in. If you allow yourself to feel defeated, you will lose the drive to keep going and possibly find your niche.

Another Article on Worker Confidence

2010-06-10T11:07:00.002-06:00

Here is yet another article indicating that worker confidence is increasing. People are confident they will find new jobs and are leaving old ones. Could this mean more available jobs in coding?
More employees jump ship as economy improves

Could More Job Openings be on the Way?

2010-05-26T10:35:00.002-06:00

Here's another interesting article - this time from the Wall Street Journal - about the increasing rate of people leaving their jobs. With other job options for experienced workers and the recession on the upswing, people are feeling more comfortable abandoning jobs for happier times. While this may mean they are leaving positions in less than favorable working conditions, it could potentially leave employers open to hiring and training inexperienced people. So I ask you one question: Are you willing to work somewhere that has employee morale issues just to get experience?

I will let you ponder that while you click this link to the article: More Workers Start to Quit.

10 Best Cities for the Next Decade

2010-05-26T10:16:00.004-06:00

I always like to pass along any links I can find about getting jobs. While this article is not specifically about coding jobs, it does list 10 cities that could prove to be hot spots for more jobs in the future. And when more jobs are created, that means more people. And people need health care. And all the health care claims they generate need to be coded and billed. See where I'm going here?

If you took the time to research the job market before you enrolled in coding classes, you should have a good idea of what's out there. If not, I encourage you to look into relocation to get a job. I know a lot of people are rooted in their communities and either can't or don't want to move, but if it means getting your foot in the door, it could be a necessary evil.

Enjoy this article from Yahoo Real Estate: 10 Best Cities for the Next Decade.

Get Your Paint Brush

2010-05-24T16:37:00.010-06:00

I've been painting a lot lately. I recently had the intense urge to splash bold color on my bathroom walls. And I have to say, that while I love making drastic changes to a room and gazing admiringly at the finished product, the actual process of getting there drives me a bit nuts. While I was prepping and painting, it gave me a lot of time to think about... well, everything - including coding, mentoring, and blogging. And it struck me how much painting is like coding.

Maybe you don't paint the way I do, but as a typical perfectionist coder-type, I'm pretty picky about the end result. I always tell people that should this coding thing not work out for me, I'll go into interior design (LOL!). Finally, I've found a way to tie two of my passions together! At any rate, I hope you enjoy the analogy.

It's All in the Prep Work
First of all, I hate blue tape. Not because I have an aversion to the color blue, but it stands in the way of what I'm really looking forward to - the transformation that comes with brushing and rolling a new color onto the walls. And in an effort to paint the wall a dark purple with bright white trim while avoiding getting paint on the floor, it meant either a very steady hand or the use of blue tape.

While I was taping, my mind wandered to the people I've talked to who are trying to get into the coding field and how I often hear complaints about the education piece of coding. I liken taping off a room to getting a coding education. No one is going to recommend my painting skills if there is paint slopped all over the place. Likewise, no one is going to recommend me as a coder if I'm not educated.

Do You Have the Right Paint Supplies?
I wish I could say that my project took only one trip to the store to get the paint and the few supplies I needed (since I have the desire to paint something every year or two) -but it took three. The first trip resulted in a gallon of purple paint, ceiling paint, a tarp, blue tape (!), and a couple of other essentials that I couldn't remember if I had or not. The second trip garnered me a few more paint brushes for trim.

I thought I was set.

If only. At 6:00 pm on Sunday, I started going through paint cans of redecorating sessions past trying to remember which subtle shade of white was the right one for the trim. When I eventually found it, I opened the can and it was dried solid (when did I paint last anyway?!). I thought of using another white for trim, but while it wasn't dried out, it was in a sad state and ready to be retired. I thought about forgetting it and worrying about it next weekend. But I know me - it would probably never get done. So I headed back out for one last trip to get some trim paint.

Then I was set with another decision - which color of white should I get? If you've ever chosen white paint, you know there are about 5000 different shades of white. The old colors I had previously used were either a little two yellow or a little too green. So I selected a shade in the same color family as the purple and soon I was back home, painting the trim.

So how is this like coding? Well, if the prep work is the education, then your supplies are the educational institution you select. A higher quality institution means a higher quality you. I could have painted the trim with the yucky, rotten back up paint, but it wasn't the shade of white I really wanted and I knew the end result would not hold up to my standards. You can select an education based on cost, time, or promises the institution makes to you. But is it really a quality institution? There's a reason some educational institutions are more expensive. The only real answer to this is to get references from people in the industry. If you are working with a school, ask them to provide references from graduates. Make sure that the education you're seeking will set you up for the job you want, which means preparing you for the right certifications.

If you select the wrong educational institution only to find out later that it's an issue with hiring managers, be prepared to go back. Trust me. I was not happy that I had to go back to the paint store. But I am very happy with the end result. If you can't get anywhere with the education you received previously, find out what you need to do to get the education that will get you somewhere.

Don't Forget to Accessorize
Since I have fantasies of making a living transforming people's living spaces, for me no room is complete until it's been redesigned down to the last accessory. I've had this bathroom remodel planned for months, inspired by some personal stationary. I searched in stores and online for the perfect (and affordable) shower curtain, wall hangings, light fixture, and other room accessories. The end result was a complete cosmetic overhaul - the only thing I kept in the room besides the existing plumbing fixtures were the towel bars and soap dispenser. These final touches make all the difference. Let's face it - without them, this room is just a giant grape.

I always recommend that people accessorize their coding careers by picking up a specialty (or two). It's going to make the difference between you as a coder and you as a highly skilled coder. Specialties such as interventional radiology, cardiac catheterization, pain management, and radiation oncology are very difficult areas in coding. If you can code any of those specialties - and keep up with the frequent changing in coding rules and regulations - you will be highly marketable. But be careful. Unless you are willing to relocate to get a job, make sure you are seeking a specialty that is in demand in your geographic area.

When is the Painting Done?
I would like to tell you that the bathroom is done and it's beautiful and I will never change it. The truth is, I still need to replace the broken light fixture, hang the vanity mirror, and do a couple of touch ups. In another few years I will probably be sick of the color and want to change it again.

Likewise, once you complete your coding education, you won't be done. Coding requires continuous education to maintain your certification and keep up with medical technologies. And just when you get that most difficult area of coding down, Medicare will change the rules and you'll have to learn it all over again.

So keep up those painting skills and best of luck on your career remodel!

5 Pointless Job Search Tactics

2010-05-19T07:49:00.001-06:00

I recently came across this short article on the 5 mistakes people make in trying to get hired: The Savvy Networker.

Interesting Article About What You Might be Doing Wrong in the Hiring Process

2010-05-13T10:59:00.002-06:00

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.

Repost: Make $40K Working from Home as a Medical Coder!

2010-05-10T20:58:00.004-06:00

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.

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

2010-05-10T18:10:00.005-06:00

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

2010-05-10T16:44:00.002-06:00

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.

Code Words for Getting Your Foot in the Door

2010-03-11T09:11:00.008-07:00

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!

Follow me on Twitter!

2010-03-11T09:09:00.001-07:00

You can find me on Twitter through codercoach@gmail.com. I will be posting blog updates and other information as I have it.

Coding is Just Looking up a Code in a Book…

2010-02-16T23:24:00.003-07:00

…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.

ICD-10-CM, ICD-10-PCS... ICD-WHEN?

2010-02-09T22:03:00.005-07:00

The buzz in the industry right now is the implementation of new code sets for reporting diagnoses and hospital inpatient procedures. The new coding systems, collectively referred to as ICD-10, will be implemented on October 1, 2013. That may seem like a long time away, but to coders, it's like telling everyone in America that they have less than three years until we only speak Japanese here and that English will be outlawed. In other words, it's a big deal. So many experienced coders and coding students are all asking the same question: when do we need to learn ICD-10?

ICD-9-CM vs. ICD-10?
First, let's get straight what exactly we're talking about. Currently, we use the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to report diagnoses and hospital inpatient procedures. ICD-9-CM is divided into three volumes:

Volume 1 - Tabular list of diagnosis codes (lists all codes with their descriptions)
Volume 2 - Index of diseases
Volume 3 - Tabular list and index of procedures

ICD-9-CM diagnosis codes are used by every health care setting (e.g., hospitals, physicians) to report patients' conditions. Volume 3 procedure codes, on the other hand, are used only for reporting procedures on patients in the hospital inpatient setting. They are not used for hospital outpatient or physician services, which are reported using Current Procedural Terminology (CPT) codes. As a result, you will see ICD-9-CM code books sold as either the physician's edition (volumes 1 and 2 only) or hospital edition (volumes 1, 2, and 3).

It seems logical, then, that ICD-10-CM will replace ICD-9-CM, but it's only partially true. The diagnosis portion of ICD-10 is part of the clinical modification (ICD-10-CM) and the procedure portion is part of ICD-10-PCS (Procedure Coding System). In order to simplify, some articles will refer to the system collectively as ICD-10 or ICD-10-CM/PCS. When it comes time for training, though, you want to make sure you are getting trained in both CM and PCS if you plan to work as a hospital inpatient coder.

Why Change?
I've often been asked if it's such a big deal to switch why we don't just stick with ICD-9-CM. There are many reasons for making the switch to ICD-10, but here are the main reasons:

ICD-10-CM/PCS offers better specificity in reporting diagnoses and procedures
The US is the only G7 nation that does not use a version of ICD-10, which makes comparing data worldwide difficult
The structure of Volume 3 ICD-9-CM codes does not allow for proper expansion of the code set in order to report new technologies

Will CPT be Affected by ICD-10?
When the proposed rule announcing implementation of ICD-10 was released, there was a lengthy discussion about the possibility of replacing CPT with ICD-10-PCS. Researchers determined, however, that the two coding systems were developed for different purposes, which did not make them interchangeable. CPT was developed originally to report physician services while ICD-10-PCS was developed for hospitals. The use of CPT will not be impacted by implementation of ICD-10-PCS and it will still be required for reporting on physician and outpatient hospital claims.

How Different is ICD-10?
While the general format and look of the ICD-10-CM tabular section doesn't look too different from ICD-9-CM, the codes themselves do. Existing ICD-9-CM code format is 3-5 numeric digits, except in the case of V and E codes. ICD-10-CM codes have 3-7 alphanumeric characters. To me, the codes look more like license plate numbers! The method of looking up a code is similar to ICD-9-CM - you locate the main term in the index, consult the secondary entries, and then consult the tabular listing to confirm code assignment.

ICD-10-PCS codes are very different from ICD-9-CM procedure codes. Coding in ICD-10-PCS understands a great understanding of the procedure performed, as the main index term is the root operation rather than the eponym or name of the procedure. For example, there is no term in the ICD-10-PCS index for "Whipple procedure." The coder must know which of the major root operations this falls under and code appropriately. Once the procedure is located in the index, the coder will find only the first 3-4 of the total 7 character code listed. Those first characters will lead the coder to tables, not a tabular list, that allows for building the rest of the code.

Who Will be Affected Most?
There is much debate about who will be most affected by implementation of ICD-10. For physician offices, although physicians and their coders will not need to learn ICD-10-PCS, they will need to learn ICD-10-CM. If the physician uses a superbill (a list of commonly used codes for that practice), it will need to be redesigned - and expanded - to include the ICD-10-CM codes. Some physician practices may find it tedious to continue to code using a superbill as it goes from a dual-sided to a multi-page document. Practices that do not currently use superbills and rely on coders to assign ICD-9-CM codes will need training in ICD-10-CM.

Hospitals, although only required to report ICD-10-PCS codes on inpatient claims, may choose to collect ICD-10-PCS data on all patients (including outpatients) in order to compare data internally. It is common practice currently for hospitals to collect ICD-9-CM procedure codes on all patient, even though they are "scrubbed" from the bill. As such, hospital coders will need to learn both ICD-10-CM and ICD-10-PCS. Of the two coding systems, ICD-10-PCS is expected to require more education as the structure is completely different from ICD-9-CM procedures. In addition, the clinical knowledge required to assign an ICD-10-PCS code is much greater than that needed to assign an ICD-9-CM code. I think coders with CPT coding experience will find the transition easier because of the level of detail needed to report those codes.

Current Preparations
Right now AHIMA and the AAPC are training future ICD-10 trainers in preparation for training the masses. Software companies that utilize ICD-9-CM codes are currently applying the General Equivalency Mappings (GEMs) to map between ICD-9 and ICD-10 codes and beta testing the new code sets to ensure they work accurately. As an industry, experts aren't recommending that front line coders get trained prior to 2012, however, it is recommended that employers conduct a gap analysis to see what training their coders need and provide medical terminology, anatomy and physiology, and pathophysiology training starting now.

ICD-When?
If you are a coding student, AHIMA recommends that your educational institution begin ICD-10 training in 2011 for associate and baccalaureate degree programs and in 2012 for coding certificate programs. If you plan to code prior to October 1, 2013, you will still need to learn ICD-9-CM coding and if you plan to graduate in 2012, it is likely you will learn both systems. For those considering enrolling in a coding program, determining the ICD-10 education schedule of the school will tell you a lot about the institution. Beware of the school with no plan.

The best part of the transition is that this is a great time for new coders to enter the field. This is a do-over, only it's the experienced coders doing to do-over and they will struggle with it just like new coders. It's going to be a level playing field for anyone interested in being a coder. So if you've ever considered it, now is the time!

Upcoming Speaking Engagements

2010-02-04T11:43:00.002-07:00

Well 2010 is shaping up to be a busy year for me indeed! My speaking calendar is filling up and I wanted to let you know of some dates in case you are in the neighborhood and want to stop by! Here's what I have scheduled to date:

Fourth Tuesday of each month – Coder Coach presentation (presenter and/or facilitator), Denver, CO
April 13 – “Taking the Shock out of Electrophysiology (EP) Coding” – Local AAPC Chapter, Denver, CO
April 23 – “Soft-Hard Cath Lab Coding in an EMR Environment” - AAMAS Annual Meeting, Orlando, FL
May 5 – “Cardiac Catheterization: Beyond the Basics” - CHIMA/WyHIMA Annual Meeting, Golden, CO
June 17 – “Cardiac Catheterization Coding” and “The Importance of Networking in Coding” – Local AAPC Chapter, Colorado Springs, CO
September 2 – “FY 2011 CMS IPPS Update” – AHIMA Audio Conference

If you have any questions about specific events, please feel free to email me at codercoach@gmail.com.