Medical coding as a career?

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Fascinating! I didn't know any of this.
Originally Posted by spiderlashes5000
Whenever I meet someone and they ask me what I do for work, I always preface my answer with a comment along the lines of "I work in a field that most people have never hear of, so I'm not going to be offended if you don't low what it is..." I'm more surprised when I talk to someone who IS familiar with it.
Originally Posted by Corrina777
Stupid question but do you use software or the actual books?
I use a combination of both, which is what I also see with the best coders I know. Encoders (coding and grouping software) can be very helpful, but they are definitely not a substitute for knowing how to use the books. In fact, especially when I'm dealing with CPT codes, I would rather use my book than the encoder on a difficult case because encoders are created by people and they only work if you follow the logic of the programmer who created it. My facility uses 3M, which is known as the Bentley of encoders, but I've still found places where the encoder logic will lead to the completely wrong set of procedure codes if you aren't careful. Basically, you have to know the books well enough to make sure the encoder is leading you where you want to go.

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I can't believe how involved this is!

Can you humor me here? Say I go to the ob/gyn, and I have an annual pap test (the new digital kind of reading), a manual pelvic exam, a manual breast exam and a mammogram.

What would you receive in the way of a transcript or a report or what? And what would the result of your work look like?
3b (with 3c tendencies) on modified CG

I use a combination of both, which is what I also see with the best coders I know. Encoders (coding and grouping software) can be very helpful, but they are definitely not a substitute for knowing how to use the books. In fact, especially when I'm dealing with CPT codes, I would rather use my book than the encoder on a difficult case because encoders are created by people and they only work if you follow the logic of the programmer who created it. My facility uses 3M, which is known as the Bentley of encoders, but I've still found places where the encoder logic will lead to the completely wrong set of procedure codes if you aren't careful. Basically, you have to know the books well enough to make sure the encoder is leading you where you want to go.
Originally Posted by Corrina777
Okay, yes I definitely understand that but what about online/e-books? When you say you use the books I assume you mean the actual physical books. What if the book was online and you can search through it, which I'm confused as to why that's not more common. I'm assuming the books can be in pdf format and I don't understand why one would not use that instead of the books. Also there can be software that would make searching through the book faster and put everything online.

Just trying to understand, we had a coder tell us that coders will always use physical books no matter what, but she never told us why.
I can't believe how involved this is!

Can you humor me here? Say I go to the ob/gyn, and I have an annual pap test (the new digital kind of reading), a manual pelvic exam, a manual breast exam and a mammogram.

What would you receive in the way of a transcript or a report or what? And what would the result of your work look like?
Originally Posted by spiderlashes5000
This is slightly out of my realm because I've never done physician coding (yes, it's that different from hospital coding), but I'll do my best. Most physicians offices work with what's called a superbill. You've probably seen it- it's a sheet, usually two-sided, and the doctor checks off boxes next to diagnoses (why you're being seen), and procedures (what was done). Technically there should be some kind of progress note in your chart (paper or electronic) that details the encounter more. A good coder will verify that the documentation in your chart matches the superbill, and that is technically the correct process. I cannot vouch that this is always the case. The coder should also see copies of the lab results from the pap and the transcribed radiology report for the mammo. I'm not at work today, so I can't give you exact codes ATM (I just tested for my black belt Friday and Saturday and took today to recover). Annual exams will generally be reported with a diagnosis code that starts with a V (regular yearly physical is V70.0, I'm not sure what the gyn exam code is). There would be an additional code to justify the mammo (a normal screening would be V76.12, if the mammo was ordered because your doctor felt a lump, it would be 611.72 instead). If you have a family history if breast cancer, that would also be reported because it changes the mammo from routine screening to high risk screening). Any other findings documented by your physician would also be coded (diabetes, hypertension, etc). Coding cannot be based on nurse's notes, so if your nurse writes that you're overweight but the doctor doesn't mention it, it doesn't exist). For the procedures, physicians only use CPT code. Im sure there is a specific CPT code for the annual exam (it will be 5 digits and begin with a 9), an depending on how much of an exam the dr does aside from that, there could possibly be a separate E/M code (these are the general office visit codes, based on how extensive your exam is). Depending on where you get the mammo done, in their office or elsewhere, will determine who codes and bills for the mammo procedure (also a 5 character code- it can be a numerical code that starts with a 7 or an alphanumeric code that starts with a G, depending on payer requirements (Medicare sometimes requires the use of HCPCS codes rather than traditional CPT codes for certain services). There can also be additional codes if the mammo was more than just a very basic mammo). In addition, you will be billed for the laboratory piece of evaluating the Pap smear. If your doctor's office sends it out to a full lab, like Quest or LabCorp, they will bill you separately (lab, pathology, cytology codes are all 5 digit CPT codes that start with .
I apologize that I couldn't give you more specifics, but hopefully this gives you an idea (I'm working at another hospital tomorrow, but will be back at my own desk on Wed and would be happy to provide more specifics then, if you're interested).

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I'm so happy you made this thread! I work as a CNA now and I was going to advance to become a nurse, but, after working with people on a daily basis, I'm not sure if I want to anymore. Customer service and working with the public is just so draining. Then I learned about medical coding and transcriptionist and learned that you can work from home and I was sold.

But I also heard it is hard to find a job in both fields. Is that true? Also, which field is best to go in to: coding or transcribing?

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I use a combination of both, which is what I also see with the best coders I know. Encoders (coding and grouping software) can be very helpful, but they are definitely not a substitute for knowing how to use the books. In fact, especially when I'm dealing with CPT codes, I would rather use my book than the encoder on a difficult case because encoders are created by people and they only work if you follow the logic of the programmer who created it. My facility uses 3M, which is known as the Bentley of encoders, but I've still found places where the encoder logic will lead to the completely wrong set of procedure codes if you aren't careful. Basically, you have to know the books well enough to make sure the encoder is leading you where you want to go.
Originally Posted by Corrina777
Okay, yes I definitely understand that but what about online/e-books? When you say you use the books I assume you mean the actual physical books. What if the book was online and you can search through it, which I'm confused as to why that's not more common. I'm assuming the books can be in pdf format and I don't understand why one would not use that instead of the books. Also there can be software that would make searching through the book faster and put everything online.

Just trying to understand, we had a coder tell us that coders will always use physical books no matter what, but she never told us why.
Originally Posted by Josephine
Our encoder does provide ICD-9 (and even ICD-10, which goes into effect October 1, 2014), but I completely agree with the statement about always using paper books. I use the electronic version when I'm working off-site because it's a hassle to carry a pile of code books around. But I've found that the electronic versions don't have all of the notes that are in the tabular itself (and I'm not sure that the AMA would be now enough to allow for easy electronic access to their CPT codes without a huge amount of cash in it for them). The other part is that most coders write lots of notes in their books, and I do t see that as something that can easily be done with an electronic version, especially when it comes to moving your notes into the new book every year. In ICD I can understand using an electronic book, if the coder had the ability to make notes and transfer those notes each year. But thats because ICD has a logical index. I cannot imagine ever being comfortable with an all electronic CPT book because I don't use the index (when I was taught coding, the coder who was teaching me literally said "This is the CPT index. Pretend it doesn't exist evaluate it's less than useless.") I code in CPT by flipping to the section (or to multiple sections if I'm unsure of which way to go with something). As I said in my last post, I don't use the encoder at all for difficult CPT coding cases- I can literally find it faster flipping through my book. My other concern, as a manger, is that I have a hard enough time making sure that some coders read the section notes in CPT when it's physically on the same page as the codes they're looking at. My experience with electronic books is that the screen shows less than a full page, and I know I should not have to worry about this, but I do worry that some coders will miss important information.

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I'm so happy you made this thread! I work as a CNA now and I was going to advance to become a nurse, but, after working with people on a daily basis, I'm not sure if I want to anymore. Customer service and working with the public is just so draining. Then I learned about medical coding and transcriptionist and learned that you can work from home and I was sold.

But I also heard it is hard to find a job in both fields. Is that true? Also, which field is best to go in to: coding or transcribing?

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Originally Posted by sakiohma
It is definitely becoming more difficult to get into coding, but at the same time, there is a huge demand for coders pretty much everywhere in the country, and the shortage is expected to get much worse over the next two years. The problem is that with the increased scrutiny on coding, most places have started to require a coding credential (not just taking a class, but sitting for one of the national tests). Because many facilities are working with a close to bare bone staff, most places are also requiring experience, which is the catch-22. I work in a facility that does have the ability to take people with a credential but no experience, but that's only because my position exists. Even a credentialed coder needs time to adjust to the computer systems, the style of the documentation, and learning how to code in the real world, where the documentation is often less than ideal. Based on my own experience, it takes about 4-6 weeks to get an inexperience coder up a running, compared with 1-2 weeks for someone with experience, so it can be very challenging to put that kind of time in.
I can't speak to transcription at all, because it's the only area of HIM (Health Information Management) with which I have no experience. Which one is best is really more of a personal question. Each field has its pros and cons. I wrote more extensively about some of the things to consider before going into coding in one of my previous posts on this thread.

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I use a combination of both, which is what I also see with the best coders I know. Encoders (coding and grouping software) can be very helpful, but they are definitely not a substitute for knowing how to use the books. In fact, especially when I'm dealing with CPT codes, I would rather use my book than the encoder on a difficult case because encoders are created by people and they only work if you follow the logic of the programmer who created it. My facility uses 3M, which is known as the Bentley of encoders, but I've still found places where the encoder logic will lead to the completely wrong set of procedure codes if you aren't careful. Basically, you have to know the books well enough to make sure the encoder is leading you where you want to go.
Originally Posted by Corrina777
Okay, yes I definitely understand that but what about online/e-books? When you say you use the books I assume you mean the actual physical books. What if the book was online and you can search through it, which I'm confused as to why that's not more common. I'm assuming the books can be in pdf format and I don't understand why one would not use that instead of the books. Also there can be software that would make searching through the book faster and put everything online.

Just trying to understand, we had a coder tell us that coders will always use physical books no matter what, but she never told us why.
Originally Posted by Josephine
Our encoder does provide ICD-9 (and even ICD-10, which goes into effect October 1, 2014), but I completely agree with the statement about always using paper books. I use the electronic version when I'm working off-site because it's a hassle to carry a pile of code books around. But I've found that the electronic versions don't have all of the notes that are in the tabular itself (and I'm not sure that the AMA would be now enough to allow for easy electronic access to their CPT codes without a huge amount of cash in it for them). The other part is that most coders write lots of notes in their books, and I do t see that as something that can easily be done with an electronic version, especially when it comes to moving your notes into the new book every year. In ICD I can understand using an electronic book, if the coder had the ability to make notes and transfer those notes each year. But thats because ICD has a logical index. I cannot imagine ever being comfortable with an all electronic CPT book because I don't use the index (when I was taught coding, the coder who was teaching me literally said "This is the CPT index. Pretend it doesn't exist evaluate it's less than useless.") I code in CPT by flipping to the section (or to multiple sections if I'm unsure of which way to go with something). As I said in my last post, I don't use the encoder at all for difficult CPT coding cases- I can literally find it faster flipping through my book. My other concern, as a manger, is that I have a hard enough time making sure that some coders read the section notes in CPT when it's physically on the same page as the codes they're looking at. My experience with electronic books is that the screen shows less than a full page, and I know I should not have to worry about this, but I do worry that some coders will miss important information.
Originally Posted by Corrina777
Okay that makes sense. So far there are no complete soft versions of the ICD 9/10 books. If there was a way to enter notes on the soft copy and have them imported over to the new version (which I would think is easier than the other way) do you think people would be more likely to use it? Screen size would definitely matter, if you can't see everything on a screen or two that you can in a book I can see how stuff would be missed.

I don't remember exactly how the CPT book was layed out but I still fail to see how it wouldn't be easier flipping through and electronic version.
Speckla
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My initial post didn't even contain anything of what I intended to say. I have been doing medical coding and billing for nearly 8 years now and that's what I am in school for. It is a very involved job and it is helpful if you have a very good memory. I do not use CPT codes but I still have to have a course in them and I can see it as good knowledge to have. I can work in any hospital, doctors office, or medical fields that deals with billing or coding after I graduate. I have the job experience and the knowledge but I need the paperwork to back it up.

And I sincerely apologize if my posts came off as argumentive or disagreeable. I love my job and I can do it well but I am not so great at describing it.
curlypearl likes this.
I can't believe how involved this is!

Can you humor me here? Say I go to the ob/gyn, and I have an annual pap test (the new digital kind of reading), a manual pelvic exam, a manual breast exam and a mammogram.

What would you receive in the way of a transcript or a report or what? And what would the result of your work look like?
Originally Posted by spiderlashes5000
This is slightly out of my realm because I've never done physician coding (yes, it's that different from hospital coding), but I'll do my best. Most physicians offices work with what's called a superbill. You've probably seen it- it's a sheet, usually two-sided, and the doctor checks off boxes next to diagnoses (why you're being seen), and procedures (what was done). Technically there should be some kind of progress note in your chart (paper or electronic) that details the encounter more. A good coder will verify that the documentation in your chart matches the superbill, and that is technically the correct process. I cannot vouch that this is always the case. The coder should also see copies of the lab results from the pap and the transcribed radiology report for the mammo. I'm not at work today, so I can't give you exact codes ATM (I just tested for my black belt Friday and Saturday and took today to recover). Annual exams will generally be reported with a diagnosis code that starts with a V (regular yearly physical is V70.0, I'm not sure what the gyn exam code is). There would be an additional code to justify the mammo (a normal screening would be V76.12, if the mammo was ordered because your doctor felt a lump, it would be 611.72 instead). If you have a family history if breast cancer, that would also be reported because it changes the mammo from routine screening to high risk screening). Any other findings documented by your physician would also be coded (diabetes, hypertension, etc). Coding cannot be based on nurse's notes, so if your nurse writes that you're overweight but the doctor doesn't mention it, it doesn't exist). For the procedures, physicians only use CPT code. Im sure there is a specific CPT code for the annual exam (it will be 5 digits and begin with a 9), an depending on how much of an exam the dr does aside from that, there could possibly be a separate E/M code (these are the general office visit codes, based on how extensive your exam is). Depending on where you get the mammo done, in their office or elsewhere, will determine who codes and bills for the mammo procedure (also a 5 character code- it can be a numerical code that starts with a 7 or an alphanumeric code that starts with a G, depending on payer requirements (Medicare sometimes requires the use of HCPCS codes rather than traditional CPT codes for certain services). There can also be additional codes if the mammo was more than just a very basic mammo). In addition, you will be billed for the laboratory piece of evaluating the Pap smear. If your doctor's office sends it out to a full lab, like Quest or LabCorp, they will bill you separately (lab, pathology, cytology codes are all 5 digit CPT codes that start with .
I apologize that I couldn't give you more specifics, but hopefully this gives you an idea (I'm working at another hospital tomorrow, but will be back at my own desk on Wed and would be happy to provide more specifics then, if you're interested).
Originally Posted by Corrina777
That was great. More than enough detail. I appreciate it. Never even considered the amt of work put in.
curlypearl likes this.
3b (with 3c tendencies) on modified CG

I was intrigued by this thread, so I went in search for more info and found that AHIMA offers a decent online certificate course. Of course, you also have to take the test for your credentials, but it didn't seem like a bad deal. Unfortunately, I also found bulletin boards full of disappointed job seekers trying to get past the 2 - 4 yrs of experience requirement.

Can any of you in the field recommend a way to get around this? Volunteering? Try to find a dr. just starting out and work parttime or for peanuts?

Last edited by CurlyCurlies; 04-22-2013 at 01:21 PM.
I completed a medical coding program which was very thorough and took the CPC exam, which I did very well on and passed on the first try. However, I applied for jobs for months, and could not get hired. Every single place I applied stated you needed two years of experience. No one near me would take volunteers since they did not want volunteers to have access to medical records. It was impossible for me to get any experience in actual coding. The places I applied to would not accept experience of working in a medical setting. They wanted two years of actual coding experience, and anywhere that had medical clerical jobs would not allow anyone other than people they had hired as coders to do any coding. I am very sorry I did it.

That is just my experience. I hope others have a better experience. For me, it was an absolute total waste of time and money.

Medical offices and hospitals want people with experience because the job can be extremely complicated and mistakes can cost thousands of dollars, plus they can get offices in major trouble. I never saw a single job post that was willing to take new graduates.

As far as working from home, I didn't see where that was allowed until you had at least several years experience in the field.

Last edited by sherry7899; 04-28-2013 at 07:16 PM.
Unfortunately, getting that first job is often right place, right time. Based on what we're dealing with here, some places might be more willing to take on new coders over the next year and a half, only because they might not have a choice. ICD-10 implementation is going to further exacerbate the shortage that already exists.

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Speckla
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I was intrigued by this thread, so I went in search for more info and found that AHIMA offers a decent online certificate course. Of course, you also have to take the test for your credentials, but it didn't seem like a bad deal. Unfortunately, I also found bulletin boards full of disappointed job seekers trying to get past the 2 - 4 yrs of experience requirement.

Can any of you in the field recommend a way to get around this? Volunteering? Try to find a dr. just starting out and work parttime or for peanuts?
Originally Posted by CurlyCurlies
We had a lady at our workplace who had just graduated and she did an internship at a doctor's office. She learned a lot and had the education and hands on experience needed for most jobs.

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