What Does It MEAN to be a MEDICAL CODER?

What Does It MEAN to be a MEDICAL CODER?

This post is a Bit Different!  It is a Compilation of a couple of long threads from the main JFAMC FB group!  The COMMENTS on BOTH of these posts that follow…are EDITED… 
~~~~
What Does It MEAN to be a MEDICAL CODER?
——Leslie LeBrun Johnson…
I’ll apologize right now if this rant comes across a little harsh, but I’m a little out of patience with those of you who are demeaning & insulting our profession.
Oh, I’m sure you don’t realize that you’re devaluing our profession – but let’s set this record straight as to what, exactly, a coder is & what we do.
We do *more* than pick numbers.
In no particular order:
1.) We are the 2nd to last, sometimes *the* final gateway before a claim goes out the door.
~~
2.) We are a small cog in the wheel of the revenue cycle process.
~~
3.) We are the keeper & protector of our clinicians.
~~
4.) We are the educators of the billing staff, of the clinicians, of other coders, of the doctors, of administrators who have no clue about what we do.
~~
5.) We work coding denials – who better?   Billers aren’t trained the way a coder is, to see what coders see, to understand the way a coder understands.
~~
6.) We are fussy, nit-pickers & sometimes arrogant in buying into the hype that we know it all when we really don’t.
~~
7.) We are auditors – of documentation, of the revenue cycle, of the codes, of the charges, of the billing system, of the payments that come in.
~~
8.) We are detectives, piecing together every single thing from the most hideous of handwriting to the most complex of cases that take a while to understand sometimes.
~~
9.) We are students for LIFE because as much as we know, there’s so much more to learn.
~~
10.) We are the whistle-blowers for fraud if our clinicians, administrators continue to do the wrong things to garner profit even after we’ve proven it was wrong.
~~
11.) We read EVERYTHING – LCDs, NCDs, NCCI Policy Manual, OIG, CMS IOMs, Federal Register, PFS RVUs, Payer policies – and we do it on our OWN time, more often than not.
~~
12.) We get frustrated with coding from superbills because we realize that coding is so much more than picking a number for a word we can barely pronounce, let alone read.
~~
13.) We are Faustian (or polymathic) in nature because no matter how much we absorb, no matter how much we read, we can never be satisfied by knowing what we think we know – we crave MORE because we don’t feel right about our codes until we KNOW what we know and WHY we know it.
~~
14.) We are the ones who cry and/or pray when we see things in these reports that would make others throw up or run away.
~~
15.) We are not physicians, but we are expected to be able to discuss cases, surgeries and codes as if we are – because we should be knowledgeable about what it is our employers do. If we’re lucky, they’ll teach us, but more often than not, they expect us to KNOW.
~~
16.) We are beaten up, challenged, mistreated, misunderstood and often times by our selves as well as by those with whom we work. Many times we can’t even talk about our day, about the patients we see, about the types of cases we come across because who, in our families & friendship circles, can understand?
~~
Yes! We take tests.
~~
No two specialties are alike and although we proudly wear CCS, CPC, CPC-A or whatever initials are after your name, we do not, we cannot know every single specialty there is, regardless of the number of years you’ve been a coder.
~~
You’ll be tested for each specialty you apply for – until/unless you’ve gotten so much experience or your name becomes recognized & your knowledge is well known in a particular specialty area.
~~
Yes!  We must continually LEARN.
~~
Medicine doesn’t sleep. If we aren’t taught, we have to teach ourselves or pay for someone else who can/will teach us – and sadly, very often at our own expense!!   We don’t get to say: “I learned it so I don’t need any more training,” unless you want to find yourself a dinosaur without a job. Some employers move at such a fast pace, they want a worker who can hit the ground running.
~~
Do you realize that an experienced coder in a particular specialty can often spot a correct CPT code from an incorrect CPT code just by looking at it, without having to look it up?
~~
Did you know that most experienced coders can look up the RVU of a code to tell their employer who asks which of two codes pays more?   And — that they can do it WITHOUT an encoder or 3M or Supercoder tool, too.
~~
They have familiarity with LCDs & payer policies of various payers so they can help educate their physicians on medical necessity & utilization.
~~
A fast-moving employer who wants an experienced coder cannot or will not stop the revenue cycle process to TEACH this stuff, they want the coder to KNOW it!
~~
Some employers have been caught in audits and *must* have experienced coders *ON SITE* to keep them from having to pay steep fines again because the inexperienced coder can pick the numbers but they can’t translate their findings in the ways experienced coders can. They don’t know how, yet.
~~
I could tell you stories … many of us who have been around could, too, if you’d listen.
~~
We work for Physicians and other Providers.  We hold their livelihoods, their licenses in our hands each day we code. This is serious business I’m talking about.
~~
Lucky is the coder who gets hired right away with minimal experience, a brand new certificate and a “how to” guide from their school, but the learning curve in the real coding world is sometimes very steep and it’s often very frustrating.
~~
Trial by fire can be an excellent teacher, but let me tell you sometimes that fire burns! So you want to work from home? It’s just not always practical nor is it possible.
~~
Get *off* the computer & cell phones, get *out* in the field and get the jobs that are out there that lead you up the ladder to where you want to go.
~~
Opportunity doesn’t always knock – sometimes you have to walk right up & into it, but you can’t do it if you’re always playing on the phone or computer/laptop!
~~
Truth be told, some of the BEST & better paying jobs can’t be done from home. If you wish to progress in this industry, you probably won’t be working from home unless you end up in a corporation that outsources and/or off-shores so they’re set up for it.
~~
We PARTNER with the billing team to work coding denials & understand how payers want things coded & billed.
~~
We PARTNER with our IT teams to make sure the codes are correct in the billing system.
~~
We PARTNER with our clinicians to make sure the documentation is correct for what they want to bill out.
~~
We PARTNER with the audits team to help educate our fellow coders when they are weak in areas.
~~
We PARTNER with our physicians who help us understand while we help them understand – even when they don’t want to.
~~
We PARTNER with other coders to exchange information & educational resources so that we can do our jobs better.
~~
We often do all of this and more for the love of our job as opposed to the money we can make from it.
~~
Don’t get me wrong – the money *will* come once you’ve learned, applied what you’ve learned, paid your “dues” and taken several lumps along the way.
~~
Depending on where you go, you may have to work other aspects of the revenue cycle process – EMBRACE it, don’t fight it and PLEASE don’t whine about it.
~~
I don’t like doing some things that seem like a step backwards, but let it never be said that I will not step up to the plate when needed!   If a better way can be found, being in the trenches will help you be creative & innovative to find that better way & to be the kind of team player people want on their team. ????
~~
Which are you – the Lone Ranger or the Team player????
Comments — (Edited)
~~
**CW — I’ve been a coder for 21 years. It gets harder every year. I do hospital coding. I had one coding job where the coder was the cleanup crew. If Radiology, Lab, Charge staff made a mistake, it was our responsibility to catch the edits and send emails…
~~
**BKW — I get out of work at 3 on Thursdays. My front desk girl called in sick today. So not only did I have to work front desk, I had to work 3 hours past my ending time. I’m salary, I get no extra money. I have feet issues, so I’ll be in pain for half a …
~~
**MPMcM — So very true. Like many others here I have been in the industry over 20 years and done every aspect of the office. It makes your job as a coder easier if you know every angle. I couldn’t agree more!
~~
**CML — Well said. But I guess I’m the only one who just shrugs my shoulders? If anybody thinks what I do is “easy”, it doesn’t bother me. They can think whatever they want to think. Its not worth my energy to correct them if they think I’m a secretary or they think I do data entry. I seriously seriously do not care WHAT their opinion is. I’m a contented little coder and not going to let the turkeys get me down, lol!
~~
LH — As a newbie to CPC studies ..I want to ask questions to experienced coders because …I am in the dark. I hope my questions are answered because … I really need help !
~~
**PH — Wish schools wouldn’t tell you how easy it is to find a coding job and oh of course you can work from home. Really? With no medical experience? Sure np lol
~~
**CW — Would some of the new coders thought about doing this if it wasn’t a remote job? I only ask because back in the 90s there was no remote, there was a coder shortage and nobody wanted to do it. lol
~~
**CBA — Awesome! I usually get the whole “Oh you work from home, you got it easy. Or got it good.” Yeah I got it good. And I worked for it! But it certainly isn’t always easy!
~~
**LI — This is why I love this page and the people on it…What I learn as a newbie on here is priceless!!!
~~
**ADK — What I get from all of this is that coders are some of the most dedicated, unselfish people, who do whatever it takes, never stop learning/educating not only themselves but those they work with and for and are very passionate and perfectionistic (in a good way) about what they do.
~~
**AM — This is a Great post and VERY true!!! Anyone who doesn’t understand this needs to really rethink what their job is, Leslie, I don’t think that you ranted, but told the truth. Sadly there are too many people who don’t bother to take the time to find out what coders/billers actually do,
~~
**MP —  Have I not commented yet?   Shame on me.   Leslie has a handle on this very accurately. With all due respect, testing and practicing are gifts and working from home in a field that is so broad with no one to talk things over with is very very hard.
~~
**JP —  You are so right when you say “opportunity doesn’t always knock”. I remember the times when I got the jobs faster when I had to walk to the businesses with a Resume and Cover letter in hand. I got those jobs faster than just emailing my Resume.
~~
**TPW — I am a self taught in all aspects of my career. Nothing has been handed to me and I have worked hard to get where I am. Things have CHANGED SO MUCH in all of the years I’ve been billing/coding and I’ve always been responsible for myself in order to be accountable to everyone I have worked for. BE THE CHANGE. Work Hard!
~~
**CML — That’s how that expression was born after all, from Liberace. Someone once asked him after one of his piano performances if he was hurt or offended when given a bad review . He answered “Hurt? Oh yes, I cry. I cry all the way to the bank.”
~~
**SHV — I commented previously but I had to share this. The very next day after reading this post, I had to put a young lady in her place about our profession. She actually believed coders just pick numbers and place them on their charts. Lol! I had to tell he…
~~
**AMS — This was great Leslie and soooo true! Most of us have worked extremely hard to get where we are today! Excellent post my friend!
*************************************************************
[October 15, 2016]  From an awesome coder, for whom I have great respect..…and I am honored to call her my friend, M. P.
 ~~
This is oh so true!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I can’t possibly agree with her more!!!!!!!!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~
*Ahem* Just going to dust off my soapbox here.   
~~
For a while now, in groups and just discussions with prospective students, I’ve noticed a growing trend: “I want to get into coding because it’s a fast, easy way to make good money working from home.”
~~
I urge you to realize how much those statements belittle the coding profession. If you do decide to study coding for those reasons, you will soon learn a few things the hard way: 
~~
1. There is not much that is easy about learning to be a coder or being one.
~~
If you’re not entirely sure what a coder does, let me try to DEFINE it for you:   Coding is the analysis of documented medical information, translated into alphanumeric codes under a classification system.
~~
I’m not really sure how that seems like something that is fast and easy to learn.
~~
In order to analyze information, you have to understand it first. That means you have to understand disease process, medications, treatments, procedures, etc. You better know enough to be able to ask a physician for a query and make sure it’s valid. Sure, you may not have to do brain surgery, but you better know enough to code it. You will be shocked at the amount of knowledge you need to have to simply “assign a code.” 
~~
2. While others may disagree, I don’t believe coding is always something that can be learned.
~~
I mean that in the sense that sure you can take a few art classes, but that doesn’t make you an artist. 
~~
Coding is a skill, a knack, and some people just have it, and some people don’t. And try as you might, study all you want, you just either have “it” or you don’t. 
~~
3. CONTINUING EDUCATION: Coders are constantly learning. Whether it be a new guideline, coding clinic or even a new system. In the coding world, there’s not much that is easy about change. 
~~
4. AUDITS/SCRUTINY: Your work is always up for criticism by multiple sources…. ALWAYS!! You will have internal or external audits and ‘their incentive’ is to find something wrong. Consulting companies do not make as much money as they do to tell a facility “everything looks wonderful here!” And when it comes to RACS…you are wrong even when you’re right. 
~~
5. PRODUCTIVITY: You have daily/weekly productivity requirements that you need to balance with accuracy and quality requirements. While some managers may be understanding that you got hit with a 37 day stay right after a 58 day stay, others will not be so understanding and will still expect you to meet average productivity requirements. And if you’re working for a contract company — you better be moving, you’re there to help pick up the slack.  
~~
6. WORK AT HOME: ‘Working from home’ still means that you are WORKING. Your systems are constantly monitored to make sure you are actually working. Working from home only alleviates a daily commute. It doesn’t mean you can walk away for 15 minutes and put your baby down for a nap or throw in a load of clothes. I’ve found that I work more now at home than I did on site. ` **MANY/MOST companies/facilities with Remote Coders now have clauses in their contracts that the coder WILL NOT be the primary care giver for either a ‘dependent child or a dependent adult’.
 ~~~
Comments to this post—(edited):
~~
**DV —  It’s a skill that is always evolving. I learn something all the time.
~~
**KE  — I must add a few additional items ☺. The CPC exam is not easy.  Just because you pass does not mean that you can do the job. As mentioned above it is a skill which takes time master as well as mentoring from college worker’s which is hard working from home.
~~
**LR — It has to be something you’re passionate about, and it’s definitely not easy to learn, I’m still new and I know I have a lifetime of learning ahead of me
~~
**JBW — I have been coding for just about 3 years now, and I still think on daily basis that I don’t know enough, that I have so much more to learn and master. It is definitely not as simple as throwing some codes on a claim and getting paid like some may think it is.
~~
**DE — This is truthful, more than the blogs floating around touting a certificate in two easy classes. It speaks to the coders that are just beginning, that may wonder why a certificate is not enough to be hired anywhere, why pre-employment testing is necessary. We all have to climb the ladder.?
~~
**PK —  #4 is Especially True! If you can’t take constant and on-going critiques of your work……this is most likely NOT the appropriate career choice for you!!
~~
**DH I agree with you, especially #2!!
~~
**TM —  Well said. It grinds my nerves when I see, “I want to go into coding so I can work from home.” THAT should NOT be the reason to choose the coding profession
~~
**SK —  Coding is a lot like opera – you either love it or hate it. Sure, you may learn to appreciate it one day, but that passion for it? You either have it or you don’t.
~~
**PK  —  Another POINT! I frequently hear of and read of people who declare: I’m going into Coding because I NEED to work from home because I have ‘a bad back’ or ‘I live far from town’ or ‘I have a special-needs child’…..or ‘insert any other of a dozen reasons as to ‘WHY’ you need to ‘work from home’!  
~~
BY and LARGE…..employers DO NOT CARE what ‘YOU” need. They may ‘express compassion’ that you have an injury or a small child or a multitude of other reasons as to why you need X, Y, or Z in order to ‘do your job’; however, at the ‘end of the day’…they’re running a business!
~~
They are MUCH MORE interested in what you can bring to the table to satisfy the needs/requirements of their particular project.
~~
***Telling your NEEDS…won’t get you very far, either, usually!
~~
In 30+ years of working in this industry, I am aware of ONE PERSON who was already working for a physician (and had worked there for several years). Her child was in an accident, and required several months at home, while he was unable to attend school. Because the physician already knew her work ethic, and she had worked for him for quite some time,  the physician made arrangements to allow her to work from home, so she could care for her child). (The injured child was young enough that he couldn’t stay home without ‘an adult’ on the premises, but was old enough that he didn’t need constant attention.)
~~
That is ‘the only time’ I have seen, in my personal experience, where an employer willingly accommodated a ‘Needs Situation’ for an employee!  (and TRULY, it was done more to accommodate the needs of the clinic than it was the needs of the Employee!  The Physician didn’t want to have to hire someone to ‘take her place’)!
~~
**DMA —  I was a stay at home Mom with a 25 year old associate degree in business that wasn’t worth a whole lot because of all of the technology changes during my downtime. I have always been intrigued my medicine and had thought long and hard about going to ~~
~~
**TH — Yes, I think when I’m working from home some people who are not coders think Im taking an ‘easy’ day. Nothing could be further from the truth. It is not easy. Although I love it I also use my own time to do my studying and research.
~~
**AHC — ♡ will be copying and pasting for my students
~~
**PW — Most people don’t know what coding is let alone how much knowledge it requires. There are so many areas and specialties, payers, laws, guidelines, etc! The classes and exam hardly scratch the surface of what you need to know. I have learned so much in …
~~
**KK  —  It has always been my experience that you work longer and harder remotely than onsite in any industry.
~~
**SB — Amen! Everyday on this site somene’s always saying they only want remote because they have children. Many people had to work on site before they got remote. It is obvious the only reason some of these people are going to school for this because they think they will automatically get a remote position.
~~
**MF  —  I was a retail pharmacist for 25 years. I have extensive training in pharmacology, disease states, and have even taken cadaver anatomy. I have clinical experience and am no stranger to documentation and patient charts…nd y’all, this coding stuf…
~~
**SB — I am sick of people asking if anyone know of remote positions. Do your own RESEARCH!! LOOK IN THE FILES. SEARCH INDEED, MONSTER, CAREERBUILDER. HOSPITAL WEBSITES.
~~
**PK  — In the next few days … I’m going to take this post and the comments and create a document that will LIVE PERMANENTLY on the JFAMC WEBSITE!!   I firmly believe that this information is of sufficient importance that it needs to be readily accessible for PROSPECTIVE STUDENTS/NEW CODERS to access!
~~
**MP  — What a perfect thread. I personally have taken heat from some when I have been annoyed by the constant ” is it remote? ” questions because that tells me your priority is to stay home and you will never see or experience what I have in the operating roo…
~~
**SS —  the constant learning is why I got into coding.  I love challenging my mind everyday 🙂
~~
**RP —  I have been telling myself I might not be a coder because I’ve been unsuccessful at getting that first job. But… Pam, anyone & everyone can become a musician. It just is a matter of practice & a coach that can communicate in a language you understand.
~~
**AHC  —  This is the honesty that is needed for this profession. So many new students and people looking to get into coding are misled into believing that coding is easy, the jobs are falling out of the sky, and that you can work remotely right off the bat. N…
~~
**JLB  — I couldn’t agree more, Pam. I have a BA in English, an AAS in Nursing and was a manager in healthcare for many years. I decided to take the AAPC CPC course just to see what it was. I was shocked to see just how challenging coding was but stuck to my gu…
~~
**SBE  —  This is excellent. Coding is not for everyone and not everyone will succeed at it. It is not and never has been an easy job. Many coders I worked with in the past retired when ICD-10 was implemented because it was “too hard” –
~~
**PK —  I get INCENSED when I read the ads in the Supermarket Tabloids and the magazines found in most beauty salons — both hair and nails; you know, the ones where you see Advertisement after Advertisement with a young woman sitting a kitchen table, with a s…
~~
**DE — I know, I think colleges and tech schools should be sued for misrepresentation. Remember the days of advertising on the back of a matchbook, or on late night TV. The good old days.
~~
**KMBB — It is also difficult to find someone willing to mentor. I have experience in billing, in auditing primary care encounters and now I work in medical records. I feel the more I learn in the different aspects of the healthcare the better coder I will be o…
~~
**KB  — There is a lot of truth in this, but in my personal experience, I’ve been EXTREMELY fortunate to work for 2 AMAZING bosses who were super flexible with my life as the mother of a special needs child. I do think, however, that I was able to prove my wo…
~~
**IK  —  I wouldn’t trust anyone who is looking for an easy way to do things. That’s NOT what employers are looking for as well.
~~
**DP  —  I agree 100%. Good luck to those who think coding is an easy way to make money. When I hear people saying that I always always have to correct them. I don’t care if they say “who asked you?” I rather be judged for being noisey and clarify some things to those uninformed aspirant coders, than stay quite and let the ignorance grow.
~~
**RAB  —   Great article.  This article is a home run! It brings true reality to the life of a “real coder”. Although many would like to work from home, there is nothing that can replace the value of working in hospital, clinic, etc. Understanding the work flow, and the clinical side of medicine adds incredible value and in-depth knowledge to the coder, reimbursement specialist and auditor.
~~
**LDKM  —  This hits the nail right on the head…this says it ALL…you need to be dedicated to coding, willing to learn, not afraid of criticism or change and willing to WORK, no matter your location!!! It is an AWESOME profession and I am so glad to be a part of it. We are an awesome group of individuals, but we work as a team to network and help each other in any way possible!!
~~
**PMN   —  Well said.. I teach ICD coding elsewhere and I have students saying there’s too much homework or this is hard … Yup!  It’s not easy but the only way to learn is to do the work, it’s not for everyone but it is a great career for those willing to put in the time and effort.
~~
**KS  —  This is so true and I wish people would get of the mindset that Coding is easy because it’s NOT and you are always learning new things.
~~
**DE  —  Coding is intense, yes. I think the most critical aspect is compliance, ethics and law, regulation, and knowing the government is 100% involved in healthcare from insurance to payments. Know that if you are coding incorrectly there are some dire consequences.
~~
**SB —   I got into coding because I read a ton of information that said I’d have to work hard for 3-4 years to get good experience and THEN I could start making good money. Fast and easy is RARELY worth the outcome, but then again I am old enough to remember having to wait for something.
~~
**JD  —  I love this! It’s exactly what people need to realize before getting into coding. I work remotely and because of the hurricane and coders on our team being displaced for their safety we are putting in mandatory OT weekly (normally 8-12 hours). If your not willing to get criticized, continually learn, or put you big girl panties on to have your fellow coders backs then this isn’t for you.
~~
**MS  —  Thanks for this post! It so true! I have been lucky enough to work from home for the last 8+ years and it’s no piece of cake. In most cases those of us at home are under more scrutiny than our counterparts in the office and I 100% agree… coding is so… 
~~
**DMC   —    Amen! Worked in an office for 25 years. Now I work remotely and twice as hard!  Scared I’m gonna miss something in reading charts.
~~~~~~~~~~~~~
The COMMENTS on these COMBINED posts…are EDITED. 
GOOD LUCK on YOUR Journey! 

Leave a Reply