Getting Started In Medical Coding – https://youtu.be/cFyW-mwRAJA Medical Coding – Is It Right for You? – https://youtu.be/qlXKdUV_eRE
Decide what kind of coding you would like to pursue
Professional (Provider) – Coding for services provided by doctors and physician extenders such as surgery, office visits, and procedures. Inpatient – Coding for hospital stays and cost of care / diagnoses related to an inpatient admission. Outpatient – Coding for diagnoses, procedures and services performed in the outpatient setting (ER visits, same day surgeries, diagnostic testing and outpatient therapies. Risk Adjustment – Diagnosis based risk coding
If you are interested in inpatient coding, you should look to get certified through AHIMA. If you want to get into professional, outpatient, or risk adjustment coding, you should look to get certified through AAPC.
For more information on credentials, check out this video – https://youtu.be/O_bAPRwwqcs If you’re unsure which route to go, the most popular choice is professional coding, meaning you will want to become certified as a CPC (Certified Professional Coder) through the AAPC.
Pick a school
Check for courses through your local community college or technical institute.
Check if your current employer has a school agreement for reimbursement.
Check for local instructors in your area at AAPC.com. Keep in mind that if you do not know medical terminology and anatomy, you may have to learn those concepts separately if your program does not offer them.
If you are interested in doing Self-Study, check out this video with tips for medical coding self-study tools: https://youtu.be/x2h67zmLzlo
** I do not provide personal advice or endorsements of training programs other than the AAPC training. If you are unsure of where to get training, I would suggest signing up with the AAPC. **
Understand the cost of being a coder.
Memberships must be renewed every year to keep the credentials required for medical coding. Significant code changes occur every year, meaning new code books need to be purchased. Membership dues and books alone will cost about $400 each year. You need to maintain membership to keep your medical coding credential(s).
Certification will increase your chances for getting a medical coding job. Most employers only hire certified coders, but having a certification is not a guarantee of finding a job. After you complete your training, you will need to take and pass a certification examination. Check the information on AAPC or AHIMA for specifics on certification.
You have been working hard, studying, and exploring all the different facets of medical coding. You got your certification. You landed a job. You’ve been delving deep into your medical records and assigning the codes to the best of your ability. You’re excited and proud and feeling confident. But then it happened.
You failed your coding audit.
It’s often devastating but can happen even to seasoned medical coders. So what do you do when you’ve failed your internal coding audit as a coder? Here are some suggestions to help work through the findings.
1. Take a look at each of the cases where there were mismatches and review the documentation for yourself. See if you agree with the feedback or if you have a difference of opinion. It could be that the auditor did not have the depth of knowledge of the specialty that you have and may have missed some deeper interpretations or regulations regarding how that service is supposed to be coded. Even auditors aren’t perfect and you may have more information to clarify your thought process. If you feel the audit is incorrect, don’t be afraid to challenge it.
2. Talk to your employer about additional education. If they feel that there is further training needed, ask them what resources they have available. Is there another coder that can mentor you? Do they have training modules that you can take? Is there a webinar are or seminar that you can participate in that might elevate your understanding?
If you’re informed there is no budget for additional training, there may need to be a very frank discussion about how you’re expected to improve without any additional resources.
3. Leave your ego at the door. As medical coders, we always want to do things correctly. We pride ourselves in being extremely precise and accurate in our methodology. It comes as a big blow to our egos when we’re faced with the fact that we may not have done something correctly. It happens to the best and even the most experienced coders. Take the opportunity to learn from your mistakes look to improving in the future and growing.
4. Reach out to your network for help. Maybe there’s someone at your local chapter that codes the same specialty and can give you some advice. Or maybe you just need another colleague that understands your situation and can lend an ear for you to vent. It’s important not to let your pent up frustrations affect your work ethic, attitude, or performance. It’s OK to be frustrated for a short period, but grant yourself the peace of mind to learn and move forward.
Obsessing over the negative aspects of an audit only serves to feed negativity and promote toxic work culture. Learn from these situations and you’re sure to rise to the top!
A TB test or PPD ( purified protein derivative) is a common method for testing patients for tuberculosis and is often performed for pre-employment clearances. It is also known as the Mantoux test. In the procedure, a small concentration of PDD is placed just under the skin to form a small bump or bubble. Within 3 days the spot is checked to see if there was a reaction, which could indicate the patient may have tuberculosis.
A TB test is coded with CPT 86580 Skin test; tuberculosis, intradermal. This code includes the substance that’s injected, the administration, and the patient return visit to read the test. No additional codes for administration, medication, or the follow-up read should be billed.
The ICD-10 code for standard screening should be Z11.1 Encounter four screening for respiratory tuberculosis. Check out this infographic for FAQs.
Polydactyly occurs in about 1 out of every 500 births in the United States, affecting both male and female babies equally. In most cases, it is a small piece of aberrant soft tissue adjacent to the thumb or pinky, but in some instances, there can bone and joint involvement. Knowing what to look for can help you decipher the procedural note and assign the correct code.
If the extra digit has bone involvement (not just soft tissue), CPT 26587 Reconstruction of polydactylous digit, soft tissue and bone is utilized. Check for clues in the operative note such as the use of bone cutters or a statement that bone was removed. The pathology report should also be reviewed to verify if the specimen contained bone or just soft tissue. If the excision consisted of soft tissue only, use CPT 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions.
CPT 11200 is also utilized for repair of supernumerary toes that are just soft tissue with no bone involvement. Polydactyly of the toes with bone involvement should be coded 28344 Reconstruction, toe(s); polydactyly.
The key is to review the notes and the path report to determine if the specimen contained bone or just soft tissue. While there are no specific modifiers for supernumerary digits, some payers may want to see RT or LT to track which hand or foot was repaired. Be sure to monitor any payer denials to determine if there is a modifier preference.
More and more people these days have a “side hustle” or an
extra way to earn income. There are traditional side jobs as well as more
creative ways to earn income like selling crafts on Etsy or working as an
online personal assistant. The internet is filling up with new ideas to earn
some extra income without having to leave the comfort of your own home. There
are blogs and websites dedicated to sharing ideas, particularly when it comes
to stay-at-home moms looking to make some extra cash.
With the prominent promotions of medical coding as a
work-from-home job, there are more and more people looking into medical coding,
and that includes seeing if it’s a suitable side job.
But is medical coding a good side hustle?
First, let’s look at the requirements of becoming a medical
coder. To be successful in this position, you need to have an interest in
reading and analyzing medical records. Minimum requirements to take most coding
classes include an understanding of medical terminology as well as anatomy and
physiology. An average professional medical coding preparation course consists
of 80 hours of education, followed by sitting for a grueling certification
exam. None of that comes cheap. An all-encompassing package will easily cost
$2,000 – $5,000. That’s a lot to invest for a side hustle.
Classes, training, exams, and it doesn’t end there! To join
the AAPC or AHIMA (one of which will likely be mandatory for jobs in medical
coding) will cost over $100 annually, and you’ll have to invest in meeting
continuing education requirements and assessments. Not to mention, that
entry-level positions are hard to come by, and part-time entry-level positions
are even harder.
While it may seem like a dream job to sit at home reading
medical reports and punching in a bunch of numbers, there is a CONSIDERABLE
investment in this career. While some mommy blogs might suggest this as a way
to earn income while you’re at home watching your kids, that simply isn’t a
realistic expectation. Medical coding is an intense and serious profession, and
not an easy career to navigate.
If you’re willing to dedicate the time and concentration, it
can be an extremely rewarding career and eventually you may be able to land a
position working from home. Check out websites like aapc.com for more information
on how to become a certified medical coder.
A modifier 24 can be utilized to pay for unrelated evaluation and management services during a global period. In the case of a transplant (such as liver or kidney), a special condition is carved out in modifier 24 guidelines that allow for billing of immunosuppressive therapy management during the 90-day postoperative period.
Outpatient office visits or inpatient visits for immunosuppressive therapy management by the same physician that performed the transplant can be unbundled and billed separately per CMS Claims Processing Manual Chapter 12 30.6.3. Documentation should indicate that the visit is for post-transplant immunosuppressive therapy to support the usage of the 24 modifier. While there is no specific guidance on diagnoses that will support coverage, a status code for an encounter following transplant (ex: Z48.22 Encounter for aftercare following kidney transplant) would likely be acceptable.
ICD-10-CM coding has historically taken a back seat to CPT coding when it comes to professional billing. ICD-10-CM is used for a variety of reasons such as tracking disease process and spread of diseases but most importantly it’s been used to drive medical necessity together CPT paid. With productivity standards in coding and CPTs being the “money” codes, ICD-10-CM has really taken a back seat. Coders will sometimes neglect guidelines or select codes that are less specific just to cut down on time and meet their productivity standards.
Much of the health care industry is still in the fee-for-service mindset. An example of fee-for-service is a patient that goes in to see their Primary Care Physician for management of chronic conditions and the Physician gets a fixed fee regardless of how well or how poorly that condition is managed. If the patient is compliant and keeps their conditions under control, the provider gets a set fee. If the patient doesn’t understand their management plan and has severe exacerbations that land them in the hospital, that provider still gets their fixed fee for the visit. But now that landscape is starting to change. The CMS quality payment program is starting to adjust fees of providers so that providers with good outcomes get a slightly increased fee while providers with poor outcomes get a slightly decreased fee.
It all comes down to good documentation. Providers need to document appropriately to support the codes they are submitting. Billing a specified, higher severity code but not documenting to that severity (or not documenting at all) can have a huge financial impact. CMS estimates that every year there are hundreds of millions of dollars of over payments to Medicare Advantage plans based on diagnoses that were inappropriately submitted. Through programs like the RADV (Risk Adjustment Data Validation) audits, CMS is looking at potentially huge recoupments from the Advantage plans.
The less money the insurance plans have, the less money they’ll have to reimburse providers. While there may not be an immediate punitive impact on the provider there will be a definite trickledown effect. The Advantage Plans are also beginning to conduct their own “validation” audits on providers and group practices in effort to prevent any recoupments from the RADV audits.
This means that risk adjustment coders are not only needed on the insurance level and the federal level but also on the provider level as well. Medical coders will need to know if the documentation is going to support the requirements and guidelines of external audits. Risk adjustment coders are also needed to validate diagnoses as they pertain to the quality payment programs for CMS.
Audits and adjustments are continuing to rise. Risk adjustment coders who can navigate these complicated policies and master the ICD-10-CM guidelines are in high demand. If you’re interested in obtaining your CRC credential and working in risk adjustment check out the Risk Adjustment Online Course we have available. It utilizes the AAPC curriculum for training medical coders but with the addition of some vital supplemental information, great animations, fun extras, and fantastic resources.
I’m a firm believer that you can learn just about anything watching YouTube tutorials. There are lots of amazing, inspirational stories of people building houses, businesses, machinery, and more that were self-taught by watching YouTube tutorials. With the rising cost of education, countless people are looking into such alternatives to learn skills that don’t require formal education. Many people interested in medical coding are curious if they can self-teach these concepts.
Is it possible? Yes. Is it easy? Absolutely not.
Self-taught medical coding is easier for those already working in the health care field that has a good basis of medical terminology and other insurance concepts. It would be extremely difficult for someone who has absolutely no background in healthcare or any exposure to medical coding. While all the three coding books utilized (ICD-10, HCPCS, and CPT) come with instructions, it’s harder to understand how to utilize them from scratch.
Learning medical coding completely for free
simply cannot happen because the books need to be purchased, studied, and are
mandatory for testing purposes. But, if you’re determined to do self-study,
here are the most budget-friendly suggestions I can offer.
These are the books needed for professional medical coding, which is coding for physician and other medical provider services.
CPT is Current Procedural Terminology. This book is for coding for procedures and is required for the CPC (Certified Professional Coder) exam. The CPC exam dictates that you must have the AMA version of CPT books only. I would recommend getting the edition for the year that you will be taking your examination in.
ICD-10-CM is for diagnosis-based coding for professional services. For the CPC exam, you can use any version of ICD-10-CM that you want. Make sure you have the CM edition, and not PCS. PCS is only utilized for hospital/facility coding, and not required for the CPC exam. Here is a suggestion of one you can purchase easily online through Amazon. You can check out some of the reviews for more information as well.
HCPCs are codes for durable medical equipment, medications, insurance-specific codes for procedures, and other services. You can have any edition of HCPCS book that you want for you or exam. You can buy the one above off Amazon easily. If you’re an Amazon Prime member they will even ship it to you for free.
Step-By-Step Medical Coding is an instructional guide that is utilized very commonly in medical coding classes in colleges and technical schools. While you won’t be able to access the teacher’s information (such as test answers) there are select case answers and rationale in the back of the student guide. I would suggest purchasing this book as well as the coding books indicated above. Current year coding books are required when you are testing for any certification exams through AHIMA or AAPC. You can write, draw, highlight or tab the books in just about any fashion you want. You cannot staple, paste, tape, or add additional pages into the book or white-out entire pages of the book for notes.
Check us out on YouTube for some great tutorials and information on medical coding. There is also chapter-specific information that you can find through your YouTube searches. This will help you in understanding the concepts that will guide you to becoming a medical coder. When you’re ready, purchase some of the practice exams through the AAPC to get some simulation of what the certification exam will be like.
While you can’t become a certified coder for free, there are ways to cut down the cost if you are interested in self-study. Power the tools above and try to stay as focused as possible. Make an agenda for yourself and stick to it. Good luck!
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Every job has obstacles — even medical coding. In an industry
that changes as often as healthcare, the obstacles often change as well. However,
some of those hurdles can be universal for all medical coders. Let’s explore
some of the common obstacles in the medical coding field, and what you can do
to overcome them.
There’s a lot of hype around medical coding. While it IS a booming career with
lots of great benefits (such as working from home), the over-hype can lead to a
lot of disappointed newly certified coders. Some educational institutions will
make a medical coding career seem as easy as taking a few classes and passing
an exam. New coders become filled with dreams of immediately being hired on to
work in your jammies at home. There are some institutions that will go as far
as to bait moms with claims that they can do medical coding from home while watching
What results are throngs of new medical coders that don’t understand what their “apprentice” status means and are frustrated that they can’t find a work from home job. Institutions are leaving out the concept that although there is a huge need for medical coders, the need is primarily for experienced medical coders. Entry-level positions are hard to come by, and unfortunately, a lot of companies aren’t structuring their staff and workloads properly to allow for entry-level coding positions. There’s also an unfortunate prevalence of “we don’t have time to train new coders” mentalities in the industry.
Learn the stories of how other coders got their first start
in medical coding. Understanding how they got started and what to expect can help
bring some clarity for frustrated coders.
Not Knowing Guidelines
It can be very shocking when you’re coding a specialty service for months, or maybe even years, and suddenly something in the guidelines catches your eye.
Does that say what I think it does?
Has that ALWAYS been there?
HAVE I EVEN BEEN CODING THIS CORRECTLY THE ENTIRE TIME?!
The best thing you can do Is talk to your manager and
discuss your discovery and determine next steps. They will know the best way to
correct the error going forward and if they have the capacity to review and
adjust potential prior mistakes.
The industry has common standards for productivity for medical coding. The benchmarks change depending on the type of coding (professional, outpatient, inpatient, risk adjustment, etc). Meeting those standards is a surprising challenge! Lots of things can factor into lower productivity such as office distractions, poor physician documentation, EMR challenges, or time researching new or complicated coding guidelines. If you’re having problems reaching your productivity, you may need to analyze your day and see what’s taking the most time. There’s no way to quantify what you’re doing without going through the task of timing out all the phone calls, emails, and research.
Not Finding a Job
Finding your first job in any industry is a challenge, and
medical coding is no exception. If you’re looking for your first job (or even
just a new job) check out my blog 7
Tips to Finding a Medical Coding Job. Learn how to target your efforts and provide
quality over quantity when it comes to your job search!
There’s no bigger ego-crusher to a coder than failing your
personal internal audit. Coders are held to very high accuracy levels (usually 95-99%)
and we pride ourselves in our attention to detail and accuracy. No one wants to
bill a service incorrectly. If you don’t meet the required accuracy of an
audit, just take it as a learning opportunity. It’s a time to recognize where
you may have a weak area, address it, learn from it, and look forward to your
future success. Never let an audit defeat you.
No Remote Jobs
No commute, no stuffy work clothes, no annoying co-workers
and funky smells from the lunchroom! It sounds like a dream to work from home
but finding permanent remote coding positions can be a struggle, especially for
apprentice coders. When it comes to remote jobs, knowing the right people and
having the right resume is key. Check out 7
Tips to Finding a Medical Coding Job to find some ideas on where to find
them, and look to companies like Project
Resume to make your resume stand out for those highly-desired remote
Navigating Insurance Policies
It seems so straightforward in class, but out in the real-world insurance policies don’t always line up with coding policies. Insurance contracts are binding legal agreements, and healthcare institutions must follow the guidance provided in the contract when billing for those insurances. Learning which insurances want things coding certain ways can be daunting. The best way to combat this is to ask for any cheat sheets your organization may have. If they don’t have any, start developing them yourself and update when you get any new feedback on denials and trends!
There will always be obstacles in medical coding. New guidelines, new policies, and learning new specialties are just the tip of the iceberg. The first two years as a coder is a HUGE learning curve. Take each new experience, change, and restructuring as an opportunity to show how adaptable and eager to learn you are. But don’t be afraid to voice your opinions and concerns as needed.