HIM Transitions : Coding

HIT Jobs in High Demand

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 26 Oct 2009 11:08:00 GMT

The introductory course I teach in health information technology (HIT) gives students the basics on health information. This week I did a lecture on the diversity of career options available in HIT. Students coming into the program are usually familiar...(read more)

ICD-10 Anxiety

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 21 Sep 2009 11:34:00 GMT

I try to attend coding updates annually, and I always learn something new. I attended a workshop this week on the 2010 ICD-9 changes. The amount of information is just mind-boggling. It is a good thing I don't have to perform coding for a living. The...(read more)

Not Another Test

Carol Dantzler-Harris, MEd, RHIA, CPC — Wed, 09 Sep 2009 11:49:00 GMT

I was thrilled to pass the American Academy of Professional Coders (AAPC) certified professional coder (CPC) test on the first try this past spring. The experience was nerve wracking, and I didn't think I would survive it. Well, you are reading this blog,...(read more)

First AAPC Chapter Meeting

Carol Dantzler-Harris, MEd, RHIA, CPC — Tue, 26 May 2009 11:41:00 GMT

I attended my first AAPC local chapter meeting last week. The meeting was an informal session on the daily duties of a coder. Coders shared their stories on a typical day at the office. Some people had a dual role of office manager/coder and others functioned...(read more)

Certifiable

Carol Dantzler-Harris, MEd, RHIA, CPC — Tue, 12 May 2009 13:03:00 GMT

Over the last 6 months my behavior can best be described as certifiable. This is an old school term that means that I have been totally off my rocker. I have not been the most pleasant person to live with these few months. My husband was just about ready...(read more)

Breaking Into Online Teaching

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 02 Feb 2009 18:48:00 GMT

I begin my journey transitioning to a new career in adult education 3 years ago. After spending years working in health information, I felt that I had accomplished my career goals and desired to change the direction of my career. After investing so much time in this field, I wanted to carefully weigh my options for the future. I wanted to spend the second phase of my career enjoying my work and making an impact on others. I have always enjoyed the training aspect of my career in health information. The best part of being health information professional is to invest in others by teaching them what you have learned over the years. Teaching seemed to be the right fit for me to remain in the field I love and teach those coming into the profession.

My goal was to teach at a traditional school in the health sciences area. I knew I needed to go back to school to obtain a master's degree to meet the qualifications for an instructor. I found an online school that would work around my work and family life. I enrolled in the school of education in 2005 and obtained my master's in 2007. I contacted local community colleges and technical schools in my area looking for my first teaching job. Also, I targeted online schools to broaden my search. I applied at several online schools for part-time and full-time teaching positions. Although I had years of experience in health information, I did not have any teaching experience, and in particular experience with facilitating classes online. Most online schools want you to have at least 1 to 2 years of experience teaching online.

I continued to send out résumés and contacted health information program directors offering my services as an adjunct just to get my foot in the door. Eventually, my persistence paid off by attending a job fair for instructors at a community college. I talked with the dean and chair of health science programs and played up my experience. I expressed my desire to teach any courses in the health sciences area. I completed an application and left several résumés. I got the name, position and phone number of every person I spoke with at the job fair. I graduated 3 months after the job fair and got an offer to teach in the medical assisting program. I was finally going to realize my dream of teaching.

Although I did not have a year of teaching experience preferred by online schools, I continued to pursue online schools as an instructor. I refused to take no for an answer. You must be persistent and play up your experience as much as possible. I was contacted by an online school for an adjunct position. I made it through the initial human resources screening interview. After a few weeks, I was contacted by human resources and a series of interviews was set up. I made it through the series of interviews and was asked to submit an essay on my teaching philosophy. I was offered the position and was on the top of the world.

Here are a few tips on how to break into online teaching:

Assess your skills as health information professional. What courses are you qualified to teach?
Target local community colleges in your area and offer to provide your services as an adjunct instructor. Some community colleges offer online courses.
Contact the program directors of health information programs in your state. You can get a listing from the state health information association.
Broaden your search by considering teaching in areas such as medical assisting, office management, secretarial/unit secretary.
Create a computer file of the contacts you have made and follow up on these. The goal is to keep your name fresh in the mind of the potential employer.
Attend faculty job fairs at community colleges. Bring an updated résumé and be prepared to sell yourself.
Take courses related to instructional technology (courses on e-learning, podcasting, instructional design).
Get comfortable with navigating and researching on the Web.
Update computer hardware and software. Teaching online requires that you have updated software and hardware.
Conduct research on online schools that you are interested in. Make sure the school is accredited. Look at how long the school has been around. What is the graduation rate? Are there problems with student retention?

The best advice that I can give anyone interested in teaching online is to showcase your unique skills as health information professional. Be persistent in your search for an online teaching position and market yourself to online institutions. We have been educated and trained to perform a variety of tasks that make us uniquely qualified to teach students over a wide spectrum.

Unexpected Events

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 17 Nov 2008 12:48:00 GMT

My week started off the same as usual. I was preparing for classes, grading assignments, and answering endless e-mails. The kids had their homework and projects that needed my attention. Of course, don't let me forget the house work that never seems to end.

I have my week planned out in advance. I know how much time will be needed to juggle teaching my courses, study for the CPC exam, and juggle the kids and the husband in all of this chaos. Also, I had an interview this week for another teaching position. This went well and I hope to hear back from them soon. So far, my week is going according to plan.

The kids wanted to rent the third installment of the long and drawn out Pirates of the Caribbean movie for the weekend. Since my husband is working this weekend, he thought one of us should have some fun. The kids and I cleaned the house and prepared to run a few errands on Saturday. We hit the Walmart around 2:30 in the evening and so did everyone else in town. Once the Walmart nightmare was over, we went to Michael's and bought supplies for my daughter's math project. Ok, now it is time to go home and finish the house work and get ready for a night home at the movies.

I was less than a mile from home when my cell phone rang. Of course, it was buried in the bottom of my purse. It was my husband and he wanted to know where are you. I replied, "We have been running errands." He asked, where are you? I replied, "We are at the Harris Teeter grocery store." He asked," Are you on your way home?" I replied, "Yes we are less than a mile from the house." He informed me that I needed to go home because the alarm company called and the fire department is on their way to our house. I was completed stunned. He replied, "Did you leave the stove on? I replied, "No." At this point, I started to second guess myself and thought I must have left something on.

My husband stayed on the phone with me and keeps asking, "Do you see any smoke?" I was absolutely terrified that the house would be up in flames. When I turned on my street, I could see and hear all the commotion from the fire department. I stop the car on the side of the street and told the kids to stay in the car. The fire department was trying to determine if anyone was at home. I told them that I was the owner. When I opened the door, I was afraid of what I might see. There was no sign of smoke or fire. The fireman went into the attic, searched upstairs and went under the crawl space on the side of the house. Luckily, there was no smoke or fire.

I was told that it was probably a power surge. I felt relieved. The situation could have been worse. About 30 minutes later, I kept hearing this sound. It sounded like a motor from a fan. My daughter heard it too but we couldn't figure out what it was. We only heard the sound in the mud room. I called my husband and he asked me to put my ear to the floor. I heard the sound of water underneath the laundry room.

Apparently, a pipe burst and triggered the fire alarm. The price of paying for a busted pipe is a small price to pay for the safety of your family and home.

Post-Election Blues

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 10 Nov 2008 14:03:00 GMT

The most urgent thing on my plate is studying for the CPC exam. I have purchased the CPC exam review guide, attended the CPC exam review, purchased index cards to study the medical terminology and came up with a study schedule. My intention this week was to stick to my study schedule no matter what. Well, my plans seemed to go downhill election night. I was up on Monday night flipping through every channel to hear what the pundits were saying about the candidates.

The talking heads did not disappoint. They gave their views on who would win the election based on their analysis of the poll numbers. I usually don't listen to any of these talking heads but as the election was drawing closer to an end, I found myself drawn to their constant chatter.

On election night, we decided to have an election party and watch the results roll in. My 9-year-old son has been extremely interested in the election and begged to stay up. I comprised and told him that he could stay up until 9 p.m. He was disappointed and wanted to stay up until a winner had been declared. I told him that the election would be so close that it would take until midnight to determine a winner. My laptop was set up with MSN.com which provided up to date information on how long the polls were going to be open and when the polls closed. The MSN web site displayed a map of our country divided into red and blue states. When the state was called, the map changed to reflect the winner and how many electoral votes the candidate won. My son worked the laptop and gave us minute by minute information from the laptop.

The rest of us were glued to the television watching the election returns come in. We flipped between all the major networks to see if they had any new information. We were on the phone with family and friends for their assessment of how they thought things were going. I was surprised that it did not take all night to determine a winner. After the election was called, it was a relief that it was finally over. I did not go to bed until almost midnight.

Although the election is over, I find myself missing my favorite talking heads. No more analysis of the red and blue states. Gone is the Electoral College map with the fancy graphics. I'm not sure that I can wait another 4 years. I think I am suffering from post-election blues. Is there an ICD-9 code for this condition?

CPC Exam Review

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 03 Nov 2008 12:33:00 GMT

I attended the CPC Exam Review on Friday to prepare myself to take AAPC CPC exam. The exam review was offered by the local AAPC chapter to prepare applicants to take the exam. There were about forty participants representing insurance, physician offices, hospitals, clinics, education and students. The majority of the participants were required to take the exam for employment purposes. The students need to take the exam to have better opportunities of landing their first coding job.

The instructor for the exam review is also the proctor for the CPC exam. I have been on the AAPC website to review the coding certification information but there is nothing like first hand knowledge of what to expect. The instructor gave practical test taking suggestions in addition to providing specifics about the exam.

The CPC exam is divided into three sections. Section One: Surgery and Modifiers; Section Two: Evaluation and Management, Anesthesia, Radiology, Lab & Pathology and Medicine; Section Three: Medical Terminology, Anatomy & Physiology, ICD-9-CM, HCPCS, and Practice Management. There are a total of 150 questions on the test. The AAPC allows 5 hours and 30 minutes to complete the test. The applicant must pass each section to pass the exam. Failure on one part of the exam will mean that you failed the entire exam. The applicant must score a seventy or higher on each section to pass. If you fail the test, you will be allowed to retake it within 12 months free of charge. After the second time, you must pay the application fee to take the test.

There were participants at the review who had taken the test before and had to retake it because they did not pass one section of the test. They did extremely well on the other sections of the test but failed one section by just a few points. I asked the instructor what the national passing rate was for the AAPC. She did not know the national average but did say that the local chapters results were not good. This did not make me feel better. It only increased my level of anxiety.

The instructor informed participants of how the questions might be asked on the exam. She asked us a couple of questions and our brain turned to mush. She was trying to illustrate the point that you must read every question carefully or you will be thrown off track. She informed us on what the AAPC will allow us to mark in our coding books. She cautioned against excessive highlighting in our coding books. She recommended reading the CPT guidelines in the front of each section in the code book. This way you will already know the guidelines and will not have to waste time looking up the guidelines in the book during the test. The same is true of ICD-9 guidelines.

Here are tips for preparing for the AAPC CPC exam:

Study two to four hours a day
Know the CPT, ICD-9 coding guidelines
Read and review the CPC exam review guide
Complete the Pre-test and Post-test on the CPC exam review guide
Complete the Mock AAPC test in your CPC exam review guide
Practice CPT, ICD-9, HCPCS coding
Use flash cards to review medical terminology
Use the CPC exam review to study anatomy/physiology
Stop studying at least 3 to 4 days before your exam
Only the AMA CPT code book will be allowed for the exam. (You must have the current year.) You will not be allowed to take the exam will an old code book.
AMA Professional CPT book is recommended (because of the extensive diagrams, color coding, and tabs)
The ICD-9 and HCPCS code books can be published by any source but must be the current year's text.
Allow 2 minutes per question on the exam (medical terminology, anatomy/physiology, practice management) You will need more than 2 minutes on the actual coding questions
Take your breaks as scheduled
Bring several sharpened #2 pencils
Bring plastics rulers to use as bookmarks
Bring bottled water, snacks
Read each question carefully
Skip questions that you don't know and come back to them later
Review the bubble test card to be sure that you marked all answers
Relax it's finally over!

With any luck you might be successful taking the exam. The instructor pointed out that participants who use the CPC Exam review guide have a better success rate passing the exam. The author of the review guide developed the AAPC curriculum and develops test questions for the exam. I already have my CPC Exam review guide and have gone through it once. Let's hope that I am part of the successful group!

CPC Exam Strategy

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 27 Oct 2008 13:58:00 GMT

I have been thinking of ways to tackle the CPC exam. The process of preparing for the examination is overwhelming. The CPC exam will cover medical terminology, anatomy and physiology, practice management, CPT, ICD-9 and HCPCS coding conventions and guidelines. I will have to apply the CPT, ICD-9 and HCPCS coding guidelines to actual case scenarios. There are so many areas that I need to study. I definitely have enough resources to study for the exam. There is no way that I can memorize all this information.

Developing a test strategy that works for me is crucial to my success. I decided to focus on the areas in which I am weak. The CPC exam review guide comes with a CD that allows you to take a pretest. I decided to use this pretest to see where my weak areas are. I wrote down the areas that I am weak on and need improvement before taking the exam. I went through my resources to determine if I had enough information to cover these areas. I plan on spending the bulk of my study time on these areas. After I am sure that I have a thorough understanding of the information, I will take the CPC exam review test again and compare my results with the first test. This should give me an indication of the progress that I have made. Hopefully, I will have made some progress.

I wrote down all my weak areas and seeing them on paper makes them real. I will tackle one area at a time. Once I am satisfied with my level of comprehension, I will check off the area on my list and move on to the next. Also, I will set a target date for a completed review of everything on my list. Working with a deadline will prevent me from procrastination.

As I have been studying for the CPC, I am aware of the areas in which I have a strong comprehension level. The medical terminology, anatomy and physiology, practice management and ICD-9 coding are my strongest areas. I still plan on studying for these areas but probably not with the same intensity of the areas in which I am more vulnerable.

I will be attending a CPC exam review next week. This review will be a simulation of the actual CPC exam. The test will be timed and proctors will be assisting with the exam review. I am hoping to get a feel for the actual test and pointers on how to take the exam. I will let you know how this turned out next week.

Test Preparation

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 20 Oct 2008 13:02:00 GMT

I am preparing to take the coding certification examination by the AAPC (American Association of Professional Coders). I purchased the coding certification exam review text as suggested by one of the members of the AAPC. The exam text recommends certain steps to study for the exam. I reviewed these steps but felt that I needed to develop my own strategy to prepare for the exam.

The most important factor in studying for the examination is time. Time is a precious commodity that I have very little of. My days and evenings are full with the classes I teach and trying to keep pace with all the expectations. I am under contract with a couple of schools and it can be overwhelming to keep the train from derailing. Unfortunately, this is a fact that I cannot do anything about. I must make adjustments to get in enough study time.

I am at my best in the early part of the day. My brain seems to function better and I have more stamina to keep going. Studying in the evening will not work for me. I am usually zapped of energy by the evening. My focus is simply not good. Since my classes are in the mornings at the community college, I will have to study in the evening on these days. The online classes allow me to control the schedule.

On my days at the community college, I will study two hours in the afternoon before my kids come home from school. On my off days from the community college, I will study three hours in the morning. On Saturday morning I will devote three hours in the morning and take a break from studying on Sunday. The most important thing about this schedule is having the ability to stick to the schedule. This means developing a routine study schedule and following it no matter what. I plan on using a calendar to record my study schedule. This gives me a visual of the time I am spending studying or if I have missed days studying.

Next week I will discuss how this strategy is working and how I will tackle the various sections of the test.

Juggling Act

Carol Dantzler-Harris, MEd, RHIA, CPC — Tue, 08 Jul 2008 11:25:00 GMT

I have accepted my third teaching position at another online university. I will be teaching an associate-level course on billing and coding. The university is on the quarter system and the course will be taught over a 5-week period. The curriculum will have the students engaged with critical thinking by conducting research on the issues surrounding health care. There are individual and group projects that will require students to really focus on how to work as a team and understand group dynamics. The discussion posts will also involve research and forming opinions based on credible sources to support their claims. The course is accelerated and jam-packed with a significant amount of course material that must be covered in a short period of time. Although I teach at another online university, the platform is entirely different. I will have to learn my way around the online course room all over again.

The last week has involved an extensive orientation for new faculty. I am required to complete a 2-week orientation class. This orientation class is not just fun and games but I have to complete assignments by a certain date. If that wasn't enough fun, I also have a group project due by the end of next week. The training for new faculty is designed to simulate the virtual world of the online course room. Part of the orientation involves attending six weekly live chat sessions facilitated by a trainer from the university. The live chat sessions involve audio and we can actually interact with the trainer.

When I wasn't working on my mandatory orientation assignments, I was exploring the course room. I played around in my live chat room and had fun with all the cool features. I am a little freaked out by the audio for the live chat sessions. I am required to facilitate two live chat sessions a week and record them for archives. The audio classes will help me to improve my skills as a facilitator.

I am exciting by challenge of the course and the opportunity to improve my teaching skills. I feel extremely fortunate to have three teaching contracts at the same time. This will certainly keep me busy.

The scary part is keeping track of the courses and figuring out what planet I am on. How will I ever keep everything straight? How will I get all the assignments graded on time? I am sure there are plenty of technical gadgets that can keep me organized. I am working on completing a PowerPoint for the first week of class. The course starts on July 21 and I am sure that I will be stressed out until I facilitate my first live chat.

Construction Zone

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 30 Jun 2008 20:15:00 GMT

As I stated in last week's article, I am in the process of developing two online courses at the community college. I will be teaching Medical Coding & Insurance and Introduction to the Electronic Medical Record to medical assisting students. I have tons of ideas floating around in my head about how I want the classes to be structured. The problem is sifting through these ideas and narrowing it down to fit the course objectives. Where do I start? Do I start developing both courses at once? Do I tackle one course and then start the next one?
I decided to start with medical coding and insurance course. I need to start with a roadmap to get to the finish line. So, I started with developing the course outline. The course outline will include the schedule for the next sixteen weeks based on the school calendar. I need to be sure that I work around school holidays and other campus events. The second step was to decide on the textbook for the course. This was an easy task because I have been reviewing coding textbooks over the last few months. I had no idea how many coding textbooks are on the market. Everyone seems to want to get in on this. When I was in school, there were not many choices for textbooks. We used a simple three-ring orange-binder that included the basics up to advanced coding. I don't recall who the publisher or author was but the instructor did an awesome job.

In my selection of the course textbook certain criteria was used to make a selection. The author of the textbook must be credentialed as a certified coder. This is the industry standard today for hiring coding professionals. The content of the textbook must be thorough and explain the concepts in a manner that is user friendly. Coding is such a difficult task to learn and with beginners they can easily get lost by a text that is too complicated. The flip side of that are some texts that I reviewed that were a little too elementary and lacking in substance. Another important factor, are texts that use illustrations and examples to reinforce the written text. This is very important for those learners who are visual. Visual learners learn best through pictures and other illustrations to help process information. I decided to go with the coding textbook book by Carol Buck which does an excellent job with explaining how to code using CPT-4. Buck uses illustrations and practice exercises within each chapter so that students can check their progress. Another reason for choosing the text, is that the students will be working in physician offices where the focus is on CPT coding. We will spend the last few weeks with a basic overview of ICD-9-CM coding.

Now that the coding textbook has been selected, I can determine how much material from the textbook we can cover in sixteen weeks. I don't want to exclude any information but I won't have time to cover everything. I will have to make this decision based on what information they will routinely work with in the physician's office. Because CPT is arranged in distinct sections, I want the students to be informed about all of these. What do I leave out? How do I balance what they need to know with the time constraints? Tune in next week for update on the construction zone.

More Changes

Carol Dantzler-Harris, MEd, RHIA, CPC — Mon, 09 Jun 2008 14:17:00 GMT

I attended an HIM workshop last week to hear the latest on the ever-changing world of government regulations. The workshop was an update on the Centers for Medicare and Medicaid Services (CMS) changes affecting coding and DRG assignment. For the last twenty years, hospitals were reimbursed under the old inpatient prospective payment system (IPPS). CMS has made major changes to the system, which is now called MS-DRGs (medical severity diagnostic related groups.) The new payment structure will be based on the severity of the patient's condition. The current 538 DRGs will be replaced with 745 MS-DRGs.

In addition to the changes with DRGs, hospitals must indicate on all Medicare claims if conditions were present on admission. Claims without the present on admission (POA) status will be returned to the facility. CMS developed a coding system for POA indicators:

Y-Yes-condition present on admission

N-No- condition not present on admission

U-Unknown- insuffienct documentation to determine POA

W-Clinically Undetermined-the provider cannot clinically determine if the condition was POA

As if POA indicators were not enough, certain hospital acquired conditions (HAC) will affect the reimbursement the hospital receives. On October 1, 2008, codes representing these HAC will not be included with calculating MS-DRG assignment.

Since these are the most sweeping changes to IPPS in over twenty years, many are concerned about how the changes will affect their bottom line. Although hospitals must be concerned about their reimbursement, the most important factor is to take the burden off coders. When DRGs were first implemented, coders had to worry about selecting the correct principle diagnosis, comorbidities and complications. Now, the coders must worry about assigning the correct principle diagnosis, comorbidities, complications, POA and HACs.

I have not worked in acute care in years. Now, I am convinced the decision to leave this area was a good one. In my years away from acute care, I have tried to keep up with what is happengning in this area. Now, that I am teaching I need to have more than a general knowledge of the world of IPPS. This area of HIM has always been subject to every changing government regulations. I spoke with coders who struggle to keep up with the changes. The biggest area of concern is the problem of continued lack of documentation. A major part of POA is having sufficient documentation to support the coding assignment. HIM managers must take the pressure off their coders and implement educational programs that will ensure compliance with the regulations.

References: MS-DRGs: CMS implements major revisions to IPPS (warning: PDF), BKD Healthgroup, by Tom Wolters

CCS Prep!, Advance for Health Information Professionals, by Cheryl D'Amato