Coding, Classification & Reimbursement

1.  Where Do I Begin? Totally New to Coding...

Posted 14 days ago
Edited by Genevieve Gabriel 13 days ago
Hello Everyone!

I have been an RN for 26 years - in Telemetry, Critical Care, Case Management, Disaster Preparedness, Emergency, and, currently, as Nursing Supervisor - in an acute care hospital. I have no medical coding experience whatsoever.

I received my MSN (Executive Track) in 2015. I somewhat wish now I had gone the Informatics route.

I have a deep desire to learn how to code and get CCA certified. But where do I begin? I don't even know coding lingo!

These are some ideas of mine:
  • Perhaps take a refresher medical terminology and/or anatomy class at my local community college?
  • Take a medical billing class at local community college
  • Volunteer at my hospital to learn how to code / get experience as a coder
Here are some questions:
  • What's the best way to start a career in medical coding?
  • Tips, tricks, suggestions, or links on AHIMA site you can suggest to make this transition easier for me?
  • Any recommended courses to take to prepare for CCA exam? (Preferably ones that are financially sound)
  • Anyone willing to be my mentor?

I found and joined AHIMA just the other day. I'm so glad I did.

Thank you kindly in advance,
Genevieve


2.  RE: Where Do I Begin? Totally New to Coding...

Posted 14 days ago
​Hi Genevieve . .. First  - Welcome to AHIMA.  You will find an amazing array of HIM and coding professionals in the organization.

Second, with your clinical background you are well-positioned for a coding career.  I suspect you don't need a terminology or A&P refresher - I'm guessing you've got that down.  I would NOT suggest a medical billing course . . . those courses are designed to teach you medical billing with a sprinkle of coding thrown in.  They are specifically set up to have you doing billing in a provider/clinic setting.  Finally, volunteering may not provide you with the technical information needed to learn coding.

There are, however; several great options.  AHIMA offers a coding basics course that provides training in all areas of coding.  Completion of those courses would set you up nicely to take and pass the CCA exam.  Also, there are many Associate degree programs that offer coding education also.

Please reach out to me and we can talk about different options . . . Kathy.devault@uasisolutions.com

Thanks,
Kathy

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Kathryn DeVault
Manager
UASI
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3.  RE: Where Do I Begin? Totally New to Coding...

Posted 13 days ago
​Hello Genevieve,  I think you have an advantage over some other people trying to become a coder.  You have the medical knowledge which, to me is a big start.  My only piece of advise is stop thinking like a nurse and train yourself to think on the other side of the spectrum.  Because in the hospital I work in, the nurses operate in a whole different environment then the billing and coding world.  Its not a bad thing, we all have the same goal, its just our focus is in different areas.  A nurse turned billing and coding is a good asset if you can change your mind set.  I have worked with a lot of nurses and not all of them are the same, and you could be different, so I wish you well, and good luck with your certification.

Take some billing and coding classes and then study for your certification.  You can do it!!  After you get your CCA and have got a couple of years coding under your belt go back and sit for your CCS.

Best wishes

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Kimberly Combs
Certified Coding Specialist
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4.  RE: Where Do I Begin? Totally New to Coding...

Posted 13 days ago
​Well!! that didn't work well.

I tried to copy and paste the requirements to become a CCA from the AHIMA website and I would'nt let me.  So,  I would recommend going to the AHIMA website and look under certifications and if you look under the CCA certification, it will tell you what you need to do to sit for the exam.

You have posted on this AHIMA engage sight, so I'm assuming you are already an AHIMA member.  If not, that is the first thing you should do before anything else.

First and foremost Genevieve, DO NOT take those online classes that so they can teach you to become a coder in six months. We call them fly by night classes.  They don't teach you anything useful.  Get your certification through a reputable sight like AHIMA or AAPC.

If you need help or want to ask more questions, I would love to help you.  I have been a coder for 18 years and I work in an acute care hospital in the medical records department.  Everyday I learn something new.  I also work with an RHIT with a lot of knowledge. She does all the inpatient coding and I do all the outpatient coding. So we will gladly help you in anyway.  I have helped a couple of people prepare to take and pass the CCS exam.

So if you have any more questions just shoot me an email and I will try to help you or guide you to where you can find out. Here is my email.

kcombs@kearnycountyhospital.com

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Kimberly Combs
Certified Coding Specialist
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5.  RE: Where Do I Begin? Totally New to Coding...

Posted 13 days ago
I agree with everything that has been said so far! Avoid billing since that really is a separate job than coding and shadow coders at your local hospital. I am working through the Coding Basics Program through AHIMA and it is great (I have 2 courses left- CPT and Reimbursement). It is an amazing program.  As far as CCA requirements, you don't need to complete the full coding program so you could take ICD-10-CM/PCS, CPT, and reimbursement  to understand the language, processes, etc, and then sit for the exam.  Then you can do 2 years of applying codes as a coder and be eligible to sit for the CCS (read the CCS requirements to see what would work best for you).  Other than that, your background will be a great help for understanding the anatomy/physiology of diagnoses and procedures which will give you a step up for applying codes more effectively.

Another tip, constantly read, post, and reply on these AHIMA engage forums!  It is amazing to be a part of these discussions and use other coders as a resource as you learn.

Good luck and welcome to AHIMA!

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Kate Krakow
Coder In Training
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6.  RE: Where Do I Begin? Totally New to Coding...

Posted 12 days ago

Thank you, ladies, for the warm welcome and for your responses!

 

Kathryn, you're right. I don't think I'll need to re-take medical terminology and A & P. Per your advice, I won't volunteer either. For the last couple of years, I've been taking classes "for fun" at the local community college (which is how I learned about coding – from my typing teacher!). With the courses already taken, turns out I can get a Medical Coding & Billing Certificate of Achievement, or perhaps even an AA, by June 2019.

 

Kimberly, I agree that having my nursing experience is a HUGE advantage. I am so grateful for that. Honestly, I don't even know the difference of how a nurse thinks vs how a coder thinks (because I just found out about coding literally 4 days ago). What I interpret so far from what I've read is: Coders are like investigators, and coding is like doing a puzzle. What you recommended – to get my CCA then my CCS – is exactly what I had in mind. I will only take courses through AHIMA, and I'll check out AAPC.

 

And, yes, I am a member of this organization. I found AHIMA as I googled about coding. I didn't even know what AHIMA meant or what it was about. My $79 new member fee has been worth every penny. What a wealth of resources this site has. Plus, I've been able to connect with you all here!

 

Kate, thank you. I will check out the Coding Basics Program. I'm still discovering all that AHIMA has to offer. I love this Engage forum and this site!

 

For you three and anyone reading this:

 

I'm close to getting a certificate of achievement in coding & billing. Concurrently, I will study/prepare for the CCA exam. The reason I chose to go for CCA vs CCS is I did not think I qualified for CCS. (Kimberly, I already had the Candidate Guide saved on my desktop). But after obtaining a certificate of achievement in coding & billing, I think I would be able to sit in on the CCS exam.

 

  • Should I get CCA or CCS certification (first) and why?
  • What are the advantages/disadvantages of CCA vs CCS?
  • Get both CCA & CCS?

 

I am planning to stay and work as Nursing Supervisor at my hospital until I retire in 10-15 years. After that, my hope is to supplement my retirement as a coder from home.

 

Well, this reply turned out waaaayyyy to long. I'm really excited about becoming a coder!
 

Gratefully yours,

Genevieve



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Genevieve Gabriel, MSN, RN
Nursing Supervisor
Providence Saint John's Health Center
Santa Monica, CA 90404
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7.  RE: Where Do I Begin? Totally New to Coding...

Posted 11 days ago
So glad we were helpful!!

As far as CCA vs CCS, from what I can tell:

CCA is an entry level certification (usually labeled a Coder I) all coding jobs I've looked at in my area (Wisconsin) ask for the CCA or CCS so there really is no difference when it comes to eligibility for jobs.  CCA allows you to get a job and gain a year or two of experience applying codes before sitting for the CCS or any other specialization.

CCS is more of a "mastery" of coding so if you have a CCS you will be eligible for Coder II and Coder III positions which require more skills, etc.  If you complete the Coding Basics Program you will be eligible to sit for the CCS.  If you do not complete the Coding Basics Program, I believe, it is 2 years as. CCA applying codes to be eligible to sit for the CCS.

My two cents, take the core coding courses through the Coding Basics Program and sit for the CCA.  You'll have a better chance of passing and can then get a coding job much quicker.  You will also have time to get very comfortable with coding on the job as well as the software used.  This will give you time to fully complete the Coding Basics Program and if you are comfortable take the CCS, if not continue working as a coder I for 2 years until you can sit for the CCS.  Either way, get the CCA first!  It's what I'm doing and I plan to sit for the CCA by January at the latest so I can get the CCA and a coding job as soon as possible.  Then I will make sure my Coding Basics Program is complete, practice on and off the job until I'm absolutely confident I can pass the CCS!

Happy Coding!!!

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Kate Krakow
Coder In Training
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8.  RE: Where Do I Begin? Totally New to Coding...

Posted 10 days ago
Hi Kate,

Thank you for your input.

I'm just learning the differences between CCA and CCS. From your response, what I extrapolated was getting a CCA then CCS is like becoming an LVN then an RN. CCA certification or LVN license allows one to be legitimate immediately and work in that field of work; and CCSs and RNs are more "mastery" (not sure if that's proper grammar) at their skills.

My thing is: I plan on staying at my job and don't intend on leaving for a coder position. My purpose in becoming a coder is to acquire a skill that would supplement my income (which I don't need to do, but why not?) until I retire. I would also be able to do it after I retire. Plus, I love that I could do coding from home and whenever I want 24/7.

I agree that getting CCA certified first, as you recommended, is a great idea. I'm leaning that way. Getting my CCA would label me a legit coder right away, while gaining experience. At the same time, from the week's worth of research I've done so far, I'm learning that with my clinical background, I could possibly go straight for CCS. I'm still gathering data.

Then, also, someone mentioned the world of CDI, which I never thought of. That's another topic.

Regardless, I truly appreciate your input. Thank you for your time and tips.

Good luck when you sit in on your exam in January. I'm sure you'll pass with flying colors!

Best,
Genevieve




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Genevieve Gabriel, MSN, RN
Nursing Supervisor
Providence Saint John's Health Center
Santa Monica, CA 90404
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9.  RE: Where Do I Begin? Totally New to Coding...

Posted 10 days ago
Hi ​Genevieve,


I wanted to share some advice as well. What I have seen from nurses that have posted on Engage that migrated into coding Is you have to turn off your 'diagnosis brain'. Meaning that you cannot infer what a physician meant or diagnose based on vitals, labs, or other test results. If the physician doesn't clearly state a diagnosis in their charting then you usually need to query if documentation conflicts with lab or other diagnostic testing. A traditional coder does not have advanced level of diagnostic skills  and are not a licensed medical professional.

I also wanted to share that you might want to look into the field of Clinical Documentation Improvement (CDI) Specialist. A CDI Specialist is the liaison between the medical staff and the coding department, as they strive to have the most accurate and complete medical record available for coding. Essentially they review the chart to ensure that provider documentation is as detailed as possible to ensure that coders have the documentation needed for accurate coding. Most CDI Specialists do review of inpatient Medicare charts. Accurate documentation for inpatients where Medicare A is the primary payer as reimbursement is based on the patient's diagnosis and not based on a how many days a patient ends up staying the hospital.Prospective payment rates are  based on Diagnosis Related Groups (DRGs) have been established as the basis of Medicare's hospital reimbursement system. The DRGs are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its case mix) to the costs incurred by the hospital. Patients who are sicker require more resources and so reimbursement should be higher. A patient with x condition will get y reimbursement regardless if the patient was in-house for 3 days vs 5 days. In order for hospitals to have optimal reimbursement patients need to be assigned to the correct DRG. A patient is assigned to the correct DRG through accurate coding assignment by an inpatient coder. Accurate coding depends on optimal and detailed documentation.  This is where the CDI process comes into play. A CDI specialist reviews the chart and queries the provider if documentation is unclear. Many healthcare professionals would make a good CDI specialist but often times are hired due to their rapport with providers.

CDI Threads on Engage:

CDI Specialist Questions


Warm Regards,




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Sarah R. Keppen RHIA
Applications Analyst
Facilitator Certification Exam Prep Community
2016 Chair Engage Advisory Committee
skeppen@regionalhealth.com
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