There will be three guest bloggers this week and the first two are nurses who have chosen career paths that are somewhat non-traditional. The first guest blogger is Jennifer Huff. Jennifer is an RN and she is also a coder. Everything we do in health care is assigned a code. The code explains to your insurance company the service provided and determines how much we are paid for providing the service. Coding is an important job and accuracy is extremely important because coding errors lead to billing errors.
Coding is an aspect of health care that a lot of people don’t know about and even those of us who do don’t fully understand the ins and outs. Jennifer did a great job providing an overview of her world and I believe you’ll find it informative. Thanks Jennifer!
What is a coder? I find that even answering this question, most people will still ask, so what is it that you do?
Coders are thinkers, investigators, educators, analyzers, abstractors, auditors…
A coder is the person that takes the patient’s health record/chart and translates the procedures and diagnoses into numerical codes. These codes in turn communicate to insurance companies and government payers like Medicare and Medicaid a request for payment. Reimbursement is generally what we think of as the primary purpose for coding but codes are used globally for research, disease tracking, and for healthcare statistics.
I often times refer to myself as a pencil pusher and at any given time you are bound to hear me say that I love paperwork! These are both characteristics that prove to be valuable for a coder. in addition, coders must have clinical knowledge to both understand and utilize the information in the chart and they must also be able to interpret the physician or healthcare provider’s handwriting. Some days this is the most challenging part!
Coders also have to abide by ethical policies with privacy and confidentiality; the coder is responsible for assigning codes based on what is documented in the chart which leads into the next most commonly heard statement…“if you would have coded this differently, my insurance would have paid.” While it would seem that changing a code would be a simple process, that really is not the case. In order for a code to be used, the provider’s note or documentation must contain the term, reason, and/or diagnosis in order for that code to be selected. For example, say we are asked to change the diagnosis code for a colonoscopy that was ordered because of change in bowel habits to screening. To take coding ethics out of the scenario all together and think about the big picture clinically, what if today the polyps were found and the only code used was screening. This person would most likely need a follow up in at least a year. If the polyp code, along with change in bowel habits were not used (and only screening was used), the insurance company might deny the follow up exam because the only record they have of the previous colonoscopy was that it was screening and since the benefits only pay for a screening colonoscopy every 3-5 years, the exam could would most likely deny as patient responsibility.
Having said all of that, the coder must assign the code based on the documentation in the chart—and unfortunately, the code assignment may not always ensure coverage or payment. The coder understands that coding for a condition that is not documented can be considered fraud and be subject to fines, penalties, and at worst even jail time.
So to summarize the role and function of the coder; a coder is the person behind the scenes that deciphers the medical record and assigns codes for procedures, office visits, supplies, injections, etc and submits to the insurance company or directly to the patient for payment. Along the way the coder becomes proficient in knowing the many many rules of the insurance companies and Medicare. The coder becomes a teacher in his or her ability to share the guidelines to other healthcare professionals.
So from my perspective…I love coding! I enjoy the challenge of figuring out crazy handwriting! For me, there’s something rewarding about reviewing a chart note and finalizing it with a set of codes.
While, the coder may not have direct patient contact, I know that what we do impacts the patient’s health care today and for years to come.