Love of detective work is, believes Wendy Tester, an essential trait for a medical coder. "I liked the Encyclopedia Brown books as a kid," she said. "A procedure should be supported by the diagnosis. You don't do a colonoscopy if the patient has an ear infection."
The medical coder converts the procedure and diagnosis codes to a numeric system that insurance carriers and government programs like Medicare use to approve payment. If the coding isn't correct, the payment can be denied.
Tester began her career in the banking industry and moved into a clinic as a bookkeeper. A co-worker needed help with coding and recruited Tester, who was looking for something more challenging. After learning on the job for a while, she enrolled in the Medical Coding program at St. Catherine University and became a CCS-P: Certified Coding Specialist—Physician-based.
The program at St. Kate's includes coursework in coding, medical terminology, health records and reimbursement systems. It also includes anatomy and physiology, which is vital knowledge for the medical coder, Tester said. "A colonoscopy has a different code from a flex sig [sigmoidoscopy] — the procedures go to different lengths within the colon. If you understand the wording on the chart, you know, 'Oh, they recorded a flex sig, but they did the whole colon.' That's one area where anatomy really is a requirement." Similarly, a glucose or troponin level might indicate diabetes or a heart attack that wasn't listed on the chart.
Basic coding work is done on the computer. Tester said that some medical coders spend their days entering data. Those who prefer problem-solving and communication can focus on working with physicians to determine why codes don't match or working with payers on denied claims. "Codes change every January 1 and the software may not be updated. We can call and say, 'It's in the book.' If you know what you're talking about, they will usually say, 'Okay, we'll have that reprocessed.'"
What has changed in your 20 years as a medical coder?
So many places are converting to electronic medical records. We have access from any physical location, and multiple people have access at the same time. The biggest improvement is legibility. Reading physician handwriting was a skill. The health information department used to manage paper records. Now and in the future, health information centers store, retrieve and manage data.
What's the career path for a medical coder?
Coding can open so many doors in health management. There are people who perform audits. Medical record analysts review records for the hospital's accrediting agency. There's resident supervision and physician education. Medical device and pharmaceutical companies need to provide the American Medical Association with justification for new codes for new devices and medications.
How do people get into the field?
It's not a field that many people think of. More and more these days, they're coming to us from schools. There are high school aptitude tests. At St. Kate's, people will start in nursing and decide it isn't for them. Their advisor will say, "This is something medical-related that's not direct patient care."
What do you look for when you're hiring a medical coder?
In addition to communication skills, I look for problem-solving skills. I don't want somebody that knows the diabetes code. I want somebody who will use their knowledge to find the answer. Codes are always changing. Do you have the ability to do the research? □
