When I look back a few years ago, I was a student carrying a degree without having a job in hand. At that time, I was desperately looking for a job. So, I was badly searching for a job for at least 4 months. In my country I can will surely say that, finding a job is also a kind of job since there are so many unemployed educated professionals here. Till this period, I have never heard anything about medical coding. Then I met one professional who was staying in my hostel, who was working as medical coder. He told me that any graduate fresher can go apply for this job in his company. He even agreed to give his reference. Since, I had no choice I immediately showed interest in medical coding. So, this was my first step toward a career in medical coding. So, finally I got selected as a trainee medical coder in my friend’s company.
Training in Medical coding
Since, I was a fresher the company gave 15 days training to us. This was the period I came to know the knowledge and skills required in medical coding. CPT codes, ICD 10 codes, HCPCS codes etc. were very new for me. But, when I read the CPT and ICD codebooks, I used to clear all my doubts. Also, I use to surf websites related to medical coding in my free time which gives me lot of information about this field. During my training, I was also told that once you feel confident or perfect with the medical codes, you should also try get some credentials. But, at that time I was just focusing on how to code a medical report with a numerical code. So, during our training session we are given few sample medical coding charts which we use to code using codebooks. These sample charts surely boost our confidence as medical coder, which really helped me to prepare for my future medical coding certification exams.
Coding Live Medical reports
Once I finished my training period, I was then placed in coding project to code the live medical coding reports. Since, I was good in coding radiology reports, I was put into radiology projects. In radiology, I used to code X-rays, MRI, CT, MRA, CTA, PET-CT scan, Nuclear medicine, ultrasound etc. The easiest charts where the chest X-ray one view and two views. Also, I used to love coding MRI, CPT codes and Ultrasound CPT codes. In ultrasound, coding for Abdomen complete and limited use to quite tough for me since we used to calculate the presence of eight organs in Ultrasound abdomen complete. Also, I used to love coding the CTA exam of chest which used to find Pulmonary embolism. Even coding for Renal ultrasound exam, we used to be very careful for coding renal complete and limited ultrasound exam. All the CPT codes has be assigned as per the coding guidelines, wrong codes were considered as Fraud. The tough section to code in radiology was nuclear medicine CPT codes, the thyroid uptake or imaging, parathyroid imaging, HIDA scan, PET scan etc. Also, the upper GI series codes used to create lot of confusion when I used to code them. The used of single and double contrast always used to land me in wrong code.
After coding for almost 1 year, my confidence increased in coding radiology reports. Now, I don’t even need a CPT code book or software to find a code, just reading a radiology medical report I can tell the procedure code. Now, since I was doing good in radiology coding, I was promoted to as senior medical coder. Also, I was moved to more complicated project in radiology like Interventional radiology.
Start as an Intervention Radiology (IVR) coder
When I was moved into interventional radiology (IVR) facility, I was given a training for 1 month. Now, this training really helped in coding the complex sample interventional radiology charts. This facility was really interesting because of the way codes used for coding. Even after going home I used to research about IVR coding on internet to find any sample coded interventional radiology charts to understand the basics. My 1-month training was divided into four weeks. So, I will tell week by week how my training was done.
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First week- Biopsy coding
The first week was totally focused on biopsy procedures. The most common among them was Fine Needle aspiration and breast biopsy. Here, I came to know about the concept of coding imaging guidance like ultrasound, fluoroscopy, CT, MRI etc. Earlier when we used to code breast biopsy was used to code along with ultrasound (76942), fluoroscopy (77002), MRI, CT (77012), stereotactic guidance. But, now new CPT codes for breast biopsy include all the imaging guidance. Also, the bone and bone marrow biopsy was little complicated to code, especially for Medicare. But in my training we use to solve the sample IVR chart will help to clear lot of our doubts. Other biopsy procedures like Lung Biopsy, thyroid biopsy, liver biopsy etc. are straight CPT codes in codebooks.
Second Week- Joint and Spinal injections
There are a lot of exams for joint and Spinal procedures. For coding arthrogram, arthrocentesis, myelogram, I learnt during this period. I got a lot of confusion while coding for arthrogram and arthrocentesis/joint aspiration. But, by solving few sample reports I came to know the difference between them. You can use arthrocentesis codes for joint aspiration as well. Here, I learnt the use of imaging guidance especially the fluoroscopic guidance 77002 which is used only for biopsy and injections procedures. Myelogram is also very common procedure and I took very little time to code these procedures. Coming to spinal injections, now we have new CPT code in 2017 for spine procedures, but earlier we use to code them along with imaging guidance. But, if we talk the new CPT codes these included all the imaging guidance and radiological supervision and interpretation done in the exam. Always, use CPT code 77003 fluoroscopic guidance for all spinal procedures, when they not include this service.
Third week- Nephrostogram
Nephrostogram was very confusing code initially in my learning days. Since, we were beginner we were lot of doubt in coding CPT codes related to Nephrotogram. The main issue here is we have separate codes for nephrostogram for new access and for existing access. Same coding issues I had with cholangiography coding. Sometimes the report does not clearly document about the access, and we land up to wrong codes. Now, the new CPT codes for nephrostogram have made the coding job easy by including the radiological supervision and interpretation. I learnt coding hysterosalphingography, abscess drainage procedures, stent placement in renal and ureter region etc. during the rest of the days.
Four week- Vascular Coding
Coding vascular procedures is considered very complex compared to non-vascular procedures. The first day I was taught about the concept of vascular family. If you know about the principles of vascular family, you will easily code any vascular chart. I used to first get confused with Selective and Non-selective catheterization due to my poor anatomy knowledge. But, later with some sample charts I cleared my doubts. It was really amazing to code the CPT codes on the basis of movement of catheter. If you know the position of tip of the catheter, you will always code the correct codes. The new CPT codes for upper extremity (36220-36228) for catheter placement has made the coder job very easy. Coming to interventional radiology procedures like angioplasty, stent, embolization, thrombectomy etc. these procedures cannot be learnt in few days. So, I finished my training for 1 month, the next 15 days I tried learning about these interventional procedures. Now, we have new angioplasty and stent CPT codes in 2017, which has decreased lot of headache for coders. For lower extremity coding, I never had problem in coding intervention procedures, since there are combined codes for stent, angioplasty and atherectomy. For upper extremity I have struggle to find the codes for interventional exams.
After 45 days of my coding training I was confident to code the diagnostic and interventional radiology. Soon, after few months I applied for CPC exam, since I wanted credentials for my career growth. I used my all coding knowledge for the preparation of CPC exam. And then the day came, when I Cleared the CPC exam in first attempt. I was so happy about the whole journey as a medical coder. I just wanted to share some part of my life with you guys, hope you would have also enjoyed your journey as a medical coder.