Correction to point number 1: Professional component of WHY something is done. - MTLC (bad MT form - did not proofread first!) (NM)

Wonderful! - Redpen

Excellent!  I'm glad you had a chance to attend a meeting and that it was a positive experience for you.  AAPC meetings tend to be supportive, welcoming, informative, and all good things. 

Your note that about a dozen people had just received their certification and were looking for work was . . . interesting.  What does that tell you about the belief that you need to work for a couple of years before taking the exams?   If all those people somehow managed to pass . . . well, hmm, maybe you can expect to do so as well?  

Let's see if I can add to your lovely notes:

1. Technical component and Professional component. They illustrated the distinction this way: In interventional radiology there is the technical component of what is done, and  then the professional component of something is done.

Exactly!  When a patient sees a physician in the office, the entire visit consists of the physician's professional work.  But, when a patient goes to a hospital or outpatient center to have an interventional radiology procedure done, the interventional radiologist performs a procedure (the professional work or component) in a facility that supplies equipment and personnel to perform the technical component.  The interventional radiologist goes back to his office and has his office staff code and bill the professional component.  The facility codes and bills the technical component.   What happens if the physician owns the facility where the procedure is performed?  He or she gets to code and bill both.

Something similar happens with surgeons.  They have offices, but go to facilities or hospitals to perform surgery.  The surgeon's office staff codes and bills for the office visits and for the professional portion of the surgery.  The facility codes and bills for the hospital stay that includes the surgery, or for just the facility portion of the outpatient surgery if the patient was not admitted.

Before, you might have seen "a procedure" as one thing, but now you can see that it has two separate parts.   You can see that there are jobs on both sides.

2. EMR coding. One coder said she works for a physician practice where she codes, recodes, and goes to the doctors to educate them.

Physicians sometimes have a coder who does all the coding, but sometimes they do the coding themselves.  Their coder will check and recode as necessary.  In either case, an outside coder is often brought in to check the coding that the office does and to provide education for the physicians in the group.  This is part of the practice's compliance plan in which they seek to be compliant with Medicare and other third-party payer rules by auditing what they do and getting education so that they improve.

3. Compliance. Going through coded charts to see whether the correct provider did the correct thing. Interviewed someone who works for a large clinic system. Their goal is to catch problems before the government does.

Compliance is very important because it helps you find errors and problems.  If you're doing this, it helps you demonstrate that you are doing what is necessary to find problems, i.e., that your intentions are good.  

Did this help you see that there are more jobs in coding than "just coding?" 

4. Insurance companies. There is a CPC subspecialty called CPC-P - for Payer. Often they work for insurance companies. One coder said she got her CPC-P in order to help the hospital she works at to understand the insurance side of things so they can get better claims payments and fewer denials.

5. Denial management seems to be a major area for coders to get into. One coder said, and all agreed, the obligation of a coder is to "Do all we can to make sure a service provided is paid for legally." Several coders talked about how much they crave making sure their employer/doctor/department gets paid.

I think this will become more important as time goes on.   There is a huge need for this because it is probably easier to NOT get paid than it is to get paid what you legitimately deserve.  To newcomers to the field, it often seems that if you bill for xyz, then you get paid for that.  That isn't what happens, though.  You can bill for xyz, but under certain circumstances the payer's computer decides payment is not warranted and denies the claim.  You might not know what the circumstances are that the computer used, you might not be able to figure out what's wrong from what they tell you about it, and it might just be a programming error on the part of the payer.  Denials management coders sort this all out so their employer gets paid now and so they can avoid the same thing happening in the future.

You can see that this kind of job is not just "looking up codes."   It's a lot more than that.  This kind of job pays more than plain coding, too.  This is why I'm not much bothered by the claims that computer programs will be looking up codes--that's fine with me!  No computer program is going to replace those denials management coders.

6. Education is another big area for coding. They educate providers, even follow the doctors around in the hospital or when they see patients to see whether they are documenting everything they are doing so as to get payment.

Did this surprise you?  Provider education IS a big thing.  Coding is a full-time job.  It is VERY involved . . . so involved that no provider has the time to spend figuring it out on their own.   Providers and facilities use coders to educate providers on optimal documentation (if it isn't documented adequately, you can't bill for it).   Reimbursement is becoming more and more tight, so there is less room for error and loss. 

Provider education and consulting is one area where former MTs do very well.  Their familiarity with documentation and their wide exposure to different documentation practices gives them a huge advantage.  Think about it . . . how many different variations on any type of report have you encountered?   You already know that providers use different formats AND you know that they often put things "in the wrong place," so you're not at all bothered by differences.   You're not going to be flummoxed by acronyms. 

I'll give you an example of this.  What do you understand this provider to have said?  "HEENT:  NCAT. PERRLA. EOMI. NP WNL." 

A long-time coder who had never been an MT told me she did not know what it meant, therefore it was unacceptable.  It was also "too short"  ("There isn't any detail there.  It's all abbreviations.") and the provider exhibited laziness by not typing it out, therefore she wouldn't give him full credit for the work he did and she reduced the amount billed.  And she had not only never mentioned to any providers that she did this, but had been insisting that all the other coders do the same thing.

(And, no, I'm not worried that this coder will see herself.  I would not have used it had I not seen it over and over again.  There are at least 15 coders who will see themselves.)

As an MT, you're not going to have that problem.  You're also not going to have a problem pronouncing big medical words.  A lot of coders avoid getting into provider education because it requires talking to providers.  If they have never heard the words spoken, they don't know how to pronounce or use them.

Since we're on the topic of MTs in coding . . . if you've transcribed operative reports, you'll be good at something else, too.  You may have noticed that the name of the procedure that is dictated does not always . . . match . . . what was done.  It might identify the procedure in general, but doesn't usually mention the extra work involved due to some circumstance or other, the bleeding due to puncturing something, the fact that they had to use a big sheet of mesh, or that they did something that turned the procedure from what they said it was into something else entirely.    You're going to walk right in the door and be able to read that operative report, see exactly what they did, and code it, and you're not going to be the least bit disturbed by what the title of the procedure says or doesn't say.  In fact, you're probably not even going to look at it. 

Yes, as a matter of fact I was surprised! - MTLC

Surprise - to MTLC - Anonymous