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What impact will the electronic medical record have on the medical coding career - Suzie

Posted: Mar 20, 2011

Dear medical coding students and medical coders:

I am starting The Andrew's School of Medical Coding on April 1, 2011 and I have I am looking forward to it. I want to ask you your opinions. I was at the dog park with my pug Cruncher yesterday and I was telling my friends that I was looking forward to starting school and one my friends who is an oncologist at NIH was advising me that I should think twice about starting medical coding as a profession because the implementation of the electronic medical record will have an impace on medical coding in that there will be no need for coders since the code would be put in automatically. I am a medical transcriptionist and I do not want to start off on a new career; I have seen what outsourcing has done to the profession of transcription and I do not want to go through this again. I would like your opinion about this. Thanks.

Fondly,

Suzie

Some thoughts . . . - Coder

[ In Reply To ..]
OK, I'm something of a health informaticist and a coder, too, so let me give you my take on this.

I think your friend the oncologist longs for the day that all manner of health information management professionals -- coders, documentation improvement specialists, compliance officers, privacy professionals, and the people who run after her demanding that she complete and sign her delinquent documentation -- die a slow and horrible death, and she is trying to dissuade you from the occupation in order that there be one less aggravation standing between her and her desire to do whatever she pleases. She's likely to feel the same way about health informaticists when they start haranguing her about misuse of their new EHR, too.

That may seem extreme, but it isn't very far off base. Physicians who work for the federal government (NIH, for instance), where they are paid salaries and their pocketbooks are not directly impacted by revenue issues, tend to scoff at coding. It's just something done by those annoying people in HIM. (You know, those people who suspend doctors privileges because their records aren't up to date?) In fact, they often resent having to do their own documentation in the EHR, preferring to scribble it on paper, and fight tooth and nail against it once it is installed.

Coding is more than mindless plopping-in of codes. It requires some degree of thought and decision-making. Sure, software can pick up medical terms and code them, but that's not what most coders do. An inpatient coder, in particular, does a lot more than that. Doctors don't like that inpatient coder querying them after the inpatient coder has reviewed the record and noted that they left out something important, like that bowel they lacerated or the nosocomial infection that's in the lab work but not in the progress notes.

The thing is that coding is the foundation skill for upward mobility in several related areas like consulting, compliance, and documentation improvement. What you are going to learn will lead to better things than your doctor friend envisions.

I would not worry about this. I am not personally worried about EHRs eliminating my job, because I work for an organization that is fully EHR'd and has been for years, and the EHR has EXPANDED job opportunities for people who have coding skills.

Think about it this way . . . even if the software was able to code the conditions the doctor mentioned, the problem is still going to be that the doctor isn't going to call the conditions what the software expects to see, and the doctor isn't going to document everything that should be there, and the doctor isn't going to do a whole bunch of other things that are necessary. That will create a job for you.

I think that you're smart enough and have enough background in MT to be able to get settled in coding quickly, learn everything you can, and WANT to move on to something more challenging. I think that you're in a good field for that and I also think that your school might have already thought about and planned for your eventual advancement.

So, next time you talk to your oncologist friend, assure her that you checked with someone who is familir with the field, they felt that there would be enough coding to go around for a number of years, and that your ability to advance from coding into something that the EHR is going to spawn will be excellent.

The EHR isn't going to defend her codes to the CMS auditors, you know. Someone like YOU will be doing that.

It is fine by me if the EHR plops in codes--that's the boring part of coding. There will be lots more for you to do.

More thoughts - Anonymous

[ In Reply To ..]
I have seen a bit of electronic coding where I work as an MT, and agree with Coder. What the software chooses as the primary condition is not necessarily the billable condition or the reason the person is being seen. It is a tool for data collection and statistics. I see that method as being beneficial for insurance companies to compile statistics. Also, there is no standardized method to the terminology the providers use. For inpatient as well as outpatient coding, someone needs to peruse the entire patient record to code accurately. There is computer assisted coding software, but that is merely a coding aid. As Coder mentioned there are many opportunities in the coding world and I see quite a few openings for coders (mostly inpatient) in my area. I'm a student so don't have much more to add. I'm uncertain if I made the right choice but there's no reason why you won't be successful. Good luck at Andrews, be sure to let us know how you like it.

thoughts on coding - Viva

[ In Reply To ..]
I can tell you just from going through coding courses that coding is not just a matter of inserting numbers, as Anonymous pointed out. You have to become a savvy detective and be very careful and thorough to get it right. Some of us humans are better at it than others, but a machine sure as heck cannot match us.

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