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It is remarkable how health care has evolved in the past decade—from the perspective of caring for individual patients to the focus on caring for populations. Tracking disease and illness in these populations begins with the role of coding specialists. Coding has always been a major source of data entry, since the first compilation of the codes in 1893 by Dr. Jacques Bertillon (The Classification of Causes of Death) to the current ninth revision of the ICD-9-CM, which include much more detailed codes to provide more specificity to an individual clinical picture. The role of the coding professional likewise has evolved over the decades into one of a highly technical and specialized field of professionals. Since the mid-1980s, accurate coding assignments have been directly linked to health care reimbursement. Optimum payment for services depends on the skills and expertise of the coding specialists. Not only have coding functions evolved, but how and where coding is performed has changed. Coding requirements have expanded into the outpatient/ambulatory care arena. Some factors have influenced the manner and specificity in which coding is performed and this in turn has created an increasing demand for skilled coding professionals. Some of these factors include: Ambulatory care coding requirements.The implementation of a number of coding systems, including ICD-9-CM, HCPCS, CPT, DRGs and now ambulatory payment classifications (APCs).
The Office of Inspector General's (OIG) National Correct Coding Initiative (NCCI).The American Health Information Management Association's (AHIMA) Standards of Ethical Coding.The increased coding requirements have resulted in a shortage of skilled coding specialists, and currently the supply cannot meet the demand. Many facilities finding it necessary to meet coding timetables are turning to contract vendors to provide these skilled services. More and more coders are recognizing that their knowledge and expertise can be a valuable resource in a number of areas, and they are venturing out on their own to pursue independent careers as contract coding specialists. Developing a Skills Checklist
There are some basic points that should be addressed if you are considering venturing out on your own. This type of career move will take some preparation on your part. Whatever your current level of expertise, it is very important that you not attempt to overstep your limits. Start by developing a self-assessment skills checklist to determine your qualifications. Basic coding education. As coding is much more than just data entry, the skills necessary should include knowledge in anatomy and physiology, medical terminology, basic pharmacology and an introduction to the disease process. Experience. If your experience is in outpatient surgery coding, that should be your target client base. If you are an experienced inpatient certified coding specialist, you have a variety of options.Certification. If you are not certified, you may want to consider it because many health care facilities have compliance programs in place that require coding functions to be performed by certified coding specialists (CCS). You must have knowledge of state and federal regulations that govern coding and health care reimbursement requirements and trends. Technical Skills. You must have a clear understanding of the different coding conventions (ICD-9-CM, HCPCS/CPT, DRG and APCs). You must also be computer literate, with an understanding of abstracting and encoding programs. Continuing education and professional development. Be up to speed on current and changing coding issues. Keep an open mind about expanding your coding skills. Utilize resources such as online courses, coding workshops and roundtables. Availability of Resources. Are your resources up to date? Do you have the necessary tools to do your job? Do you have access to Web-based resources?Try Consulting
As an independent coder, you can provide consulting services in a number of ways. Some of these include: Assistance—performing coding services;Advising—providing review, education and training; and Information—auditing and providing feedback and information regarding results. Whatever path you choose to take, it may require working from home, traveling, on-site services and in most cases, dealing with clients. Work at developing a personal style that works for you, and be consistent. Consider Working from Home
Over the last decade, the Internet has revolutionized organization's access to vendors, and this has enhanced home-based employment opportunities. There are now a number of Web-based coding services that utilize home-based coders. For the past two decades, the medical transcription profession has thrived in the at-home workplace. Home-based medical transcriptionists (MTs) can be an excellent reference in trying to determine if at-home coding can work for you. Coding specialists are similar in many respects to MTs in that they have a knowledge base in medical terminology, anatomy and physiology, and also abide by a code of ethical conduct as well as confidentiality guidelines. Their work also requires quiet and intense concentration. The one big difference is that coding is governed and dependent upon regulatory guidelines that continuously change. Your home-based investment may include equipment, hardware, software, modem lines for Internet access and comprehensive coding resources (hard copy and Web-based). There may be some outlay in computer training for basic problem solving and trouble shooting skills. Consider professional organizations such as AHIMA and the American Academy of Professional Coders (AAPC) for networking and educational opportunities. If you decide to work from home, remember that you will be isolated so you must develop a mechanism for communication with your clients, via e-mail or other alternate. Request feedback on your coding for your ongoing self-improvement. Other Considerations
Other considerations will include your initial financial outlay, appropriate licenses, taxes, marketing, billing for services and other record-keeping responsibilities of operating a business. Keep adequate records and billing logs. Be familiar with the IRS 20 Principles. Establish priorities for your business, including your time commitment. And above all, know your coding limitations. Also, be prepared to: Develop a resume of your education and experience. Your resume should reflect your professionalism. Include a cover letter to introduce yourself and the services you are providing. Consider making up a flier to promote your services. Present yourself for a face-to-face interview. Put yourself in your prospective client's place and ask yourself some questions about the type of services you have to offer and prepare your responses.Discuss your fee for services and terms of agreement that should be beneficial to you and your client. Sign a confidentiality statement and a contract agreement for services. Accept the client who is not interested in your proposal for services. This is a part of business. Keep checking back--things always change. Take risks, assume liability for the quality of your work and invest in your business by advertising. Keep in mind, however, that working independently or from home requires a great deal of self-discipline. If you are a successful professional, self-motivated, independent and passionate about your profession, you can succeed. Stay up to date on compliance issues, network with peers, utilize resources and be sure to invest in the tools you need to do your job. Remember that education is your investment in increasing your knowledge base and expertise. Never stop learning and growing. Quality should be the underlying goal of your business. Conduct yourself professionally and develop a good working relationship with your clients and coding peers. Keep up with new trends and technology to maintain a competitive edge. The coding environment continues to expand in a variety of directions and this can only provide more opportunities for the career-oriented coding specialist.
Donna Avila-Weil is director of HIM and medical staff services at Sutter Lakeside Hospital in Lakeport, CA. She is currently pursuing her certification in tumor registry, and updating the 4th edition of the Independent Medical Transcriptionist.
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