The enemy of all those called to serve in the medical industry is disease.  The pathogens, viruses and bacteria that cause a multitude of discomforts for humanity are an ever present danger, lurking about, waiting to inflict suffering on unsuspecting patients.  Working on your nurse assistant certificate requires a lot of study and attention to the myriad details involved in the treatment of this multitude of ailments.

Just like the ancient Chinese warrior Sun Tzu said, it is wise to keep one’s friends close, but one’s enemies closer.  When your enemies are microscopic pathogens, it can be hard to even visualize what you’re fighting against.  This is why we found it particularly interesting to look at these amazing photographs of some of the world’s most dangerous diseases, taken through the lens of a powerful microscope.  The actual structures of cancer, HIV and others are counter-intuitively beautiful despite the fact that they lead to so much pain, suffering and even death.  But a good certified nurse assistant course like the one at Allen School, prepares students for the many surprises they will encounter during a lifelong career as a certified nurse assistant

Darlene Bakaj-Wood

Darlene works as an administrative assistant/medical coder at North American Partners in Anesthesia, New Britain, CT/Melville, NY. When she first started with the company in 1990, it was called New Britain Anesthesia, PC, but then merged with North American Partners in Anesthesia in 2011. So, essentially she has been with the company for 23 years. She sat for her CPC in December 2012 and started remote coding in January 2013.

Here are some of her thoughts on coding and non-coding issues:

Do you use paper manuals or online encoders?  I use paper manuals and if I get stuck on a diagnosis or a procedure, I use the Internet for guidance. At some point, I will look into the online encoders, but using paper manuals keep you more in the trenches. 

What are your thoughts about specialty credentialing? I am in favor of specialty credentialing. With a specialty, one stands out among others while job hunting and it shows that you are dedicated to your position.

Tell me about your experience with CodingCertification.org. My education for medical coding was done online and I wanted to make sure that I was prepared for the CPC exam. While I had purchased practice tests and a prep course from the AAPC, I still felt that I was missing what I needed to be fully prepared for the exam. I was a member of the AAPC Facebook page and that’s where I learned about Laureen Jandroep and the “Blitz Videos.” This was exactly what I was missing. I don’t believe I would have passed this exam without the help of CodingCertification.org. I’ve also attended their webinars and received CEUs.

What do you find most challenging about medical coding? Cardiology coding is much more of a challenge than any other area. 

What do you like most about medical coding? You are always learning and this is also a career that can be done from home.

I have a serious medical condition, so that’s why I chose medical coding. I’m fortunate that my employer has given me the opportunity to remote code.

What advice do you have for people getting started in their careers? Give it your all. I worked 65 hours a week while raising two sons, so that’s why I chose the online route. Don’t ever give up; keep the big picture in mind while you study and you’ll be amazed by what you can accomplish. Get your CPC and then take any job in the healthcare system you can get just to get your foot in the door.

What are your future career goals? To take the CANPC exam. Once I have achieved that certification, I may look into other specialties for more well-roundedness. What I do like about anesthesia coding is that we use most of the CPC book and not just the anesthesia codes. This prepares me to code for other areas.

What are your hobbies? I am the mother of two amazing young men and love spending time with them, my siblings and their families. I enjoy crocheting, seasonal camping and reading by a campfire with my Maltese, Sadie, by my side.

How does your personality help you in your job? I have a detective-like personality. I love to figure things out. When I hear of an injury or illness, I always wonder, “How is that coded?”

Tell us a fun fact about yourself. I am a twin and my twin is an inpatient coder for a major hospital in Virginia; I guess twins really do think alike.

More Related Medical Coder Information

Be your own Medical Coding Consultant
AAPC – What does a medical coder do?

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When auditing a medical practice, the first thing I notice is the poor choice of diagnosis codes used to describe a patient’s condition. A claim is supposed to tell a complete story so the payer can determine if the claim indicates medical necessity and whether or not a visit is a medical or liability case.

Let’s say that a patient is dealing with complications from an ankle fracture during follow-up care. Using the term “ankle fracture” as the primary diagnosis is not accurately indicating the chief complaint of the visit. So how would a coder know how to code in a situation like this? The answer is simple – read, underline, and learn how ICD-9-CM works.

The beginning of the manual provides a brief introduction to the history and future of ICD-9-CM as well as characteristics, descriptions of Volumes 1 and 2 and disease classifications and a step-by-step guide teaches you how to use the ICD-9-CM properly. Understanding the official coding conventions is extremely important. Without a solid comprehension of the abbreviations, symbols and notations, the code descriptions can be misinterpreted and used improperly to code a patient visit.

The Coding Guidelines are a set of rules that complement the official instructions within the ICD-9-CM manual. Often times, a coder gets stuck with a particular case and is unsure what direction to take in order to accurately describe a patient’s encounter. The Coding Guidelines are designed to give additional instruction per section. The information provided in these guidelines is invaluable and is worth knowing what each section contains. (For students preparing for the CPC exam, be assured that many coding scenarios will point to the guidelines for correct answers asked on the exam.)

Let’s revisit the patient being treated for a complication after he fractured his ankle. How would that be coded? In Chapter 17, b.1) of the Coding Guidelines, a full explanation for coding acute fractures and after care is presented. Examples of active fracture care (800-829) are explained. Aftercare codes (subcategories V54.0, V54.1, V54.8 or V54.9) are used after the active treatment phase is completed and a list of aftercare descriptions is also provided in this section.

This patient, however, has a complication.

A special notation states that care for complications for fracture repairs during the healing or recovery phase should be coded with the appropriate “complication” code. If the “complication” was a “malunion”, we would use 733.81- Malunion, Fracture as the primary diagnosis. This malunion is a “Late Effect” of the previously classified Open Ankle Bone Fracture – 825.31. However, we would not be using the Open Ankle Bone Fracture code. The second diagnosis would be 905.4 – Late Effect of Fracture, Lower Extremity (injury classifiable to codes 821-827).

Additional instructions on fractures include multiple fractures of the same limb, multiple unilateral or bilateral fractures of the same bone, multiple fracture categories 819 and 828, and lastly, multiple fracture sequencing of codes based on severity.

In summary, coders must know all the official coding guidelines in addition to the conventions. There are quite a few items to learn but preparing your book with highlights and tabs can help you maneuver around the various sections with ease. The information provided on coding for fractures is a consolidation of the actual guidelines on fracture care, and as you can see, there is quite a bit of information provided to sequence and code accurately. Courses taught by www.codingcertification.org and www.aapc.com will teach you the proper way to use the ICD-9-CM manual and prepare you for your CPC exam as well as be your reference tool for future coding!

More Related Medical Coding Guidelines

ICD 9 CM Coding- Practice Exercise
AAPC – ICD9 Guidelines and Lab Coding

By JoAnne Sheehan

Since 1981 JoAnne Sheehan, CPC, CPPM, CPC-I, owner of Lomar Associates, Inc. has provided medical practice management expertise as a medical biller and coder, chart auditor, A/R manager , author, and consultant. She has worked on high profile fraud and abuse cases in the Boston area and is also an AAPC Licensed PMCC Coding Instructor.
She has recently joined Laureen Jandroep, CPC, CPC-I, owner of www.codingcertification.org, as an affiliate and independent support representative for CCO’s online physician medical coding program. JoAnne believes CCO offers the most comprehensive approach to becoming a proficient medical coder and is excited to be part of Laureen’s team. She looks forward to working with Laureen and her CCO team and offering students the best education and resources available for the coding profession.

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There are two definitions for electronic medical records. The National Alliance for Health Information Technology has described these two systems as follows:

An EMR system is used within a single organization such as a solo practice or group medical practice. The health information related to each individual patient is created, gathered, managed, and consulted by licensed healthcare providers and their staff.

An EHR system contains health care information on a patient but is shared across more than one health organization and is managed and consulted by licensed clinicians and staff involved in an individual’s health care.

Technically, an EHR and an EMR incorporate information between each system. They are separate systems that work together – the EMR, for use in the medical practice, and the EHR for interoperability across systems.

For a small or mid-size practice, purchasing an EMR is an expensive investment. Typically, in a small practice, there is no staff IT person and no one with internal expertise. With implementation of an EMR, contracting with an IT person will be a new expense added to the practice. Complicating matters more, is the fact that once an EMR is ready for use; productivity drops approximately 50% due to the learning curve. Providers should plan for revenue decreases ahead of time, if possible, since this transition to EMR guarantees some financial impact.

Every good business wants to see a return on investment (ROI) so finding user-friendly EMR software is essential to promote productivity and smooth cash flow. Practices are encouraged to conduct a workflow analysis by the Agency for healthcare Research and Quality (AHRQ) to address start up concerns such as readiness assessment, quality improvement and strategies for financing health IT, to name a few.

HITECH is a program designed to promote technology for patient care at a national level. With the added financial incentive from the government to put into operation EMR, medical practices are motivated to purchase EMR systems and move forward into the future. The most important factor in purchasing an EMR system is to have someone with IT expertise help the practice make the top purchase decision. Every sales person believes his product is the best, which, logically, cannot be true.

For large practices with strong cash flow and savings, purchasing a client-server EMR may be the most cost effective manner to acquire a system. For the small to mid-size practice, an Application Service Provider (ASP) often gives the best benefit because it requires the least amount for IT staff, updates and upgrades of software. An analysis of your practice’s income and ROI can help a practice decide system to purchase as well as the best vendor.

There are important items to consider when purchasing your EMR from a vendor and they are:

• Certified and compliance to all stages of the meaningful use requirements
• Backed by financially sound, industry leading vendors
• Systems than can interface with billing, scheduling, and charting
• Specific templates designed for a particular specialty if needed
• Scalable to add or reduce physicians
• Set-up provide IT support the practice may need
• Usable and acceptable by all providers involved in use of the EMR as well as the purchase
• Vendors who are qualified trainers in the use of the EMR

When implementing an EMR, select a team that will help you transition over gradually and steadily in order to succeed at making the change over happen.

This is a challenging endeavor and persistence and practice are important.

You want to understand each office procedure within the practice and how each job will be linked to the information entered into the medical record. Scanning of records will be involved as well as actual data entry. Analyzing your workflow before implementation will optimize your transition for the future.

Office space requirements must be considered as well as networking capabilities. It is sensible to have an IT company assess your office’s hardware and other network functions to make sure your office can handle the new software.

Templates are available in EMRs and can be customized to reflect the manner in which a provider treats and records information on each patient.

Besides documentation, EMRs provide mailing labels, patient demographics, e-mail capabilities, alerts on delinquent accounts and more. Research user friendly programs that allow communication between doctors, billers, and other practices.

EMRs can interface with laboratories and hospitals by providing, as well as receiving information concerning a patient. There is a lot of responsibility in the information that is shared between facilities. If your patient data is wrong or diagnosis is unspecified, this information gets transferred to another entity who relies on what you give them to treat a patient as well as bill an insurance carrier.

Providers and hospitals must use a certified electronic medical record program that allows ease of information transfer.

Quality reporting of this information promotes improvements in quality, safety, and efficiency for improved health outcomes.

“Meaningful Use” is the term given to reporting data in specific measures of health care. By qualifying as a provider, bonus payments are given to each provider but data must be reported accurately to the Secretary of Health and Human Services.

The goal of EMR/HER certification is to ensure that systems are secure, can maintain confidential material securely, and can work with other systems to share information.

For final rule on Health Information Technology Specs, etc. visit www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf.

More Related Electronic Medical Records

Different EMR Vendors Electronic Medical Record Vendors
AAPC – EMR & the Billing Service

By JoAnne Sheehan

Since 1981 JoAnne Sheehan, CPC, CPPM, CPC-I, owner of Lomar Associates, Inc. has provided medical practice management expertise as a medical biller and coder, chart auditor, A/R manager , author, and consultant. She has worked on high profile fraud and abuse cases in the Boston area and is also an AAPC Licensed PMCC Coding Instructor.
She has recently joined Laureen Jandroep, CPC, CPC-I, owner of www.codingcertification.org, as an affiliate and independent support representative for CCO’s online physician medical coding program. JoAnne believes CCO offers the most comprehensive approach to becoming a proficient medical coder and is excited to be part of Laureen’s team. She looks forward to working with Laureen and her CCO team and offering students the best education and resources available for the coding profession.

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It finally hit me last week while reviewing my Allscripts™ Practice Manager “ICD-10-CM Early Adopter Draft” for the “5th time” that months are passing quickly and that “now” is the time to officially prepare my billing and coding office for the major changes about to come.

Since the introduction of ICD-10, I have kept my staff busy with slide presentations and hands-on training of code sets. We access provider medical records and point out the poor quality of documentation and improper use of ICD-9-CM codes. We then take the same documents and code them according to ICD-10-CM requirements and add recommendations if needed.

Urgency has permeated the air and as responsible coders we know we must now aggressively move forward and begin teaching our doctors the importance of documentation and the understanding of specificity in the level of their code choices. This is no easy task. True, there are always health care clinicians who jump into the learning process, but most prefer to avoid change and hope for the best.

Although medical practices might hesitate in paying extra money for coders who are proficient in ICD-10, it is a serious enough issue that will financially impact a medical office if present staff lacks coding experience or ICD-10 training.

Planning is key so begin by finding a leader who is up for the challenge and can persuade all personnel to follow him or her. For employees who are less than par and unmotivated, this may be the time to replace them with personnel who will enhance production and keep coding and documentation ethical as well as reimbursable.

Educating your ICD-10-CM team will allow them to visually see how much is understood at the ICD-9-CM level (particularly The Guidelines) and what is needed to proceed. Visit www.codingcertification.org, www.aapc.com, www.supercoder.com, as well as insurance carrier websites like Blue Cross Blue Shield and Medicare offer guidelines for preparation.

The process can be overwhelming so by taking small steps through the transition, your practice will be ensured that all areas are covered.

• As mentioned earlier, review medical documentation and make recommendations.
• Plan a budget.

Will you need new hardware and software? How much will it cost you? Will you need training classes? The answer to that is definitely yes! When considering your budget, be prepared for cash flow interruptions. Even if your office prepares properly, you will be communicating with vendors, clearing houses, labs, other medical offices, facilities and more. Somewhere in this web of technological networking, there will be a glitch or two. Vigilance to your claim submission printouts from clearinghouses as well insurance payers is vital.
• Develop a timeline NOW if you haven’t already.
• Speak with all entities directly involved in your successful transition. You may be ready but are they?
• Assess coding staff’s expertise in anatomy and pathophysiology, medical terminology, pharmacology and clinical knowledge. If there are weak areas, start the training process now. Codingcertification.org and AAPC offer online courses to prepare your staff.

Without question, the time is NOW. Cross training, ICD-10-CM coding training, IT involvement are all key in making the biggest change to hit health care.

More Related Medical Coding Experience

Medical Coding – Modifier for assistant – RNFA Surgery
AAPC – Gaining experience

By JoAnne Sheehan

Since 1981 JoAnne Sheehan, CPC, CPPM, CPC-I, owner of Lomar Associates, Inc. has provided medical practice management expertise as a medical biller and coder, chart auditor, A/R manager , author, and consultant. She has worked on high profile fraud and abuse cases in the Boston area and is also an AAPC Licensed PMCC Coding Instructor.
She has recently joined Laureen Jandroep, CPC, CPC-I, owner of www.codingcertification.org, as an affiliate and independent support representative for CCO’s online physician medical coding program. JoAnne believes CCO offers the most comprehensive approach to becoming a proficient medical coder and is excited to be part of Laureen’s team. She looks forward to working with Laureen and her CCO team and offering students the best education and resources available for the coding profession.

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Medical Coding Certification Preperation Videos

IV Push/Hydration.

Q: If a patient’s chief complaint is throwing up and diarrhea, poor thing, and the patient received an IV Push of Zofran and hydration for two hours, would it be coded as 96374, that’s for the IV Push, and 96361 (2)? Also, are there any cheat sheets or flow charts that explain how to code infusions, pushes and hydrations?

A: I’ll let you know what I found out. I actually taught myself something new with this, so thank you for this question. There are no flow sheets that I know of. I did try and do a Google search to find any and a lot of people talked about wanting the same thing. Maybe that is something we’ll have to put on our list of coding tools to develop in our little giveaway area.

I went to SuperCoder and looked up the codes and found some information on hydration infusion. Now, this is actually in your CPT manual because I knew 93961 was an add-on code. I wanted to see because the question up here 96360 is the parent code to 361, but it doesn’t always mean that there is a parenthetical note giving us different instructions, and that’s indeed what I found.

My reply was 93961 is an add-on code, so we need to see what is appropriate to add it on to. The first parenthetical note says to use it in conjunction with 96360, so I thought I was done and was saying therefore we need to have the 96360 listed first for the first hour and 93961 for the second hour. But, upon further research I found out that that would be if hydration was the initial service, and in this questioner’s case that was not what we were dealing with.

Reading further down underneath the code, there is another parenthetical note that says to report 96361, the add-on code, to identify hydration if provided as a secondary or subsequent service after a different initial service. And here is the very code that they were asking about for that push. And this is the key if it is administered through the same IV access.

If the Zofran was administered via the same IV that is being used for the hydration, then yes, you can use the add-on code 96361 in addition to the 96374, and then you have to get into the unit stuff with the time and yes that would be two units.

If you’re on the Replay Club you’ll get a link to this article on SuperCoder. This is just the portion of the article and it was labeled

2. How Do You Code Hydration Following an IV Push?
This is exactly what you were asking. So, the question is: Staff administered chemotherapy via IV push. After that, staff administered 95 minutes of hydration. So, this is an hour and thirty five minutes.

How should we report the administration codes for this encounter?

By the way, the two codes are initial hour “each additional hour” is how it’s worded.
The answer is, if the patient received chemotherapy via IV push and subsequently 95 minutes of hydration, you would code 96409, that’s for the chemo; and then for the IV push, you’d code… you’d code for the IV push but for the hydration you’re going to code 96361 x 2 because the documentation supported 95 minutes. So, you’ll notice that the correct hydration coding involves an add-on code and not 96360.

Apparently, this is a popular question. And they go on to explain here’s why. You should report 96360 only when the hydration is the initial service. And there’s the CPT guideline: “When administering multiple infusions, injections or combinations, only one ‘initial’ service code should be reported for a given date, unless protocol requires that there’s two separate IV sites,” and that can happen too. Physician coders should choose the initial code based on the primary reason for the patient visit. Was it for chemo or was it for dehydration? And then facility coders, in contrast, follow a hierarchy outlined in CPT guidelines.

Yeah, you had it right in your question but I would go to that SuperCoder site and read that article. It was very well-written and illuminating.

More Related Coding IV Push and Hydration

AAPC – IV push with IV hydration
G0008 CPT Medicare Coding- VIDEO

By Laureen Jandroep

CPC, CPC-I.,Sr. Instructor for CodingCertification.Org. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active foster parents and spend most of their time these days just being parents which they love.

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