Rn coder or case management?

Mijourney · Oct 30, 2007

Hi. I am an RN with 10 years NICU experience. I'm looking to get away from patient care and have been researching alternative RN positions such as case management and RN coding. I have been to some of the websites mentioned to find out where to begin but they are a bit overwhelming. Can anyone give me information on where to begin to find out about details about these positions and what I have to do as for as certifications and education? Thanks in advance.

I'll offer my two cents. I think you should go for both a case management certification and a coding certification. The two do not overlap. One gives you knowledge and skills in managing tough cases and the other gives you knowledge and skills in coding, billing, and reimbursement so that you can help your case management patients when they have insurance questions. You indicated that you already checked out some websites. Keep surfing them and you will find what you need to know. I recommend that you try to get a case management position within your facility or another facility. If there is a case management department, check with the case management director in your facility and let him/her know of your interest. Maybe if there is no full-time work, there is part-time work and you can combine that with work in your current or another area. If that doesn't work, try the insurance companies if any are in your area. As you may have seen from other threads, the most common case management certification is the CCM. You have to have one to two years of experience to take that exam. For coding, most nurses seem to gravitate to the American Academy of Professional Coders because the exams are not as intense as a few other organization's certification tests. You can attempt to study on your own for the coding certification, but I strongly recommend taking coding classes if you have no experience in coding. The AAPC recommendation is to have two years of coding experience prior to taking the test. The CPC is the most common test taken from the AAPC. If you decide you would like to work as a utilization review nurse in your facility or for insurance, you will find that you will become more familiar with coding and reimbursement. Sometimes utilization review is a good segway to case management. Hope this helps.

vlntrnurs · Sep 10, 2008

You can find more information from the American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), American Medical Billing Association (AMBA), RN-coder.com, and American Association of Clinical Coders and Auditors (AACCA) websites.

There are numerous employed coders who became certified through self-study. They picked up coding instruction books, studied what was tested on the exam, and passed. You can do it too!

mmc1213 · Nov 21, 2008

I am actively pursuing different areas of nursing and coding has piqued my interest. I see that AAPC offers courses as well as RN-coder.com. Has anyone that you know self-studied and been able to work remotely from home as a coder?

vlntrnurs · Nov 22, 2008

I am actively pursuing different areas of nursing and coding has piqued my interest. I see that AAPC offers courses as well as RN-coder.com. Has anyone that you know self-studied and been able to work remotely from home as a coder?

Hi Mmc1213,

I came across this post about RN-coder.com by Kojak on Sep 14, 2008, 10:53 PM:

https://allnurses.com/forums/f8/coding-333520.html

In answer to your question: Has anyone that you know self-studied and been able to work remotely from home as a coder?

I have not heard of anyone being able to work remotely from home as a coder without on-site coding experience.

All the coders (I know) had on-site coding experience at a hospital or clinic for at least one year. After at least one year of coding experience, those coders looked for jobs to work remotely from home, and were able to get those jobs because of the one year experience.

Many hospitals and companies hire certified coders with the certifications from AHIMA or AAPC. However, they are preferring coders with the CCS or CCS-P certifications from AHIMA.

If you're going to spend your time and money, spend it on the CCS-P or CCS.

vlntrnurs · Nov 22, 2008

Hi Mmc1213,

Have you thought of nursing informatics?

You can visit the Nursing Informatics forum at:

https://allnurses.com/forums/f28/

The Nursing Informatics forum is another area of nursing that you could look into.

ski-nurse563 · Nov 26, 2008

First, the RN-Coder certification is not a widely recognized credential. I looked into it a few years back, and the "credentialing body" seemed extremely shady to me. I would go for either the CPC or CCS. I have the CCS credential--I have been told that the CCS exam is harder than CPC , and it was certainly no picnic, but I passed via self-study without taking any prep classes. Your clinical knowledge is a definite advantage, but you still have to know your way around ICD-9 and CPT very well.

Pay for RN coders is low, compared with what you can make as a staff nurse--but there are other opportunities out there if you have the credential. I have parlayed it into a very successful reimbursement consulting career.

Good Luck!

mmc1213 · Nov 26, 2008

Thanks for the info! I am going to either self study thru AAPC or take the distance learning class. Where did you start your career in coding? How did you parlay your training into reimbursement consulting? I have been a nurse for 13 years in various areas. Appreciate any info, thanks.

Mijourney · Nov 29, 2008

Just want to clear up the difference between the CPC and CCS. The CPC and CCS are not synonymous. The AAPCs CPC credential is physician-based and the AHIMAs CCS credential is facility-based. The CCS credential as indicated in a previous post is readily desired and recognizable by pretty much all facilities. The CPC ranks a close second. Both associations offer distance education courses that provide you with a foundation for taking their coding exams. They also provide networking opportunities with other coders so that you can get a feel for what you're getting yourself into.

caincreations · May 27, 2009

I am a CPC working towards my RN. This was a natural progession. I have a strong backround in compliance. An RN licence will open more opportunities for me. I currently have my own business and perform mandated audits for the NY & NJ state board of medical examiners for sanctioned practitioners. It does help to have clinical in this area, plus I could charge more then. I have 23 years experience in billing/coding, but as an RN you could take the home study course from AAPC and do well. AAPC is well recognized in the outpatient setting and with most Insurance Carriers. An RN CPC is in great demand right now, there are not many that have both. Best wishes.

caincreations · Jun 18, 2009

Coding from home is possible. There are several agencies that offer home based coding position. As a new coder I would not recommend it. Coding can be subjective and it takes time to understand the rules and regs and the subtle shadings of compliance. This is easier to do around other coders. It can be done at home if you have support network and resources to help you. I still often bounce scenarios off on other coders to be sure I am still on the right track. A big part is networking and debating with other coders. You may want to begin reading the Decision Health Part B list serv. It is free, but I warn you now it is also prolific. You may want to open a separate email for such list servs. They can be very helpful, especially in the beginning