RN coder, what type of things I need to know and things I need to watch out?

RedhairedNurse, BSN, RN · May 12, 2009

"I just 'found' a new job as 'an' RN coder."

Sorry, can't help, don't know anything about coding. :)

ohmeowzer RN, RN · May 12, 2009

what 's a RN coder? ICD-9 codes for insurance billing? thats the only coder that i can think of..

Home Health Columnist / Guide · May 13, 2009

most states have language similar to pa's practice act

21.11. general functions.
© the registered nurse may not engage in areas of highly specialized practice without adequate knowledge of and skills in the practice areas involved
http://www.pacode.com/secure/data/049/chapter21/chap21toc.html#21.1.

i don't understand why nurses accept a position if they don't understand basic requirements of a position or have the necessary skills needed to perform work listed on job description.

an staff firmly believe that nurses should carry individual professional Liability Insurance to protect oneself from legal issues arrising from patient care lawsuit and/or being called before a board of nursing.

medical coding professionals ensure that medical records and data are accurate and timely, coded to the highest degree of specificity and can financially make or break an institution, especially snf or home health agency.

about medical coding & medical records: ahima

[color=#2200cc]medical records and health information technicians

coding is different for medical office practices, hospitals, snf and home health--each is a niche market. what setting is your job, so more info can be offered...

HNursing · May 14, 2009

Thanks to NRSKarenRN,

Thanks so much for given those information. I already brought the medical insurance. I want to know if there any books out there will give more information and knowledge about it job.

One of my friend told me about the job and she said she will train me if I get hire. I never know that RN can work in a office job like that and I find it interesting to me.

Bettie P · May 14, 2009

There are many financial and legal ramifications for incorrect coding, if you are referring to assigning CPT and ICD-9 codes for patient encounters. I know, because I had to testify in front of a federal grand jury in a case where upcoding and mischarging was suspected. I would urge anyone who is considering a job in coding to not accept "on the job" training. Please, please, please consider taking the classes to become a certified coder before you take any job where assigning codes, or even just inputting the codes from a preprinted encounter form to generate an insurance bill, is your responsibility. You can not trust the doctor or the other staff to know what is right. Trust me on this. Coding is not a learn as you go thing. There is so much more to it that you would expect.

Daytonite, BSN, RN · May 14, 2009

I went into medical coding when I could no longer do the physical aspects of clinical nursing. I have taken two coding courses, one at a vocational school and one at a community college. If there is professional insurance for coders I have never heard of it. Coders don't get sued by individuals for malpractice if they make a mistake; they get fined by government agencies (like Medicare) because they have violated laws. There is no insurance you can buy to get you out of those kind of jams. Your protection against that is not to violate the law. In both my coding courses it was drummed into us that we follow all coding guidelines or agencies like Medicare will slap you on the back of your hand for committing fraud.

Beside learning how to actually code a disease or medical procedure into its numerical code, coding requires you to be aware of the current insurance rules regarding payment of claims. These change daily at the whim of each payer and they also follow the coding guidelines. Coding is part of the accounts payable function. Providers (doctors, hospitals, etc.) can only be paid when they submit bills for their services that have been converted into these codes, so that is why coding is so important.

I thought the most difficult coding course was procedural coding (CPT coding). It requires knowledge of anatomy and physiology as well as the procedure that the provider is doing. In some cases, you have to know the procedure because there are multiple codes that you must apply rather than just one code for the procedure. Case in point is coding for cardiac heart caths. You must read the notes in the code books at the beginning of each section of the code books and follow the coding instructions. Hospital coding is different from physician office coding and requires knowledge of how DRGs work and what a principle diagnosis is.

My advice is to take a coding course that is AHIMA accredited. A good company will strive to hire certified coders only. With certified coders they reduce the chance of coding fraud. The first job is generally the hardest to get. Most employers do not advertise. Many will have you take a coding exam before they even interview you to see if you can code and the questions will include several common coding pitfalls. It is not uncommon for companies to require 95% or better coding accuracy of its coders. We were audited monthly and our supervisor knew if any of our charts came back from the computer room (mismatched diagnosis and procedure codes) or an insurance company (denials) because of incorrect coding.

jjjoy, LPN · May 14, 2009

I don't understand why nurses accept a position if they don't understand basic requirements of a position or have the necessary skills needed to perform work listed on job description

I think many people figure that if the hiring manager is willing to offer a job to someone, assuming they haven't misrepresented themselves, then the hiring manager thinks that they applicant will be able to do the job, despite lack of experience.

Other side of same coin, why are so many employers more than willing to hire anyone with the appropriate licensure even when it's clear that the person doesn't have the kind of experience and skills necessary that would allow the person to be able to fully shoulder the job responsibilities from day one? Rhetorical question. There are many reasons. A facility may be under pressure to fill an RN-slot for legal reasons and may not be as concerned with the actual skills the person brings to the table. The facility may not be able to afford the salary that would be required to retain someone with more experience. Etc. With the current economy, though, more employers are being more picky, having a wider pool of applicants these days.

In the past, I've come across hiring managers that give little to no attention to the skillset and experience of the applicant, dismiss any questions about one's ability to perform the role, and simply ensure the concerned applicant that they're sure they'll pick it up quickly and do just fine... such as offering LTC charge nurse positions to new grads or hiring new grads to float teams or per diem with minimal orientation provided.

Even beyond desperation to fill RN-slots with any warm body, in general, it seems to me that it has been VERY common for nurses to be hired into positions for which they have little-to-no relevant experience. In fact, it seems that in many areas, the only way to get experience in certain areas was to luck into being hired without experience - as there may be no clear career ladder into some specialty areas.

So it doesn't seem surprising to me that a nurse might consider applying for and accepting a job for which they have little experience.

Daytonite, BSN, RN · May 15, 2009

When someone is up to no good they are going to look for a patsy to blame it on if they get caught. Not too long ago I interviewed for a coding job. They only wanted RNs for these coding positions. I took a portfolio I had put together of what I have done in my career as a coder for this physician specialty (it requires knowledge of the procedures these doctors perform in order to code correctly for them). During my interview I was asked a lot of specific questions about how I would code this or that and I responded. However, the interviewer made it very clear that they wanted to take an RN with no coding experience and train them in their coding procedures. When she said that it was like a red flag. That is something you say to impress someone who doesn't understand how the laws drive this field. I had worked for a huge company and knew exactly what she meant by their coding procedures. It had to do with how they were going to code charts in order to get the maximum payment from insurance companies just shy of staying within the federal laws. However, they were looking for a unwitting, unsuspecting participant and that wasn't going to be me since I had as much training as the person who would probably be orienting and training me to the job if I got hired and they couldn't have that.

ANMCoder&MOM · May 15, 2009

Hello, I am new to this site, this is my first post. I actually ran accross this googling a coding subject for one of my assignments for school. I am in my last week of Medical Billing and Coding Certification schooling. From all that I have learned in the last 10 months of school is that coding is very detailed and you need to be precise when submitting a claim. If you code wrong it take longer for reimbursment and you could possibly get in serious trouble. I know I still have'nt got it 100% but with practice it gets easier. You could purchase the CPT and ICD-9 books over the internet and I suggest you do if the new job dosent supply them for you. They are books you must have there's no way around it. Also the codes are updated annually so make sure you get the newest editions. I would also suggest buying used College course books off of Amazon (They are very expensive new). They will teach you everything you need to know and each book will have practice tests and answers chapter by chapter. I also suggest, if you have never worked in a medical setting to learn medical terminology. This is pretty important, medical language can be confusing. I was planning on selling my books after graduation anyways so if your interested let me know. Here is a website to order the ICD-9, CPT and HCPCS coding books. WWW.ELSEVIERHEALTH.COM I hope this has been helpful. Good luck with your new job there hard to come by in this economy. To get a coding job is great resume experience, not every company requires a certification but most do so kudo's to you!

Daytonite, BSN, RN · May 16, 2009

Hello, I am new to this site, this is my first post. I actually ran accross this googling a coding subject for one of my assignments for school. I am in my last week of Medical Billing and Coding Certification schooling. From all that I have learned in the last 10 months of school is that coding is very detailed and you need to be precise when submitting a claim. If you code wrong it take longer for reimbursment and you could possibly get in serious trouble. I know I still have'nt got it 100% but with practice it gets easier. You could purchase the CPT and ICD-9 books over the internet and I suggest you do if the new job dosent supply them for you. They are books you must have there's no way around it. Also the codes are updated annually so make sure you get the newest editions. I would also suggest buying used College course books off of Amazon (They are very expensive new). They will teach you everything you need to know and each book will have practice tests and answers chapter by chapter. I also suggest, if you have never worked in a medical setting to learn medical terminology. This is pretty important, medical language can be confusing. I was planning on selling my books after graduation anyways so if your interested let me know. Here is a website to order the ICD-9, CPT and HCPCS coding books. WWW.ELSEVIERHEALTH.COM I hope this has been helpful. Good luck with your new job there hard to come by in this economy. To get a coding job is great resume experience, not every company requires a certification but most do so kudo's to you!

Ha! Ha! Ha! We had a corner in our coding lab at the college that I used to call Coding Jail. We talked about incorrect coding and fraud a lot. Our instructors were tough. Every one was an HRIA and certified coder as well. No one ever got into the high 90s on a test. CPT class was very difficult. The highest grade I ever got was an 88 and all I ever did was study for that class. We had NCLEX style questions on our advanced ICD-9 class tests and some of them were hard. I purchase my code books from the AMA including the DRG manual. The AMA also has many other supplemental books to assist with coding. We were also taught to use the 3M encoder because almost all the hospital coders use an encoder and do not code from manuals. The encoder takes some getting used to.