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A day in the life: Medical coders

ER medical coder Rebecca Stubbs

ER medical coder Rebecca Stubbs

It’s still dark outside when Becky Stubbs, CCA, CMBS, arrives for work at Akron Children’s Hospital.  Stubbs, an ER coding specialist, begins her shift at 4:30 a.m.

“I like to work early in the morning,” she said. “It’s usually a very peaceful and quiet time.”

Children’s has dozens of medical coders working throughout the hospital. The coders review all medical charts to determine if the services provided have been properly coded.

Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes are recognized by third-party payers and describe services provided to patients and the reason for their visit.  Appropriate use of these codes ensures optimal reimbursement.

ER doctor Maria Ramundo shows nurse Kimmie Jacobs and ER coder Rebecca Stubbs something on the screen

ER doctor Maria Ramundo points out key information on screen to nurse Kimmie Jacobs and medical coder Rebecca Stubbs

Stubbs, who has been a medical coder at Akron Children’s for 10 years, logs on to her computer and accesses the list of charts she needs to review.

This morning there are already nearly 200 charts for review. Stubbs opens the first chart and starts to read the physician’s notes when something catches her eye.

From her experience, she knows that documentation is missing from the note to support a service that was performed.

Stubbs sends an email to the physician asking him to review the chart again to either add or clarify the needed information.  In some cases, she will speak to the physician or nursing staff in person to request the additional information.

Once the addendum is added to the chart, Stubbs can complete the coding and enter the charges.

Medical coder Sarah Ellis

Medical coder Sarah Ellis

“We want to accurately account for all the care we give to our patients so that we are fairly reimbursed for the work,” she said. “This job takes a lot of detective skills. You have to be able to dig into the charts, see if there is anything missing and figure out what it is.”

Not far from the hospital, in the former Y building at One Canal Square, Sarah Ellis, CPC, starts the day with a look at her work queue.

Ellis has been a physician coding specialist at Akron Children’s for seven years. She reviews charts from the pediatricians employed by Akron Children’s Hospital Pediatrics.

“Our goal is to ensure that everything is billed correctly and completely,” she said.  “I know how important it is for the charts to be correct, not only for the hospital but also for our patients.”

An incorrect code, for example, could result in a procedure not being reimbursed by a patient’s insurance company.

Just as Ellis is about to review a chart, her phone rings. It’s a physician calling with a question about a code. She listens to the physician, then refers to a large reference book on the desk to help answer the question.

Medical coder Sarah Ellis

Medical coder Sarah Ellis

“What I like most about this job is that it’s never the same every day,” said Ellis.  “A good medical coder is someone who is very curious and likes to investigate.  Sometimes I can answer a question in just a few seconds; other times I need to look into it. I can usually find the answer I’m looking for, but it’s nice to know that I also have really great co-workers I can bounce ideas off of.”

There are currently more than 13,000 ICD codes. In October 2014, a revised set of codes will be adopted that contains more than 68,000 codes. The revised codes, referred to as ICD-10, will be much more detailed.

“The new codes will require more specific and detailed documentation from the medical record and the providers,” said Rhonda Petruziello, BBA, CPC, CPC-H, Akron Children’s coding/compliance manager.  “In the current ICD-9 system, one diagnosis code for fracture of shaft of radius now becomes 10 different diagnosis codes in ICD-10.”

Back in the hospital, Jan Gerzina, RHIT, is reviewing a chart on a recent hand surgery. Gerzina, a coding specialist in general surgery, plastic surgery and ENT (ear, nose and throat), notices immediately that something is missing.

“The chart only mentions three tendons but I know this procedure includes four tendons,” she explains.

She sends an email to the physician asking him to review the chart.

Surgery medical coder Janice Gerzina

Surgery medical coder Janice Gerzina

“Our physicians are just as concerned as we are that the information is accurate, and they really are very easy to work with when we ask them to take another look at a chart,” Gerzina said.

Gerzina, like Stubbs and Ellis, has two large computer screens on her desk. One screen shows the chart under review, while the coders use the other screen to research what codes to use. Each coder can review nearly 70 charts a day.

“Medical coding is an intense field and there is a lot of information to know,” said Gerzina. “I appreciate the fact that Children’s values the importance of continuing education and encourages us to keep on top of the changes in our profession.”

Children’s is partnering with the University of Akron to develop a program to educate students who are interested in becoming medical coding professionals. Along with assisting in developing the curriculum, Children’s will also offer internships to qualified students.

“This is a growing field,” said Petruziello. “Medical coding takes a unique individual with a very specific skill set. But for those people who enjoy solving problems and doing research, it can be a very rewarding and fulfilling career.”

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