Coding for ICD-10

Wow, it doesn’t seem that long ago that I was learning all about Diagnostic Related Groups (DRG’s) and now it is time to learn a new way of coding. I am so glad that I have a pre-nursing background and that I continue to teach and work with allied health students today. It keeps me young. I try to always keep one hand in full grip of the basics of medicine and one hand always ready to reach for the new concepts that come along. We really needed to be life long learners if we are going to really understand and embrace ICD-10.

I hope that the new coders that are just coming into the career field do not have to go through what I went through to learn coding and to transition to DRG’s. I know now that I was hired because of all my pre-nursing education and my on the job training in respiratory therapy. I can still remember when they offered me the job as a coder. I was so excited to be offered a job in the medical field that was full time days. The administrator told me upon hiring me that they did not have a medical records director in place. After working for about two weeks, they sent me to a workshop in another city to learn everything I needed to know about coding and DRG’s. I really relied upon my medical background to grasp everything that I needed to know. I kept all kinds of medical books, surgical books, dictionaries open in front of me as I coded the diagnosis and the procedures. If there was something I didn’t understand I would try to ask a question of the physician on the case. The physicians came to the medical records department on a regular basis to complete their records. It was acceptable for coders and physicians to discuss cases in the dictating room. I can still remember the other people in the department and how they related to me as a new person and in my new role. They were like, Oh she is the one that works with and talks to the doctors, ooooh. Most of my coworkers acted like they were all scared to even say hello to the physicians when they came into the department. I became very comfortable with working with physicians early on in my career. Before I knew it I was asked to join them in their committee meetings and take notes

Finally the day came when I was introduced to my new boss. She was young and pretty and single.
She was fresh out of college. After working with my new boss after about three months and DRG’s was coming closer to being fully implemented in our state, I can remember asking her a question about a particular case that I was working on. I was having a challenging time trying to really grasp the concepts of all the DRG’s and how to map them. I approached my director with a question. She tried to explain it the best she could. I still did not get how she arrived at her choice. I sat the record to the side and thought I would try again tomorrow. I approached her again the next day and she explained to me again what the DRG should be. I asked her why that particular DRG and she got very upset with me.. I got upset when she changed her tone of voice and she ended up saying to me, do I need to draw you a picture? I was so hurt by that comment. I shouted back to her, “I guess you do and left her office”. I finally assigned the DRG that she suggested and submitted the claim but I realized that I had a lot of work to do to really understand the concepts behind how to select the best code and the best DRG’s.

In reflection, I think about how hard it was to learn and apply new concepts and I think about how hard it is going to be for some of these hospitals when they need to train their staff on coding for ICD-10 and really start implementing the system. I think about the coders themselves and the countless hours of sleep they are going to lose when they try to implement this new mandate. Are hospitals going to hire a pretty little thing, right out of college and think that she can do the job of implementation by herself? Are administrators and Health Information Managers (HIM) going to send people to a one day workshop and think they can learn it all there? What about productivity rates? Are hospitals going to only hire people with years of experience? There is definitely going to be a learning curve? Who is going to pay the price?

Tags: Coders, Coding ICD-10, DRG's, HIM, medical records