Medical Coding: In over my head?
September 7, 2014 3:48 PM   Subscribe

I've been taking the American Assoc. of Professional ( Coders' CPC-H certification course in medical coding for facilites. To be perfectly honest, I did this on a whim (I spent all of two days researching "start-from-scratch" career paths, thinking that was the only way to go for someone in my position). I liked the idea of a decent salary after taking a six-month long course and doing a year or so of internships. It seemed to be my key to validation as a productive adult. I'm a quarter of the way into the course, though, and I feel like I'm in way, way over my head. I paid over $2000 for the course and related materials/exams. What do I do now?

No matter how hard I try, I can't wrap my head around the fine-tooth-comb level of analysis the work requires. Every time I think I have it down, there's more information to memorize and it's all so, so dry. My anxiety about needing to remember hundreds of incredibly specific guidelines ( the chapter-specific guidelines really are the worst), modifiers, laws, etc all under the threat of governmental audits is overwhelming.
I came into this with some knowledge of anatomy and biology, but that was it. I don't know if I'm meant for this.
- What the hell do you do to memorize every little rule and detail? How do you avoid regularly making costly mistakes when there are so many variables?
- Is there any hope of my ever passing the certification exam?
- Is there anything besides anatomy that I should have had experience in prior to doing this?
- Are there any supplementary resources you can point me to that don't excel quite as strongly as the AAPC's own books in making things as clear as mud?
- What is being on the job actually like?
- Do you have any other advice?

Everyone else... what are some other ways I can start learning things from scratch and begin making money within the next year or two if I fall flat on my face trying to make it in the world of medical coding?
posted by marsbar77 to Work & Money (17 answers total) 11 users marked this as a favorite
To clarify, I have no medical office experience, as many others starting out in MC seem to have going in. I feel so stupid, even having earned consistently high marks in many of my science-related courses in undergrad...Something's missing here. Also, about half the way through the course, not 1/4th.
posted by marsbar77 at 3:52 PM on September 7, 2014

As my mother is fond of pointing out, "Real life is open book." Just get a system for indexing these things.
posted by Ruthless Bunny at 3:58 PM on September 7, 2014 [4 favorites]

>>How do you avoid regularly making costly mistakes when there are so many variables?
based on 2 of my medical biller friend's griping about their co-workers, most don't avoid costly mistakes. Heck, half the places they worked at, or people they dealt with, didn't even have an ICD-9 book onhand.
posted by Sophont at 3:58 PM on September 7, 2014 [1 favorite]

As my mother is fond of pointing out, "Real life is open book." Just get a system for indexing these things.
This idea was of some comfort to me initially. The problem with this line of thinking is that you can't take your own notes with you to the exam and b) What I'm really afraid of is that, even with every book in front of me, I won't know to apply certain things when they're called for on the job. Okay, no more threadsitting. Looking forward to any advice.
posted by marsbar77 at 4:02 PM on September 7, 2014

Is there any kind of practice test or study guide for the exam you will need to take? If so, I advise you to get those materials and learn as much as you can about how the test is laid out and what might be asked. This can guide your studying and note taking and memorization - you will know if you need tiny details or if you merely need to know how to find something (i.e., which section of some manual).

Have you sought out help from coder forums and discussions? Just immersing yourself in such discussions, especially amongst people who are new to working as coders might be helpful in putting things into your brain in several contexts, making them easier to pull back out later.

You might also look into books about how to memorize things, especially if you have lists you need to memorize. There are so many different ways to do this that you can probably memorize enough lists of relevant things that when you walk into the exam, you can then sit down and put the lists on paper and have them to work from, since you can't take notes in with you. (Hopefully they give you paper?!)
posted by AllieTessKipp at 4:15 PM on September 7, 2014 [2 favorites]

Also - if you are only part way through your course, you can rest assured that as you progress, many of these things will become second nature as they become more familiar. This is what happened for me with medical transcription and the course I did for that. Don't give up yet. :)
posted by AllieTessKipp at 4:17 PM on September 7, 2014 [2 favorites]

free videos -- I don't know if they are any good but it seems to me it would be less dry?

When I worked for an insurance company, we had software at work for looking up codes. Here is a website with similar functionality: Find A Code So I assume that if you can get through the certification, you can use software to help you find the actual codes you need if you know the overarching rules.

I had a brief course on medical coding as part of my training for becoming a "certified life and health insurance specialist." So I have not been a coder but I have had exposure to it. The code system mostly is fairly logical in terms of breaking things down from larger category to smaller, with a few weird exceptions that show up in odd places in the codes. I haven't worked in insurance in more than 2.5 years, so I can't think of a specific example. But on my job, I and others basically learned the weird little exceptions that came up the most often for our line of business just by repeated exposure. You know: "What is the code for (weird little exception)? I am not finding it under (seemingly logical broader category). Oh. Yeah. This is that one that comes under (bizarre category that makes no freaking sense)."

The other thing that is generally helpful in the medical field is taking Latin (and/or Greek). I took a couple of quarters of Greek in college and also studied Greek and Latin root words in high school. When my ex was taking Latin, he had classmates who were in it specifically because they were premed and they wanted help coping with the medical words. I found my background in language helpful when I took a college biology class and also when I was in training for health insurance.

In my work in insurance, my experience was that I came across the same codes over and over and over. Granted, this was related to the fact that I worked a specific line of business (accident claims). But that seems to be sort of the norm. So, again, if you can get through the certification, you may find yourself just rubber stamping "Dr. Z performed surgery AAA and Dr. Q performed surgery AAB, bill to yadda yadda insurance company. Rinse and repeat."
posted by Michele in California at 4:22 PM on September 7, 2014 [1 favorite]

You might be too conscientious / perfectionistic about this. My experience is that people who are the type of people who earn high marks in science in undergrad are a bit overly conscientious when it comes to real-life things. You are overthinking it. Try your hardest and keep working hard and do your best. Chances are you'll pass and do fine. The government is not going to put you in jail for making honest mistakes, ok?
posted by the young rope-rider at 4:24 PM on September 7, 2014 [2 favorites]

Last note, promise. I discovered Find-A-Code a few weeks ago, and while I love it, it isn't always accurate ( obviously) and I feel like there's still so much room for error in terms of things like sequencing and modifiers and, yes, bizarr-o classifications. Okay, getting away from my desk now for my own good.
posted by marsbar77 at 4:25 PM on September 7, 2014

Also, if you haven't spent a lot of time in relatively low-status jobs you are probably surprised by the amount of threatening and dire consequences!!! etc. that you're facing. It's all bullshit, seriously, designed to put a stick where there's not a sufficient carrot (in terms of money and prestige). You're fine.
posted by the young rope-rider at 4:26 PM on September 7, 2014 [5 favorites]

I do outpatient coding rather than hospital facility coding, which I do understand is a bit of a different beast; also, I did a week long boot-camp which specifically prepares you to pass the test (in fact I have done this twice - about a decade ago I got certified and worked part-time as a coder for two years, and now have gotten recertified when my previous career imploded). To be clear, I did the bootcamp instead of an AAPC course not in addition to.

The tests are hard, I'm not going to lie. I'm a straight A student and got a 76% on my most recent test (70% is a pass). But this is doable.

My advice:
Don't worry about memorizing everything - it's an open book test, and you're very much expected to use them, including on the job. Work on memorizing principles and plan to look up everything else.
Think of the first test as a practice - you get a free second attempt, and you should focus on the first try as a learning experience.
Work on skimming over a dictation and picking out key pieces because frankly, the hardest thing about the test is that it's time and if you're a slow reader and try to read everything, that's where you'll get into trouble.

As far as the job goes...I like the coding. That's the easy part for me. The billing and dealing with insurance companies and customers who want to argue their bill are the stressors. If you work in a hospital as opposed to from home, you'll be part of a team that will help with questions. You're welcome to msg me if you have specific questions for me.
posted by kattyann at 4:26 PM on September 7, 2014 [2 favorites]

What the hell do you do to memorize every little rule and detail? How do you avoid regularly making costly mistakes when there are so many variables?

To clarify, are you asking for study tips?

When I was taking accounting courses, I started out feeling overwhelmed and like I would never understand all the rules. The truth is that, no, of course I wouldn't ever *understand* all the rules -- they're based on traditions and circumstances that I could never have guessed, in a lot of cases, so they're not really something that can be logic-ed out by an accounting student. I needed to forget trying to *think through* the accounting work as though it were a series of math concepts, and I needed to just memorize it as it was.

I think that you're probably feeling overwhelmed because you're trying to figure out how the whole system works. You're not going to be able to figure that out. There's maybe not even a fully coherent system in the first place. Just memorize the facts.

When you've got a ton memorized, you'll find it easier to make connections and see patterns in how coding works, but don't try to jump the gun on that. It'll just frustrate and confuse you.

Memorization can be boring, but it's easy. Just don't overthink it. If you're an auditory learner, try to find a way to listen to the material read/spoken aloud as much as possible. If you're a visual learner, draw as many charts and diagrams as possible so that you can see the concepts in a physical space. Do both, if possible. Use mnemonics and methods of loci *very* freely. Even coming up with them is usually helpful. There are tons of ways to work on getting material memorized, so don't worry about whether you'll be able to do it, just make sure you give yourself enough time to do it. Also, try to go over the material you have to memorize frequently rather than in large bursts.
posted by rue72 at 4:33 PM on September 7, 2014

For learning big piles of information, I adore Anki. About a week before the end of one semester, a professor declared knowing the exact dates of certain events to be worth extra credit on our final. I'm usually crummy at that kind of thing but I made them all into Anki flashcards, and I'm pretty sure I passed the exam on extra credit alone. Break everything apart as small as you reasonably can; I don't know anything about your intended field but "chapter X"/"big list of guidelines" is almost certainly way too large of a category to be trying to memorize. You want cards that say things more like "guideline Y"/"specific details; relevant to chapter X".
posted by teremala at 4:38 PM on September 7, 2014 [3 favorites]

you can't take your own notes with you to the exam

OK, but the process of creating your own notes is what really helps you learn the material. Make your own flashcards and review them. Turn lists of guidelines into acronyms (choose one key letter from each guideline and then reorder them to spell--or misspell--a word), then put all the acronyms for one set of guidelines into a cartoon picture to help you group them together mentally.

Get creative, and make such thorough study materials for yourself that you could sell those materials to someone else who wants to study for the same exam. Take the pressure off yourself as you put your notes together by focusing how helpful those materials will be for the hypothetical person who will use them after you.

What I'm really afraid of is that, even with every book in front of me, I won't know to apply certain things when they're called for on the job.

What I do when I'm afraid of something like that, is I follow that line of thinking all the way through the worst-case scenario and out the other side. So, let's say you screw up on the job. There's an audit, and you're found to be at fault. You get fired. You end up looking to start from scratch in a new career. Oh hey, that's what you're doing now. You're alive and breathing and it's going more or less OK, right? So, you could do this again with a different career if you had to.
posted by Bentobox Humperdinck at 4:44 PM on September 7, 2014

Based on my wife's experience in a podiatrist's office, I think that a specialist's practice would be much simpler. They deal with a much more limited range of codes. In fact, in her employer's office, the doctor determines the code. So you have a fallback position.
posted by SemiSalt at 5:20 PM on September 7, 2014 [5 favorites]

Yes to Anki/SuperMemo/other delayed repetition software. Make sure you read some of the SuperMemo guides for getting maximum value, like how to formulate knowledge.
posted by anaelith at 5:07 AM on September 8, 2014 [2 favorites]

It doesn't sound as if you are enjoying this. My advice would be to ask for a pro-rated refund and look for something else.
posted by bkeene12 at 9:38 AM on September 8, 2014

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