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Medical Coding One of Health Care's Hottest Career Choices

Complexity of new diagnosis codes means formally trained medical coders are more in demand.

Quitina Clements’ entire 27-year career, most of it at DCH, was spent as a medical transcriptionist working from home. At 46, she decided to go back to school for medical coding.

“I loved being a transcriptionist, but transcribing was fading away,” Clements said. “Personally, I was a little burned out and wanted to make a change. And the future for coding looked good.”
Quitina Clements recently finished her education to become a certified medical coder at DCH.

So while continuing to work full time for DCH and raising two teenagers with her husband, Clements hit the books at Wallace State Community College, Hanceville, Ala. Except for two trips to the college, she completed all her coursework online. She participated in the school’s four-semester medical coding certificate program. Once she completed the courses, Clements successfully passed the certified coding specialist exam of the American Health Information Management Association. She’s now been a medical coder for seven months.

Pam Pitts and Crystal Kramer in DCH Health Information Management are glad that Clements made the switch to coding. Pitts, administrative director, HIM and Kramer, coding compliance reimbursement manager, are dealing with the same shortage of certified medical coders that is sweeping the nation.There has always been a shortage of formally trained coders,” Pitts said. “But with ICD-10 coming, it’s changed the whole coding process. The complexity is tremendous.”

Impact of ICD-10

The medical coding field will expand from the World Health Organization’s 17,000 ICD-9 codes to approximately 141,000 ICD-10 diagnosis codes. “There’s also a whole new set of procedure codes to learn that coders have never dealt with,” Kramer explained.


Some coders have learned three sets of codes as the industry grew in complexity – ICD-8, ICD-9 and now ICD-10. Some nearing retirement don’t want to learn the ICD-10 codes, Pitts said, creating job openings here and across the United States.


The United States is the last country to adopt the ICD-10 codes, which offer greater clinical detail and specificity. Disease classification has been updated to be consistent with current clinical practice, too.


Accurate medical coding is important because it determines how DCH is paid by Medicare and insurance companies, Pitts explained. Coding also can be used to grade hospitals and doctors, such as providing complication rates.


“You are painting a picture of what happened while that patient was here. It has to be very comprehensive,” Kramer said. “If a coder incorrectly codes something, it stays with that patient for a lifetime. The focus and accuracy required are huge.”


Educational Requirements and Testing

Most medical coding programs fall under the realm of health information technology or health information management. Medical coding students may attend a certificate program like Clements did or participate in a more comprehensive program which leads to an associate or bachelor’s degree. Students take courses in anatomy, biology, physiology and pharmacology. An associate degree in health information management requires more extensive anatomy and other classes, plus some prerequisites, but can lead to greater opportunities such as management, Pitts said.


For the past five years, interest in the medical coding and health information technology programs at Wallace State has remained steady, said Donna Stanley, the school’s HIT program director. “Most of our students are not ‘right out of’ high school. We are more likely to have students who have worked in another field or those that have been stay-at-home moms. But we also admit a few younger students each year, too.”


DCH prefers to hire applicants who have completed a CAHIIM-accredited program and passed one of three exams: registered health information administrator – RHIA; registered health information technician – RHIT; or the certified coding specialist – CCS, Pitts said. It is important to choose the right college because only graduates of CAHIIM-accredited programs are eligible to take these exams. CAHIIM is the Commission on Accreditation for Health Informatics and Information Management Education. This accreditation ensures that students receive the necessary background to perform the coding function in today’s environment, Pitts explained.


The University of Alabama at Birmingham and Alabama State University in Montgomery offer CAHIIM-accredited bachelor’s degree programs. CAHIIM-accredited associate degree programs are offered by Wallace State in Hanceville and Bishop State in Mobile.


Benefits of the Job

Since every patient is different, and insurance company and Medicare guidelines often change, Kramer said, medical coding doesn’t get boring. And once coders get some experience, they may work from home. Several shifts are available, too.


“One of the hardest decisions was making the decision (to go back to school),” Clements said. “It’s never too late to learn something new. One reason I chose coding is to still be able to work at home and still be able to work for DCH. It’s the best of both worlds.”

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