E-Codes in SPACE!!!

Here's something amusing Kevin (the pharm tech) emailed me once:

So a few days ago we were talking about "E codes" (cdoes [sic] describing how a person has died). Here's what I found

E845 Accidents involving spacecraft

E928.0 Prolonged stay in weightless environment

These two are are bonus codes I found these interesting because on is specifically for "acts of war".

E926.0 Death by Laser

E997.0 Death by Laser during Wartime.

Yep, that's about the limits of my coding knowledge - which I know only 'cause they were pointed out to me. Sarah, you can have your spotlight back now...

Husbandly Input

My lovely wife has invited me to contribute here. Not sure what I'll say or do about that - I'm not a coder, she is. I suppose I may sometimes have insight into what it's like to live with a coder. Let's see... She talks about work a lot. In fact, the three people I spend the most time with in Seattle are a medical coder, a pharmacy tech, and a pediatric nurse. At least once a month I have to say something along the lines of:

"Can we please talk about something all four of us have in common?"

Yep, that's about the limits of my insight. I'll share more if anything comes to mind.

Improvement can suck

So, the company I work for has a department that just checks everyone's work to make sure that we are compliant with government regulations for billing insurance. We creatively called it the "Compliance Department".
They're job is to check the work of the coders (my job) and make sure that we are interpreting the Doctor's dictations correctly to get the right code number off to the insurance companies. They do many other related things, but that's what my perception is because I never see them do anything else.
What bugs me, is how they do this process. They host training sessions every month to show us coders how to do our job. I love that because I could use the extra training, and improvement. But often, they tell us that the dictations/documentations that we are reading, are not complete, or that the doctor's did not document well enough.
Say Doctor "Bob" sees a patient for a twisted ankle and he asks the patient if there's anything else wrong. If the patient says "Yes, I have a scab on my elbow that won't heal" the doctor ought to write that down. If Doctor "Bob" does not think it is not related to the ankle, he might leave it out of the documentation. But then when I read it and I see that Doctor "Bob" prescribed a medical ointment for the elbow, I'll say "Why?" I can't bill for the ointment because Dr. "Bob" didn't say what was wrong with the elbow.
So, us coders get this training first and the Doctors get it months down the road. - sometimes only weeks or days, but still...
That means that when Dr. "Bob" finds out that I didn't bill for the ointment, he asks me why and I have to tell him that it's his fault. Now he's mad at me because I didn't tell him. But it's not my job to tell him how to document properly. He's been a doctor longer than I've been out of high school. And as my job stands, I am supposed to interpret the documentation as it is written and assign a code number based on what the doctor wrote.
This is a simple version of what really goes on, but Can't Compliance educate the doctors around the same time we are getting education?

So here is day 2 of being a blogger. I'll just get into it and tell you what I do.
I work at a hospital, where Doctors see patients. Those Doctors then want payment. So they submit their work to the insurance companies (if the patient is insured) and the insurance pays them (hopefully). Anything the insurance does not pay, the patient is responsible for. My job is to submit that work to the insurance company so the Doctors can spend their time actually seeing the patients instead of just tromping through red tape.
It's actually more complicated than that and we have a multi-step process with different departments and positions.
Step 1: Collect Underpants...
Er...
Step 1: Doctor see's patient
Step 2: Doctor writes down what happened - dictation
Step 3: Dictation goes to insurance
Step 4: Insurance checks coverage dates/amounts
Step 5a: Insurance pays
Step 5b: Insurance denies payment
Step 6a: Money is recieved and there is much rejoicing
Step 6b: Appeals begin
Of course this is not as simple as I make it look. I don't actually send the dictation to the insurance. I 'translate' it first. It's more like encoding a message for delivery in a covert operation. You see, the insurance company doesn't want to determine how much money should be paid for putting 5 stitches in a scraped knee, vs. 8 stitches. That's where my job comes in. The government has largely regulated how much money can be gotten for stitching up a knee. It's because Medicare is the largest insurance payer in the US and that's all government. The way they regulate it all is by having each problem get a numbered code, and each treatment get a numbered code. I have to find the correct codes and give them to the insurance.
So there's these books...
There's one for "Why you saw the Doctor" and one for "What the doctor did". Each of them is about the size of a phone book, with thousands of codes in each. So each time you see a doctor, someone like me is digging through a 'phone book' size code book for what's wrong with you, and then another 'phone book' size code book for what the doctor did.
Of course, the Doctors don't always write everything down, sometimes I can't read thier handwriting, there are spelling errors, and sometimes they just forget something. I still have to figure out what they meant.
Of course, on top of all that, I work at a teaching hospital.
Yes, like that show, ER. Doctors come here to teach other doctors, and the ones that are being taught are seeing patients. This adds more complications to billing out visits for the Doctors. When a student takes all of the medical classes to become a doctor, they have to spend a certain amount of time at a hospital doing rounds with an Attending doctor, learning what it's like to work at one. They don't get paid for this, so I can't bill anything they do. After they graduate, they still don't know that much about being a doctor, so they have to take up a residency under a teaching Attending Doctor somewhere. They still don't get paid for this, so I can't bill anything they do. But Medical Students and Residents document what was done to treat the patient. So the Attendings are the only one's that get paid. And that's where most of my complications come in. Now that I've properly set up what this blog is about, I can get into. - with my next post. Need to go read some charts.

My first post

So this is my first blog post, on my first blog. I'll just give some detail on who I am and why I decided to blog.



My name is Sarah Bergstrom. I'm a 28 year old happily married woman, living in Seattle, WA. I graduated from Apollo College last year, in Medical Billing and Coding and then moved from Albuquerque, NM all the way to Seattle, WA.

In a nut shell, I've been looking for ways to spend my breaks and lunch at work that don't involve spending time in the cafeteria alone. My job involves spending copious amounts of time sitting in the same chair, in the same position, doing the same things on the computer. I don't need to run off and get something to eat everytime I want to do something not work-related.

I also need a way to talk about all of the job-related things that go on here, so that my husband won't be driven crazy by boring Coding stuff. I love my job, but that doesn't mean it is for everyone!



So, I work at Harboview Medical Center, a Level 1 Trauma center in the heart of Seattle. If ever there were a crazy place to be, it would be at such a place. I've been here since August 21st, 2007 and I really love it! I like the people and the work. The company I work for is really awesome.



I currently code for Physical Rehabilitation, and Psychology. Both are interesting areas full of lots of stuff for me to do. Speaking of which, I'll go get back to it now.