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September 4, 2006
A major obstacle to establishing a coding career is the Catch-22 of needing experience to get a job and having to get the job to gain experience. There are programs all over the country that will provide a “coding certificate” once the student has paid tuition and graduated, but without actual coding experience and a professional coding credential, it’s extremely difficult to find employment in the field, let alone start with inpatient DRG coding. Burlington County College (BCC) in Pemberton, N.J., has teamed with Shore Memorial Hospital in Somers Point, N.J., to build a coding career path that may solve this conundrum. Janet Evans, coding program coordinator at BCC, explains that students must first learn the basics upon which a successful career is built. The program takes approximately one year to complete and includes courses in medical terminology, anatomy and physiology, pathology, and even pharmacology in addition to basic ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification) and CPT (Current Procedural Terminology) coding. Evans says the capstone of the program is a 14-week internship during which the student is in class coding real patient charts for six hours each week. Professional coders, who work with the students to code deidentified patient charts, start with simple cases and eventually progress to more advanced medical and surgical scenarios. Her students show enthusiasm for the program even after graduation, validating its success as well as its promise. Phyllis Heaton, who is currently employed at the hospital where she served her internship, is grateful for having had the opportunity to take the 2-D theory of classroom training and convert it to a 3-D experience working on actual patient charts from their partner hospital. Heaton passed her Certified Coding Specialist (CCS) test cleanly after completing the program and internship, adding clout to her resume with the nationally recognized professional credential from the AHIMA. Fran Morrison, MBA, RHIA, director of patient information services at Shore Memorial Hospital, is a committed partner with BCC. She is also a primary driver of the vision to develop a model program that will meet the needs of both the professional coding community and the medical providers who will ultimately employ them. Because students come to the hospital with basic clinical skills as well as initial coding competency, Shore Memorial can concentrate on polishing their inpatient skills during the internship. This focus is an exciting step up from the average coding program that may provide classroom training but has no pathway to move into the real world of the industry itself. Guiding students through the complex medical challenge of inpatient DRG coding is an integral part of the final educational experience and a facet that makes BCC’s coding program unique. Shore Memorial, a 296-bed general acute care hospital, features specialty departments such as neuroscience, cardiovascular, and cancer that allow students to experience a wide range of patient cases. In addition to working on “canned scenarios” with all the requisite information documented for the coding exercise, this set-up places the students in the middle of genuine documentation issues, including the challenges of poor handwriting, pending labs and pathology, and symptoms that still need final diagnoses at discharge. If these opportunities and benefits are not sufficiently impressive, there is also the opportunity for a limited number of students to be accepted into an externship program at Shore Memorial. The program, which runs concurrently with the coding program and offers a small stipend, allows the facility to evaluate the student as a prospective employee, helps defray tuition and living expenses, and provides professional experience. A measure of any educational program’s success is its track record when it comes to sending graduates off into the profession. The number of students with a “coding certificate” is typically quite different from those who have coding jobs. Employers are faced regularly with the onerous task of explaining to hopeful grads that a college coding certificate won’t guarantee employment. As a result, the facility and the school become the subject of disdain from students who have spent time and money to complete a college program but nevertheless find it difficult to find a job in their chosen profession. How does BCC’s coding program stand up to the test? Although only one class has graduated from this fledgling effort, Morrison says that even though not all graduates chose to take the CCS exam immediately after graduation, those who did passed it. She also says that of the six graduates, four have obtained employment in coding positions. While still in its infancy, this team effort by BCC and Shore Memorial Hospital offers hope for aspiring coding professional and encouragement to other schools and facilities to share both the expense and risk of training the incoming generation of coders. A major obstacle in getting the coder from the classroom to the facility has traditionally been the dual issues of time and money. It takes time from the facility and its staff to deidentify charts for the program. It takes time to donate the training and feedback to the college, and anything that takes time also takes money. The risk includes the possibility that, having provided the time and money for an internship program, the coders it nurtured will take their new skills elsewhere for employment. An imaginative and aggressive college has teamed with a hospital that dares to step up to the challenge and take the risk of providing opportunity to gain competent and professional coders for its own needs. Morrison has hired two graduates from BCC’s first graduating class but has had one move on to another facility—so she has experienced both the risk and the reward. Morrison hopes to add two other providers and partner with additional educational institutions in the area to maximize the opportunity and minimize the individual risk for all participants. The national community of schools and medical facilities could do well to consider this progressive and evidently successful endeavor. While there is risk to any venture, the commitment and drive generated by the professionals behind this program are impressive as well as encouraging. Continued efforts and similar success can help close the book on the Catch-22 chapter and open a volume of opportunity for aspiring coders. — Judy Sturgeon, CCS, is the hospital coding
senior manager at the University of Texas Medical Branch in Galveston.
While her initial education was in medical technology, she has been
in hospital coding and appeal management for the past 18 years.
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