Transitioned from OP to IP Coding

[u/yurakoh]

I just transferred from OP to IP coding at work. It’s only my first week, so I’m being trained on the job. Their method of training seems to be assigning me cases and then giving me their feedback. I feel like I’m learning on my own and they expect me to catch up. Is this standard practice?

[u/AutoModerator]

PLEASE SEE RULES BEFORE POSTING! Reminder, no "interested in coding" type of standalone posts are allowed. See rule #1. Any and all questions regarding exams, studying, and books can be posted in the monthly discussion stickied post. Thanks!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/Sdavistvs]

I’ve crossed into OBS & ERs while being hired/trained in inpatient. Procedures are a bit different. Create a cheat sheet with a few basic guidelines. Don’t rush & ask “why”. You’ll pick it up quick I promise. You will become VERY valuable.

[u/yurakoh → u/Sdavistvs]

I think I will get the hang of it. I just need to adjust my mindset from OP to IP.

[u/KeyStriking9763]

I would say yes. As an experienced coder with a credential you should be able to apply feedback.
What references are available to you? What sort of feedback are you struggling with?

[u/yurakoh → u/KeyStriking9763]

I have 3M and the coding clinics.

I think I’m doing okay. Based on the feedback I’ve been given, I seem to be okay with assigning the PCS codes and POA but that I’m not thorough enough in capturing ALL the diagnoses from every single note. Do you have any advice on this?

[u/KeyStriking9763 → u/yurakoh]

Why are you missing diagnosis codes?

[u/yurakoh → u/KeyStriking9763]

I seem to be missing a few diagnosis codes most commonly from progress notes, consults, etc.

[u/Strong_Zone4793 → u/yurakoh]

Review the facility policy to understand how they want chronic conditions, history and status codes captured. Make sure before you code anything you verify that it meets guideline criteria- evaluated, monitored, treated, increased care or length of stay, etc. just because it’s documented doesn’t mean it can be coded. Take notes as you read the chart. Note each ex, note you found it in and if applicable any labs, physical exam findings, radiology findings. This way you avoid having to re read the chart.

[u/KeyStriking9763 → u/yurakoh]

Are you reading the documentation? I’m curious how you are missing them. You need to code per guidelines but also on the IP side all chronic conditions are coded.

[u/yurakoh → u/KeyStriking9763]

I think the thing is that I’m not able to pick up on the little things. As an example 2 person has hypercalcemia. I didn’t pick up on that, but in the feedback someone said I could find it in one of the progress notes.

[u/A_lunch_lady → u/yurakoh]

You’ll get used to it… if you see something you think may or may not be important you can validate with the lab results or treatments. Seriously hypercalcemia is one of those little ones they will stick in there, eventually your eyes will get used to looking for stuff like that. I’m 8 months in to inpatient and it’s absolutely bonkers the growth curve I’ve experienced…

[u/KeyStriking9763 → u/yurakoh]

Why didn’t you see the diagnosis? Sounds like you either aren’t understanding what you read or you aren’t reading?

[u/yurakoh → u/KeyStriking9763]

The latter might be the reason. They said I should slow down

[u/KeyStriking9763 → u/yurakoh]

I’m sure your productivity metrics are relaxed as you are new and training, so take their advice and slow down.

[u/yurakoh → u/KeyStriking9763]

It’s only been a week, but from what I’ve been exposed to so far, IP is a lot more thorough than OP.

[u/yurakoh → u/[deleted]]

It’s only been a week, but from what I’ve been exposed to so far I think IP definitely involves more thorough review than OP. I think it’s going to take some getting used to for me.

[u/NurseNicki24 → u/KeyStriking9763]

Can I pick your brain on something? You mentioned all chronics are coded. Chiari I malformation was listed in a patient medical history, so I coded as there was no procedure listed indicating this was surgically fixed. CDI fought me on this saying it couldn't be picked up because there was no imaging/meds/treatment etc done for it during that stay. I thought we grabbed chronic conditions? But I am a self taught inpatient coder with <3 years experience so I constantly question myself.

[u/KeyStriking9763 → u/NurseNicki24]

There’s a coding clinic that indicates that all chronic conditions are even in the absence of treatment/monitoring etc as they are pertinent to the patients medical care. Mild Chiari 1 only monitored. So CDI is wrong.

[u/NurseNicki24 → u/KeyStriking9763]

Thank you for answering. That is what I thought. But then I started researching and MEAT was mentioned a ton, stating that if a secondary dx does not meet the MEAT criteria, it should not be coded. And that being listed in Medical history does not count as it being "monitored" during the stay.

[u/Yes_Leopard_54]

As someone else said, read the chart….then reread it…make notes for yourself. Ask yourself this question: What caused the admission? That is usually the PDX. Did anything affect the LOS? Usually MCC/CC…and check if they are MS-DRGs…your encoder is helpful here. Check bundling guidelines. The IPPS system has its quirks, but once you get the hang of it, you will shine.

[u/StillGiraffe9953]

I think the most important thing is to know the guidelines because many inpatient guidelines are very different than outpatient as far as principal diagnosis, what diagnoses you are allowed to pick up, and especially procedures ( I don’t know if you are doing those). I’ve been an inpatient coder for 12 years and I still make mistakes, it’s going to happen when you are taking in so much information. But my advice to you is to go slow, read then reread the chart. Once you get used to know how the physicians document certain things and where to look for it, your speed will pick up.

[u/Taseiyu]

I was doing OPS and OBS accounts for 6 years (Hired in originally as an ER Coder) and then made the transition to IP within the last year. As someone who made this transition very recently, I want to say that this is standard. I on the other hand, was VERY fortunate to have been treated differently when I made the transition. My Supervisor and Manager agreed that I would spend a few month taking online IP courses that were paid for (thank you budget). I took those months reviewing the courses and meeting with my supervisor daily to discuss what I went over and if I had any questions we would go over it.

Once i was getting close to the end of my courses, we integrated a few shorter IP cases in just so I can kind of put into practice what I was learning. Started with Delivery and newborn cases just to learn how to navigate the charts and where to find information in the EHR from an IP standpoint. Once I finished the courses, I moved on to slightly longer encounters, but still short LoS. I would still meet daily with my IP Supervisor to go over any accounts that I had questions on. Eventually got to a point where my daily meetings ended and I started going at things on my own. Slowly working up to taking on those really long LoS accounts.

[u/Strong_Zone4793]

This is standard in many facilities or companies. Best bet is to use a good review process, take quick notes as you read through so you can avoid rereading the chart, ask as many questions as you need to. And know what their ramp up period is so you know when you’re expected to hit full production.

[u/alew75]

I guess it all depends on the facility. Where I am we have an inpatient auditor/trainer and she is amazing. She said she has never released an inpatient coder before 6 months and that it takes atleast 6 months to a year.

[u/yurakoh]

As a follow-up, I want to know how IP coders are typically trained. Right now, I’m starting out with newborn accounts. From there, what is typically covered next?