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2008-08-17 - 5:59 p.m.

So a bad thing happened to me at work.

I work for a big corporation now. There are a lot of people up the line whose salaries are justified by their ability to identify and report negative "findings". This is done when they come to the many facilities we own and check up on us. My corporate spy came to hang with me last week and she checked my coding. Now, coding is important, because it leads directly to the payment a hospital receives. It has to be good. If you "upcode" you commit fraud and your hospital is liable for overpayment. If you under-code, you've lost money for your facility. I have specialized in rehab medicine for my whole career and am in need of some learning when it comes to the type of coding I am doing now. I don't know it all in this field just yet, so I was a litle nervous about what the corporate lady might find.

In her audit, the only bad thing she found was that I failed to code a procedure that was worth a good amount of money. My bad. Mea culpa. I made a boo-boo. I have not had to ever code procedures before and I thought another code in the list covered it and just didn't realize the additional code was needed. Lesson learned. I won't make that mistake again. That was my only solid mistake of the entire audit. The corporate lady did however take some issue with a few of my coding decisions. She also did display to me that she is rusty in her coding skills and I am now concerned about having someone judge me who is not up on things entirely herself. I can mess up enough without someone else's erroneous opinions making me look worse.

For example: She went through and recoded 15 charts, just to show how she would have done it differently. She coded things that are no longer in existance... which is a big no-no. She was concerned that I was "leaving things out", when actually, she was putting things in that you are not allowed to put in there according to coding guidelines. You are supposed to code only the illnesses that have some bearing on the current inpatient stay. She codes every single thing she sees in the chart, including illnesses that are resolved. She coded the gangrene that caused an old amputation in one of our patients. Not only did the patient no longer have gangrene, she didn't have a LEG. OK? Not correct coding. She also codes all the "signs and symptoms" a patient has in their entire stay. Coding guidelines state that you do not code signs and symptoms where a larger disease's code covers those symptoms. A patient with a blood infection will have a high white count and fever. You are incorrect if you code those symptoms. I also pointed out to her that it is pointless to code every single thing, because billing software only has spaces for 10 to 17 codes, total. She had 38 codes noted on one chart. Those codes will never make it onto the software, or to medicare. No one will ever see it but her. Her response to this was that I am absolutely correct, however, they had decided in our company to just code every single thing.

I find that to be a non-answer.

Ultimately, in her report, she told my boss that I "left things out" and coded differently than she does, but that I am a very good knowledgeable coder who made only one solid mistake by leaving out a procedure code that should have been coded. The mistake is being re-billed and no harm has been done.

My boss missed all the good stuff and seems to not trust me now. Like, I think he thinks I don't know what I'm doing now. He sent me an email telling me that from now on I have to hold yet another meeting (which is basically designed to check up on me) on a weekly basis. He wants me to track a bunch of stuff and report on it weekly for a meeting that is supposed to be done on a quarterly basis at most. Needless to say, I am extremely non-plussed. I am going to report this to the corporate lady and tell her that this extra waste of my time is not going to be conducive to better coding and see if she can help back him off. I also have to try to figure out a way to simplify this shit task he arbitrarily dropped on me and spend a little time proving myself. When she comes back in October she will audit again and hopefully I will not make any mistakes whatsoever, but you know, coding is kind of subjective from one coder to another. Many times it comes down to an educated guess and one coder will perceive it differently than another. Also, I don't trust her coding skills, since I know she has forgotten some really basic rules and I don't want someone giving my hair trigger boss any crazy ideas based on a mistaken way of thinking.

This is the sort of thing that I have to just ride out and realize it will get better. It makes me want to just find another career though. It's kind of like when I took philosophy in college. I quickly realized that my teacher could mark any test question wrong if he wanted, because philosophy is all gray areas and personal perception. He could make any question right or wrong according to his whim. I feel that this corporate lady has the ability to make my performance look right or wrong based on her whim and not really based on solid fact. If that makes any sense. I guess I am going to have to make sure I can cover my ass and back up my coding with documentation from the coding resource materials. What a pain in the ass way to live though.

Why am I not doing a creative career? I'm artistic for pete's sake.

All I need is one cool million. If any of you hit the mega jackpot, remember your old friend wilberteets. I need to hit a jackpot and stop working. I can't even make a joke here. I'm dead serious.

spring - fall

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