Medical Coding For Nurses

A lot of nurses for one reason or another have to eventually leave the “hands-on” patient care side of medicine. This happens because running themselves into the ground taking care of patient’s long term sometimes leaves a nurse with a lot of unexpected and unforeseen anxiety. The shifts they work can impose a lot of serious stress on them and their families. For this reason, making the transition from nurse to nurse coder has rapidly become the “IN THING” for nurses. A career in Medical coding has become one incredible career progression that the nurses never even planned on, so it’s easy to see why they have such and passion for the opportunity.

Why Coding Is Imporant

As an LVN, LPN or RN coder, the nurse coder would review a patient’s chart in order to accurately understand exactly what happened on the operating table and why. Nurses come into play with healthcare cases that require intense knowledge of disease management and clinical intervention procedures. Because nurses have such a robust amount disease and procedure knowledge, a great majority of nurse coders specialize in surgical coding and often work in surgical ambulatory type of settings.  In other settings, non-nurse coders are responsible for extracting clinical information from various medical reports and assign specific ICD and CPT codes that correspond to the services performed.  Nurse coders are needed to medically review cases that require deeper clinical knowledge and critical thinking.  These cases are triaged to the nurses from the coders for appropriate coding. The non-nurse coders also rely heavily on the nurse coders for extensive scrutiny of claims that have been denied.  Because of their vast clinical knowledge, nurse coders are equipped to write indisputable letters of appeals and even refile appeals when necessary. The non-nurse coders triage complex clinical medical charts to the nurse coders and also often send them a lot of the appeal cases. The nurse coders will research a variety of clinical sources in order to ensure accurate coding to include laboratory tests, radiological imaging studies, H&P’s and the transcription of the physician’s notes.  Another big part of the nurse coding job is to provide ongoing documentation improvement education to the providers for proper coding. Nurse coders will also advocate for both patients and providers on medical coverage. They do this by consistently comparing their knowledge of health care policies to the physician’s documentation. Doing this ensures the healthcare coverage meets for the necessary medical criteria needed in order to justify the medical necessity of a service that was provided. Nurse coders also play a key role in auditing denied claims.  In other settings, the nurse Coders are asked to go back behind the non-nurse coders and work as auditors to the coders to ensure accuracy before the claims go out the door.  Another appealing factor for the nurse coders is that they are often placed in leadership roles.  In a great majority of clinical settings, the Medical Billing and Coding Supervisors are almost always nurse coders.  Remote nurse coders perform all of the same tasks previously mentioned but these professionals work from home. They use secure internet connections to access all the patient records and reports needed.

The Employment Factor

Employers are highly attracted to nurse coders because nurses already have established rapports or relationships with the physicians. They know how doctors think and so they know how to get along with them. Nurse coders also have the advantage already knowing how to effectively communicate with the physicians, how to best communicate with them.  As a matter of fact, you see it time and time again, any time a physician has a question, they direct them to nurse coders before the non-nurse coders.  Understandably that’s their natural inclination ..simply because they know, the nurses understand them and know their habits. The nurse coders also already are very familiar with what documentation should look like.  Because they already have a BUILT-IN pharmacology knowledge base and an IN-DEPTH clinical understanding, the nurses bring that knowledge immediately to the table. For this reason, most coding entities have at least one nurse coder on staff.

Salary Considerations

With all of the changes in healthcare the past few years, the coding industry is ever-evolving so “job security” for medical coders is very attractive.  A lot of nurses think they’re gonna have to take a pay cut but depending on what position and which company you work for, in a lot of cases, that nurse can actually make more income as a nurse coder. As per the recent stats released on Mar 22, 2021 from zip recruiter, the average annual pay for a nurse Coder in the United States is $74,128 a year. That works out to be approximately $35.64 an hour. So basically $1,426/week or $6,177 a month.  Although non-nurse medical coders earn a median hourly salary of $27.50 an hour, according to the AAPC salary survey, nurse coders much more. The website, Nurse.org indicates that nurse medical coding managers earn $82,656 per year, while the nurse medical coding auditors earn $94,936 per year. According to the U.S. Bureau of Labor Statistics, job opportunities for all medical records and health information technicians is expected to increase by 8% between the years 2021 and 2029, which is much faster than other industries.

A Note About Transitions

So now that’ve laid out all the highlights it’s also important to lay out the warnings.  Okay my lovely nurses because the transition itself from nurse to coder isn’t always so peachy. .  I say this because its the personal characteristics will dictate whether the transition from nurses to coder will be a smooth one or a rough one..lol

Okay so let me pain an image in your mind. 

Here we have nurse coder, Eager Emma.. eager Emma is excited to learn.  She keeps an open mind at all times and never hesitates to ask the non-nurse coders for help and direction.  Because Eager Emma has no problem in being the new kid on the block and could care less about her ego, she blossoms into the most admired and respected team member of the entire department.  It isn’t long before the non-nurse coders turn to her for help and direction.  Before they know it the revenue cycle team is one giant happy family with all team members pulling in the same harmonious direction.  They hit and sometimes exceeded their month-end goals every single time. Pay increases and bonuses are rewarded to all team members alike and they lived happily ever after.

But then we have a nurse coder, Know it all Nancy.  Little Miss Nancy believes all her nursing skills will transfer over to coding without a hitch.   She begins to select codes from a preselected list of codes but when the other coders try to warn her, she tells them she doesn’t need anyone’s help.   Every time one of the coders try to tell Nancy her codes aren’t supported by documentation, Nancy tells them “Yes, but I know doctors, so I know what they mean when they document like this.”  And although the other coders try repeatedly to tell her “but it is not documented you can’t code it,” know it all Nancy dismisses it all because in her mind she knows it all.   Because of this behavior, division rapidly forms within the unit and It isn’t long before the members of the team get frustrated and unmotivated.  Needless to say, the team begins a downward spiral of missing their timely filing marks; their denied claims begin pile up and the number of appeals increase.  Before they know it, the revenue cycle team is one giant contentious train wreck with the team members pulling in separate directions.  They miss their month-end goals, there are no pay increases or bonuses, and they don’t live happily ever after.

Okay so now that you know this can go one of two ways my lovely nurses, I trust you know which behavior to take on.

RHIA and RHIT

Now in terms of what degrees or credentials do you need in order to make the transition from nurse-to-nurse coder, please note that right off the bat, you don’t need any further degrees.  You say but what about RHIA and RHIT? Okay let’s cover that really quick.

The RHIA through AHIMA is the bachelor’s degree. But if you’re looking for the truth, here it goes. Please only pursue this degree if you are aspiring for a big leadership position. In other words, only get the RHIA if your dream is to become one of the big guns who make executive decisions and run entire HIM or HIT departments in hospital settings.

As for the RHIT associates degree through AHIMA,  This degree was more so for supervisory knowledge but truthfully, this one isn’t even worth getting into any more because the truth is, over the years, this ended up not being very necessary, the RHIT is actually being phased out as we speak so never mind this one. 

If you are a nurse and solely wish to be a nurse coder, don’t pursue more degrees and instead go after coding credentials. In order to make the transition from nursing to coding, the most powerful coding credentials these professionals can attain would be the CPC and CPMA or the CCS and CPMA. 

Final Thoughts

Now listen, a lot of nurses are interested in coding but get very “put off “because the medical courses they’re looking at, is going to make them repeat all the clinical courses they’ve already had, or they get put off because its is going to take too long to complete or they get put off because the coding course cost $4K!  

Look If you’re a nurse and all you want is to be a coder, please don’t do AHIMA or AAPC, going either of those routes, there’s no need to repeat all the modules you’ve already taken and there’s no need to pay all that money.  What nurses need is a course that cuts out all the fluff, Gets to the point, teaches the fundamentals of coding, simplifies and breaks down the guidelines for code sequencing. 

A course that teaches what words to abstract from the report and, for goodness’ sake, a course that prepares for you 100% for the exam while at the same time teaches real world coding!

Take the course from Medical Coding Academy, complete it in less than three months, pass your certification exam on the first try, get the job you love with wonderful flexible hours and love your life again. It really is as simple as that.