PITTSFIELD — Ever wonder how insurers and medical facilities bill people for surgeries, illnesses and other procedures? It's all done by code.
But someone has to translate those complicated medical diagnoses into that coded language that the billers can recognize. That's where Ann Marie Perry comes in.
The Pittsfield resident is a medical coder for Beth Israel Leahy Health in Burlington. She reviews patient medical records and translates that information into alpha numerical codes for the billers to work from.
We spoke with Perry recently about how she became a medical coder and what the job entails and this is what she told us.
Q: How did you become involved in this field?
A: I had been working in the restaurant business. I had been doing that for quite a few years at quite a few places and restaurants close a lot. Although I enjoyed it — I had my original degree at [Berkshire Community College] in hospitality — I was just looking for something different, something more stable, a career I could grow in. So I looked at BCC again. I saw medical coding and health information management, and decided it would be something that I liked, and the rest is history. (She graduated from BCC in 2015 with an associate degree in health information management and a certificate in medical coding.)
Q: What was it about medical coding that interested you so much?
A: I've always been interested in the medical field. I never saw myself in direct patient care so it really is a perfect fit for somebody like me.
Q: I'm assuming that most people don't know what medical coders do.
A: They don't. If I have to keep my answer short I just say it has to do with billing. Basically, what I'm doing is reading the medical record documentation that's dictated by the clinicians taking care of the patients and the nurses and translating it into alpha numerical code, which then gets used for processing and billing, and for gathering data as well. A lot of the data that's collected, for instance say the COVID data, that's coded data.
There's a cancer registry. That's a whole separate area of coding where a lot of that data could be used for new treatment or statistics about survival rates. There's so many different facets to it.
Q: Usually when you think of codes you think of secret messages being passed back and forth. What does coding entail in this field?
A: It's an alpha numerical designation that represents a diagnosis or a procedure. For instance, high blood pressure/hypertension, the code is I-10.
Q: How do you learn these codes?
A: In school you take courses. One of the first ones that you'll take at BCC is medical terminology. You start your database understanding there with your with your diagnosis coding course. It's an actual book. A large voluminous book that contains all of the codes.
Q: Who receives the items once they've been coded?
A: The insurance companies, the billing department at the hospital, they're the first ones who would encounter it. They start the process of processing claims. If there are any problems; there might be an error that comes back. They'll alert me and say can you take a look at this. The insurance company may reject it or what have you. Later on down the line, something we hate to run into as coders, is we get audits back. The insurance company will hire third parties a lot of the time for review, and they'll come back and deny. Another part of my job is looking at that.
Q: What are the most difficult items to code?
A: I would say definitely trauma, multi-traumas. The multi-traumas are very difficult where someone gets in a bad accident and they have a lot of injuries and have to have a lot of surgeries. Those are really tough. Transplant cases can be very complicated. Open heart surgery, neurosurgery, spinal fusions.
Q: Why are they so difficult?
A: It's having to understand the most complex procedures exactly what the surgeons did. Doctors aren't required to translate anything into codes so you really have to look at those more carefully to make sure you're coding them correctly.
Q: What are the easiest things to code?
A: Joint replacements are pretty standard. Some of the mental health. When I used to work at Berkshire Medical Center I used to code their mental health and substance abuse unit. You're seeing pretty much a standard patient there and not very sick people. Those are a little less complex.
Q: Do you have to be certified or licensed to be a medical coder?
A: You don't have to be, but it's highly recommended. When I started not a lot of jobs were requiring a certification. Now from what I see almost every job requires at least one certification through our professional coding association (the American Health Information Management Association). I have four of those. (The American Academy of Professional Coders in another organization that certifies medical coders.)
Q: Do you get certified when you graduate from college or is there another step before you can work professionally?
A: You have to take a certification exam. They have various different certifications depending on where you want to specialize. There's general ones of which I have two. Then you can also specialize in different areas as well. You have to renew, I believe it's every two years for the CCS (certified coding specialist designation). You have to do continuing educational credits, and I have to renew my membership every year.
Q: After doing this for awhile do find yourself speaking in acronyms a lot?
A: Yes, and (also) I think just in abbreviation. You use the shorthand so it's pretty hard to break away from it because that's what you're reading all the time. I have a friend of mine who is a clinical application nurse and we're always talking like that.
Q: What's the best part of your job?
A: To me, you're telling the patient's story. Oftentimes it's like a puzzle to put it together. I really enjoy trying to solve that puzzle.
Q: What's the hardest part?
A: Sometimes it can be really sad. You're seeing people on their worst day, especially during the COVID pandemic. It was really tough through all of 2020.
Q: COVID seems to have affected everything in health care. Has it changed medical coding?
A: Absolutely. Every year there's an update to the code. That always happens in October. We have some new codes come in and some are deleted and changed. In April (2020) they had an emergency session and actually had to create a code for COVID. We had no way to capture it.
Q: What advice would you give to someone who wanted to do what you do?
A: For me it was tough because I was coming from a job where I was on my feet all day in an active and busy environment. I thought am I going to like this? So there could be that fear there. But I say go for it. If it's something you're interested in try it. It's been life-changing actually. I've gone from a trainee to just a regular coder and now I'm at a senior status. I have four certifications. It's provided me with the ability to make a real good income, invest more for my home, pay for my education. I never thought I'd be here seven years after I started. It's been a great trajectory for me.