Away from Patients, the Medical Coder's Work Is Critical
Posted on Wednesday, March 17th, 2010
Coding Detective: Linda Dixon, manager of the health information management department of Mercy Health/Love County, has coded thousands of medical records for reimbursement by Medicare, Medicaid and other insurance providers.
Some of the most important work in healthcare takes place away from patients.
Coding, for instance.
Assigning the correct code to each medical diagnosis and procedure is especially critical.
Proper coding ensures that Medicare, Medicaid, or other insurance programs reimburse the hospital accurately and in a timely manner.
The coder must be very familiar with the human body and how it functions. For example, a compound arm fracture and a simple one have different codes.
A disease may have an underlying cause, multiple causes, or secondary conditions.
The coder has to be able to read a doctor’s summary and the patient’s medical chart, and pull information from them in order to properly classify and support a diagnosis.
At Mercy Health/Love County, coding is performed by Linda Dixon, one of the hospital’s most veteran employees. She has 36 years of experience, mainly in medical recordkeeping and health information management.
Evidence of her experience -- neatly filed in floor-to-ceiling shelves in her office – are the 16,000 medical records of hospital inpatients, outpatients, and emergency room patients, dating back to 1998, all of which she has coded for billing. Older records are in storage.
“A new coder could not come in here and sit down, even with the new software program we have, and know all they should look for,” Dixon said.
Being detail-oriented helps, as does flexibility, because Medicare regulations and coding classification systems are constantly changing.
After years of manual coding, using printed forms and look-up tables, Dixon is elated these days about the hospital’s acquisition of a 3M Coding and Reimbursement System.
The computer program stores the ICD-9 International Class of Disease and the CPT Current Procedural Terminology, the health industry’s primary classification manuals.
“The program has replaced flipping through the code books. It presents a code when I enter the physician’s initial diagnosis and displays a number of scenarios to guide me through the medical record. Having it has saved a lot of coding questions directed to Mercy Health in Ardmore or Oklahoma City.”
A search requires the patience and insight of a detective.
For instance, if pneumonia is the initial diagnosis, was there a specific test done? If so, was the result a bacteria, a virus, or unspecified? If it was a bacteria, was it staph, strep, or something else? Different code numbers apply in each of those cases, Dixon said.
“It takes seeing a lot of complete discharge summaries for a lot of diagnoses to trigger an observation of something absent or something which was there that had been overlooked and can change the coding. You go through the orders, and you go through the medicines. It’s my job to pick up on things and go back to the doctor for verification,” she added.
Her long-term relationship with Mercy Health/Love County physicians – she joined the hospital at the age of 19, six months after Dr. O’Connor arrived -- puts her in good stead. “The relationships are great. There have been times when they ask me questions, and we just work on things together,” Dixon says.
Dixon is one of two registered medical coders at Mercy Health/Love County. The other, Connie Barker, clinic director, handles coding for clinic records.
Dixon manages the Health Information Management (formerly Medical Records) department. Vickie Preast helps code emergency room and outpatient records. Angela Lang and Cleta Rawlins are medical transcriptionists. Betty Galloway, R.N., assists part-time in the department.
Since 1996, Dixon has helped implement the Health Insurance Portability and Accountability Act, providing protections for personal health information of hospital, clinic, and EMS patients.
She also develops and maintains the extensive recordkeeping required for the biannual credentialing of the primary care practitioners, radiologists, and consulting physicians who serve Mercy Health/Love County.
Dixon and her husband of 32 years, LaRon, have two daughters, Cornelia Bass of Norman, who is assistant director of financial aid at OU, and Candice Dixon, front-end manager at Homeland, who is currently attending Murray State College, and two grandchildren.
“Coding is a science within itself that involves continuous learning and re-testing. It requires a talented individual. We are privileged to have Linda in that role and mentoring others,” said Richard Barker, hospital administrator and CEO.