# Coders being fazed out



## judy gilbertson (Jul 2, 2013)

I have been told that coding positions are being fazed out because of the EMR.  Because physicians and nurses are entering their codes into EPIC themselves, and coders are being laid off.  This is hard for me to believe.  Are coders losing jobs because of EMR?  What do you think?


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## mitchellde (Jul 2, 2013)

no I think these systems demand more qualified coders than ever befor
the clinical persons are not trained in coding and the EPIC or any other system does not have all the coding rules buil in.  ALso they do not the intellegence to evaluate the providers documentation to understand the clinic diagnosis and append the correct code, often the system assigns a very incorrect code.  We have to remember the diagnosis belongs to the patient and it must always be absolutely correct in terms of code assignment, I see many many incorrect dx codes being assigned by coding systems that do not understand the clinic dx codes nor are programed in line with the ICD structure. in otherwords every system I run into will report that 964.2 and V58.61 are the same code and are interchangeable.  CLearly there is still plenty of work for coders in the future.


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## Love Coding! (Jul 2, 2013)

mitchellde said:


> no I think these systems demand more qualified coders than ever befor
> the clinical persons are not trained in coding and the EPIC or any other system does not have all the coding rules buil in.  ALso they do not the intellegence to evaluate the providers documentation to understand the clinic diagnosis and append the correct code, often the system assigns a very incorrect code.  We have to remember the diagnosis belongs to the patient and it must always be absolutely correct in terms of code assignment, I see many many incorrect dx codes being assigned by coding systems that do understand the clinic dx codes nor are programed in line with the ICD structure. in otherwords every system I run into will report that 964.2 and V58.61 are the same code and are interchangeable.  CLearly there is still plenty of work for coders in the future.



I agree with Debra...

Denise


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## QuadRider (Jul 2, 2013)

I'm seeing the coders training the providers.  E/M, procedure and dx coding.  Sounds like the coders are working themselves right out of a job.  Management is asking this of the coders.  Guess we will see.


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## mitchellde (Jul 2, 2013)

the providers have much more important things to do rather than stay on top of the coding guidelines and rules and regulations I am not worried.


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## Peter Davidyock (Jul 3, 2013)

I am not worried either. Especially working in a system where Drs are reimbursed based on RVU's.


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## Pam Brooks (Jul 3, 2013)

I think that the concept of back-room data-entry coders is going to be phased out. However, EHRs have introduced the opportunity for another kind of coder---Auditor/Educator, Documentation Improvement Specialist and Systems Analyst. An EHR is only as good as the information it acquires and the information it spits out---creating opportunities for coders who understand documentation guidelines and who are able to communicate well with physicians.

To speak to the comment about physician reimbursement via RVUs..this also is going the way of the dinosaur. Physicians will be paid based on performance, meaning they will have to document very carefully their patient's condition, treatment, response to treatment and any factors that impact patient care. This will significantly impact their reimbursement under a pay for-performance model, and coders can assist providers in making sure that this information is captured in a reportable format (hence the meaningful use of the EHR). 

There are going to be opportunities for coders, but the coding job as we know it now, will change, and coders will have to change with the times or find themselves out of work. To anyone who will listen....keep up on the coding rules and regulatory guidance. Obtain excellent communications skills. Learn about your EHR: become a superuser. Continue your education--I guarantee that many of these jobs will require a degree. Read and familiarize yourself with the changes in the industry. Stay connected with AAPC and AHIMA, which are the two most reputable organizations with regard to coding and HIM.


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## RFoster1 (Jul 3, 2013)

Pam Brooks said:


> I think that the concept of back-room data-entry coders is going to be phased out. However, EHRs have introduced the opportunity for another kind of coder---Auditor/Educator, Documentation Improvement Specialist and Systems Analyst. An EHR is only as good as the information it acquires and the information it spits out---creating opportunities for coders who understand documentation guidelines and who are able to communicate well with physicians.
> 
> To speak to the comment about physician reimbursement via RVUs..this also is going the way of the dinosaur. Physicians will be paid based on performance, meaning they will have to document very carefully their patient's condition, treatment, response to treatment and any factors that impact patient care. This will significantly impact their reimbursement under a pay for-performance model, and coders can assist providers in making sure that this information is captured in a reportable format (hence the meaningful use of the EHR).
> 
> There are going to be opportunities for coders, but the coding job as we know it now, will change, and coders will have to change with the times or find themselves out of work. To anyone who will listen....keep up on the coding rules and regulatory guidance. Obtain excellent communications skills. Learn about your EHR: become a superuser. Continue your education--I guarantee that many of these jobs will require a degree. Read and familiarize yourself with the changes in the industry. Stay connected with AAPC and AHIMA, which are the two most reputable organizations with regard to coding and HIM.



Great advice!  Thank you!


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## bridgettemartin (Jul 3, 2013)

I think abstract coders will always be needed.  Like others have said, physicians may dabble a little in coding, but don't have the time or desire to keep up on all the coding guidelines and regulations.  However,  I also think that those coders that just do data entry from a router will no longer be needed.


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## MnTwins29 (Jul 3, 2013)

Pam is absolutely correct - the job of "coder" will be changing and it already has done so.  I moved from the traditional coding/HIM career track to compliance (auditing and education) 4 years ago and am very glad I did so.


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## tracyhelget (Jul 3, 2013)

I disagree. Especially with ICD-10 coming into play soon. Our organization is looking at adding more certified coders in the next year.


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## jmcpolin (Jul 3, 2013)

I think some companies were hoping they would be able to do away with coders, but I do not see that happening with ICD-10 and the constant AMA and MCR guideline changes.


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## JWash618 (Jul 3, 2013)

We have MANY doctors that use EMR's but they still come through the coding department for us to verify that everything entered is correct/ the documentation supports the code they chose(there's often something missing that we have to correct)


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## nyyankees (Jul 5, 2013)

Pam Brooks said:


> I think that the concept of back-room data-entry coders is going to be phased out. However, EHRs have introduced the opportunity for another kind of coder---Auditor/Educator, Documentation Improvement Specialist and Systems Analyst. An EHR is only as good as the information it acquires and the information it spits out---creating opportunities for coders who understand documentation guidelines and who are able to communicate well with physicians.
> 
> To speak to the comment about physician reimbursement via RVUs..this also is going the way of the dinosaur. Physicians will be paid based on performance, meaning they will have to document very carefully their patient's condition, treatment, response to treatment and any factors that impact patient care. This will significantly impact their reimbursement under a pay for-performance model, and coders can assist providers in making sure that this information is captured in a reportable format (hence the meaningful use of the EHR).
> 
> There are going to be opportunities for coders, but the coding job as we know it now, will change, and coders will have to change with the times or find themselves out of work. To anyone who will listen....keep up on the coding rules and regulatory guidance. Obtain excellent communications skills. Learn about your EHR: become a superuser. Continue your education--I guarantee that many of these jobs will require a degree. Read and familiarize yourself with the changes in the industry. Stay connected with AAPC and AHIMA, which are the two most reputable organizations with regard to coding and HIM.



Pam-
I wanted to jump in on this topic. We use EPIC here in Long Island. Just heard 2 NYC facilities are now using CAC (computer-assisted coding) and released their coders. So we are watching to see how it goes. We all know that Administration will look at the botton line - saving $$. I have heard that EPIC has sold it's product based on eventually replacing coders. I agree with your post and that things will change for codres. I am currently getting my HIM degree and doing a research paper on CAC for my summer class. When I spoke to the professor she really stated that coders will most likely stay and that data analysis will become important. I agree...


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## shellysk8 (Jul 5, 2013)

*Epic*

We use Epic here, and the Computer Assisted Coding is barely helpful for the most minimal of services. Anything remotely complex must be, at a minimum reviewed by the coders but the majority is actually coded by the coders. That is both for the facility and the professional claims. There are too many "gray" areas and too much complexity for anyone concerned about compliance to trust a computer to do the coding!! A practice that does so exclusively is just asking for trouble.


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## burnam (Jul 7, 2013)

I completely agree. We are finding a ton of issues in relation to diagnosis coding in our EHR. The providers just don't understand the rules nor do they want to devote the time to learning ICD-9 coding rules. We have one provider who is choosing 401.0 (malignant hypertension) on all her patients who have a high BP reading in the office. I attempted to question her on this diagnosis (as I have never seen it coded so much by one physician) and she responded to me by saying "I have more medical knowledge than you, you need to just sit back and submit my claims in a timely manner and let me diagnose the patients." I believe the EHR has caused physicians to think they know all about coding and when they are questioned on a certain diagnosis, they are offended. I just don't think the government understands the issues that EHR's are causing in relation to coding (especially in practices where we are told to use the codes providers choose). We have physicians in our practice who think they know what they are coding, but in fact don't really understand the meaning of each code and what is needed in order to properly report that code. We have ton of issues in relation to coding and the EHR. The bad thing I am dealing with is administration not backing me up and worrying about the issues I am finding. They just tell me to keep examples and they will handle it. It never goes anywhere and when they do finally have a talk with the providers, they just tell them how great they are doing and to keep doing as is. Anyone have any ideas on how I should handle this issue? I feel that I am finding many issues and my hands are tied in dealing with them.


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## yvbarry (Jul 7, 2013)

I understand coders will become coding editors...


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## umcanes4 (Jul 8, 2013)

Well, my previous employer merged with another oncology company and when they interviewed all of us, I was told I am not needed because they dont use coders due to their EMR doing everything for them. I was taken back. 

Now at my present employer, they are training the senior coders to be more of an Auditor/Educator for the Physician and their practices, especially for the E/M's. We have just beed assigned 9 courses with E/M University including the physicians. I hope that provides some help for the physicians realizing the importance of documenting correctly 

I agree with the fact that the coding field is changing and we have to be willing to change with it. This def changes the path in coding I was working towards. But it will work out someway for me


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## jimbo1231 (Jul 8, 2013)

*Physicians Coding into EPIC*

Hi Burnam,

I've been following this intersting discussion and after 30 years our field still amazes and confounds me sometimes. The latest in technology in EM/Hrs (not that they are close to perfected or user fiendly!) has led to more physicians doing their own coding. That was the standard in the not so good old days when I started out. And now it's back due to EMRs supposedly fixing everything. And of course the Scribe boom is a result basically of EHR user unfriendliness. Everything old is new again. Or as Yogi Berra said...It's like Deja Vu all over again!
Burnam, you might consider putting together a presentation on the basic rules of hypertension coding. you might use live but anonymous examples. This way no delicate but large physician ego's are bruised. Or you could ask administration if they would be willing to bring in an outside reviewer. Sometimes Docs will listen to consultants (that was a plug!) when there own personnel are not getting through.
I can't see how docs can have their head in the sand about ICD-9 when 10 (most likely) is just around the corner!

Jim


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## mitchellde (Jul 8, 2013)

Also I have looked at many of the EMR programs currently in use and the ICD-10 CM codes.  All of those I have looked are not putting in the placeholder x or the required 7th character.  The trainer for one of these bigger vendors told me those were nonessential characters and did not need to be in the code!  So how many denied claims for invalid codes are we going to see??  Also the exclud1 definition, this will cause claims to deny and many will puzzle over it for days or weeks and some will never figure out the answer.  That is just one little part of it, others have a built in "fix" for the provider, they only have to select the ICD-9 code and tthe system will convert it to the ICD-10 CM code, however there is not a one to one conversion on many codes and there is a significant number of ICD-10 CM codes that have no equal in ICD-9 to be mapped to.  Payers have already state the use of unspecified diagnosis codes will be less and less accepted.  So Coders being fazed out?  I do not see how, they will need us more than ever come about December when they are so desperate to paid.


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## TTcpc (Jul 8, 2013)

*Epic computer assisted coding*



shellysk8 said:


> We use Epic here, and the Computer Assisted Coding is barely helpful for the most minimal of services. Anything remotely complex must be, at a minimum reviewed by the coders but the majority is actually coded by the coders. That is both for the facility and the professional claims. There are too many "gray" areas and too much complexity for anyone concerned about compliance to trust a computer to do the coding!! A practice that does so exclusively is just asking for trouble.



I agree Shelly, we have Epic here also and my job is to audit (pre-bill), educate the providers on their coding/issues, and to insure that the proper coding goes out on the bill.  I have seen providers who will write a novel in the patient notes for a patient who is there simply for a follow-up to check on their treatment progress, no new issues, no changes/tests/meds; however after "filling in all the boxes" and writing an extended book on the patient they end up with a very inappropriate level 5 for a visit that should have been a 2 or 3.  Don't get me wrong Epic is much better than other programs that I have seen, but it is not without fault or the ability to "get what you want" out of it.


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## pookergirl (Feb 21, 2020)

I realize this post is old but my answer would be YES to this.  Just received an email today that Simple Visit Coding is going to be replacing the work that I and 16 others do in my department, starting tomorrow.  We just implemented EPIC a month ago.


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## SharonCollachi (Feb 21, 2020)

I'll chime in on this old post as well.  EMR sucks, and I don't know how long the current state of affairs will last. 

We only accept patients on referral from their primary doctor, with six months of treatment notes related to the reason for the referral (pain management).  About 90% of what we receive are copy/paste EMR notes (or SALT - Same as Last Time), with the only thing changed being the date, and the blood pressure.  I got one today that had TEN visit notes that had ZERO changes except the date and bp.  Zero changes.  Not a one, nada, zip.

I regularly review charges pending against doctors in my state (California) by the Medical Board to see what they are focusing on.  Almost every single one I've reviewed for the last year has had, as one of the issues, obvious EMR notes that do not change from visit to visit, and the doctor gets in trouble for improper medical records.  

Where am I going with this?  If doctors cannot document a visit properly (whether that is because of EMR or in spite of it), then how can they properly code a visit?  The documentation has to come before the coding, so if the documentation is flimsy, the coding will not be any better.


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## ccade315 (Feb 26, 2020)

I lost my job but not because of EMR, but because of the hospital out sourcing to India. AAPC is allowing people from outside of the country to be certified threw them and now we are losing our jobs because they can pay them a lot less.


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## wisibyusha (Feb 27, 2020)

Not all the companies allow to work remote if they are not US citizens. Recently, aapc member who lives in Canada was concerned because if a person is not a US citizen he/she cannot apply for US based company.


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