From triage to the Golden Gate, my journey to coding.

From my senior year in high school through college and nursing school, the only career I wanted was an emergency room (ER)/trauma nurse. I went to a fancy school I couldn’t afford and spent a year and a half obtaining medical-surgical experience before achieving my goal of working in a local ER.

I quickly found out the ER wasn’t really where I wanted to spend my career as a nurse. It was a hard lesson to learn, but as I closed the door to the ER, a door opened to an arena I had never considered ― medical coding.

A New Door Opens

My best friend from college worked for a company that cross-trained nurses into chronic condition coders, specializing in Medicare risk adjustment. The nurses used their clinical experience to help physician groups tie up the loose ends in documentation and coding for important risk-bearing data. They’d perform retrospective chart reviews to find additional diagnoses that weren’t coded but were properly documented — codes that had fallen through the cracks in the claims process.

The position paid very well, and it also offered an opportunity to see different parts of the country. They had clients from coast to coast and all points in between. The tradeoff was working crazy hours in “peak season,” but the hours were worth the rewards of the job.

For a guy who lived in a rural town in Upstate New York, you either went into the military or played lacrosse to get out of town, but the coding world opened new opportunities and horizons. I learned medical coding and traveled to clients only a couple hours away to as far as San Francisco and Seattle.

Clinical Background Is a Huge Plus

With a diverse clinical background, I understood what providers were thinking. I could see the path providers traveled in patient care; and I could identify when a patient had a condition that could potentially affect their risk score and subsequent care and resources at year’s end.

I’d notice when documentation didn’t clearly say the patient had the condition being coded. As a new coder, it was a hard transition from being a floor nurse who could see things happen in my mind and provide an intervention before they happened, to now feeling like I was handcuffed by documentation that didn’t meet industry standards for coding.

Although frustrating, it also was an opportunity to make a difference through education and conversations with clients to help them tighten up and be more efficient with documentation. It’s easy to get caught up in the business and financial side of it, but the bigger picture to this side of healthcare is that a nurse coder’s work leads to better overall care and additional resources to help manage “risk-bearing” chronic conditions.

I Found My Niche

During my traveling stint, my role was chart-review focused, rather than on documentation education. When I married and planted roots, I took on a new role with a large health system in the Twin Tiers of New York and Pennsylvania, where my sole focus is education. I teach providers and administrators the importance of documentation content and how it impacts us, positively and negatively, in value-based reimbursement.

Finding my “niche” as a nurse coder was not part of my grand career plan, but the coding world changed my life and provided opportunities that an ER nurse never could have. Without my nursing and coding experience, however, I would not be as successful in my new role as I am today.

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