From Triage to the Golden Gate, My Journey to Coding

By Steven Ovens, RN, CPC, CRC

From my senior year in high school through college and nursing school, the only career I ever wanted to pursue was an ER/trauma nurse. I went to a fancy school I couldn’t afford and spent a year and a half obtaining med-surg 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.

The Door Opens to a New World

My best friend from college had worked for a company that hired nurses and cross-trained them into chronic condition coders who specialized in Medicare risk adjustment. The nurse would use their clinical experience and judgment to help physician groups tie up the loose ends in their documentation and coding for important risk-bearing data. They’d perform retrospective chart reviews to find additional diagnoses backed up with proper documentation that weren’t coded or had fallen through the cracks in the claims process.

What attracted me to the position was that it paid very well, and it also offered an opportunity to get out and see different parts of the country. They had clients and potential clients from coast to coast and all points in between from Maine to Portland, Oregon. That came with a tradeoff of 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 up new opportunities and horizons. I learned the ropes as a nurse coder and travelled to clients as close as hours away from home to as far away as San Francisco and Seattle. As a traveler was, in one week, I could sample the clam chowder in Boston and San Francisco.

Clinical Background Is a Huge Asset in Coding

As a nurse with a diverse clinical background, I could really understand what providers were thinking and could see the path they were traveling in their care of particular patients. I could read between the lines to see instances where a patient had a condition that could potentially affect their risk score and subsequent care and resources at year’s end.

But as we often see in the coding world, the documentation didn’t clearly say they had the condition. As a new coder, it was difficult to read how a provider had all but teed up a diagnosis in their documentation, but not being able to code it according to coding guidelines and procedures. 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 it was 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 their documentation. It is 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 these “risk-bearing” chronic conditions.

Finding My Niche

During my traveling stint, my role was chart-review focused, rather than on documentation education. When I married my wife and planted our roots elsewhere, 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. In this role, I teach providers and administrators the importance of documentation content and how it impacts us, positively and negatively, in this new world of value-based reimbursement. As a registered nurse, I have an immediate rapport with the providers as someone providing education who has a clinical background and understands their role and frustrations.

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. The cherry on top is that without my nursing experience or my coding experience, I could not be successful in this new professional role.

Author bio:

Steven Ovens, RN, CPC, CRC, studied nursing at the Wegmans School of Nursing at St. John Fisher College, Rochester, New York. He is a member of the Sayre, Pa., local chapter, where he has served as president for two years.