Monthly Archives: March 2016

One Hundred and Five Days

I have 105 days left to my school time. That is 105 days to finish up the curriculum before the class (it’s online) expires. I could buy an extension, but I’ve already done that and it expires in 105 days. And I’ve been unemployed since December 30th. Bills start to pile up and such. Actually not yet, but you don’t want them to…

I have 21 chapters left in ICD 10 coding, two blocks of CPT/HCPCS coding, a block of advanced ICD-10 coding, which is case studies. Then the mammoth coding practicum module where you take everything you’ve learned to do longhand and do it with an encoder. Think learning to do arithmetic or algebra by hand with your head and fingers before you learn a calculator.

Yes! They used to teach it that way! I hope they still do.

And then there is the Final which includes stuff I slammed through 15 months ago.

Needless to say (and its not like I’ve really been here anyway) the next 105 days will be a giant rush. I am learning right now that some medical background would really help in this field. I am breaking me walnuts on my head with surgical approaches. I thought a wedge biopsy was a percutaneous procedure. Apparently that is a needle procedure, a wedge biopsy is an open approach.

The diagnostic part of ICD-10 is pretty straightforward, the PCS, the procedure part is going to prove a challenge. It is only the purely medical/surgical part of it that is proving to be a little of a challenge.

Anyway, I’ll probably not be around for the next couple of months.



What a Relief!

I have invested a lot of money and time into this career shift. A LOT OF TIME. And I have almost never been more unsure of something in my whole life. I have never been outside of the restaurant/bar business. Well, alright, in the summer of 1984 my first “job” was landscape work on some neighbor’s yard in Tucson, AZ for what was probably peanuts. It was summer in Arizona, it was brutal.

And I had a two month hardware store stint in the winter in Green Bay. The only memory of which was being blown off the road by a blizzard and stranded with a news crew filming my car with its Arizona license plates (I had just moved there). Tip: it is apparently frowned upon to get out of said car, light up a cigarette and start walking in whatever direction you think might be best. Luckily the redneck in the giant pick-up upbraided me for my stupidity but eased up when I told him I had just moved to Green Bay from Arizona. He was cool, we stopped for a few a lot of beers at a bar. All perfectly legal, it was Wisconsin and it was beer, that’s not really drinking and driving.

The other memory of that job was the lumber always showing up when the temperature dipped below zero.

So my memories of work outside the business are quite unpleasant. Except for the day I never made it.

So, last January 2015, I put aside my writing, curtailed my fiction reading (you have no idea how hard those two things were) and entered school (online school, but that doesn’t make it easier (I know, my first thought was it would be easier too) it makes it harder – think of discipline… ah, there you go) for medical coding. After working on my feet since 1984, I wanted to be off my them as much as possible. And the thought of me heading into my 50’s in basically the same line of work 30 plus years later, and helping 21 year old girls celebrate their birthdays, wasn’t appealing to me. Neither was my old ass breaking up fights.

I chose medical coding because you have to reference a lot of stuff and I love doing stuff like that. Go ahead, somebody give me a laundry list of stuff to look up and research, and I’ll go fetch it for you just like a puppy dog. It is the kind of meticulous work that has you buried for eight hours. But this was 14 months of memorizing terms and guidelines and acronyms, abbreviations, regulations, government compliance, medical terminology and jargon.

Last weekend I finally broke through to the part with the actual coding. Preliminaries, sure. A few more guidelines, oh yes. But tonight I was finally able to do an exercise that had me flipping my code book (one of them anyway, the 1150 page ICD-10-CM (that’s the International Classification of Disease 10th Edition Clinical Modification).

Without going into all the scuttlebutt about what it takes to get a code, let it suffice to say that it is absolutely not as simple as looking up “flu” in the book and writing down a code. Where would you start – the Alphabetic Index, the Tabular List? Does it matter? What type of flu?

So my first string of codes (I found it challenging and fun) were probably, or will be in retrospect, sort of easy.

  1. Chronic hypertrophy of tonsils and adenoids
  2. Fibrocystic disease of breast (female)
  3. Acute suppurative mastoiditis with subperiosteal abcess
  4. Recurrent direct left inguinal hernia with gangrene
  5. Acute upper respiratory infection with influenza

I was pretty sure I had at least the first item, but I could just as well had all of them wrong.

But I got them all right. Some of them can be downright tricky. #2, for instance has (female) as one of the descriptors. You have to be careful. Is that necessary to the correct diagnostic selection? You are not selecting the diagnosis literally, the physician does that, but you do have to take his information and choose the proper code that best fits the information.

Anyway, it was the first time I felt like this was something I could actually be doing. And you could just stuff me in a corner all day long and have me plow through stuff like this.



Write or Die


A couple of weeks ago I posted about the Flowstate app that made your writing disappear if you stopped before your designated was up. I happened upon a better (or at least it looks to be, I’ve tried neither as of yet) one today. This one has incentives and such. I don’t think the incentives would be all that great. One of them is pictures of cats and such that would pop up for achievements. Hey, if finishing an actual story and perhaps getting published as icing on the cake isn’t going to get you there, I don’t think kitty pictures will either. I think the stick is better than any carrot in this regard.

The only reward I can think of outside the actual accomplishment is like the author from Stephen King’s Misery. Get that novel done, you got your hotel room, that bottle of whatever, and a single cigarette. The only problem is – one cigarette? If I could have done that, there would have never been a reason to quit!

Anyway, in a couple of months I should be done with school. I am going to work this app into the ground. That and Scrivener.

And then I Just Wept

So I have been on this medical coding school rollercoaster for a little over a year now. It has been 100% reading – ALL OF IT. Thousands and thousands of pages of reading and not a single solitary jolt of practical application anywhere. Hundreds of pages of government documents and coding guidelines, anatomy, on and on.

And today the subject was Computer Assisted Coding, and I came across these words:

There are two types of CAC. The first is natural language processing (NLP) and the second is structured data input (or structured text input). Each of these will be described, and then an activity will be presented to provide more detailed information about CAC.

An ACTIVITY?!??! God, YES! Left me get my hands on something, let’s open up a practice coder and practice something. LET ME OUT OF THE HOUSE, MOTHER!!!!

I get to the bottom of the page, and I just sink. It’s another link to AHIMA! Ten more pages of talking about stuff in the abstract.

Locate and read the AHIMA Practice Brief:  Automated Coding Workflow and CAC Practice Guidance and answer the questions in the activity.

This is not an activity. This is more abstract reading that I will never remember because all we do for this training is read endless pages of government rules, guidelines and regulations.

This would be like taking 4 years of electronics before they let you touch a soldering iron or put together a single beginner’s series circuit. Don’t forget Ohm’s Law, children!

Why do I have to read ten pages about computer aided coding? It is not telling me about any specific computer program, nothing I can touch. Just tell me in a few paragraphs and be done with it.

Once I am done and working in the field, that will be it for me learning anything ever again. It has killed all curiosity as for as formal instruction is concerned. I will never be in school again. EVER.


So I am nearing the actual coding part of my medical coding study, but first I have to be tortured by stuff like SNOMED CT. SNOMED CT, hereafter referred to as ‘sno’, is a terminology for EHR (electronic health record) that allows for multi-axial linking of information through a hierarchical structure of clinical definitions.

I think.

There is a scene in Atlas Shrugged where a character, a steel tycoon, is listening to some government official try to sell him on some government scheme that will basically bankrupt the tycoon – bleed him dry. Every time the tycoon asks him “what is it?” meaning what exactly is this law, the government creep can do nothing but offer pitches of how awesome it is and how it will benefit all parties concerned.

But what is it?

I could not help but think of that while reading the assigned material on “sno”.

SNOMED CT based clinical information benefits individual patients and clinicians as well as populations and it supports evidence based care.

But, what is it?

The use of an Electronic Health Record (EHR) improves communication and increases…

But what is it?

If clinical information is stored in ways that allow meaning-based retrieval, the benefits are greatly increased.

But what is it?

[Next sentence] The added benefits range from increased opportunities for real time decision support to more accurate retrospective reporting…

But what is it?

SNOMED CT is useful for clinical documentation, as it supports the representation of detailed clinical information, in a way that can be processed automatically…

But what is it?

Realization of the capability of SNOMED CT to support clinical information and meaning based retrieval requires careful consideration of the actual setting, in terms of scope of use, record structure, data entry, data retrieval and communication.

But… ah hell…

If these guys were presenting anatomy, we’d never be able to perform surgeries in a few years.

If we recognize the influence the small intestine has on other systems we would…

But what is the small intestine?

The small intestine benefits all who utilize one, and, by extension, the population as a whole…

But what is the small intestine?

Well, it aides in digestion.

Ah! Great! Please go on, show me.

The small intestine-

No, show me.

The small intestine was developed during the pre-

Door closes.

Now, they did tell me (after endless sentences repeating its benefits and what it is supposed to do) that it is a clinical terminology for the EHR, electronic health record, that allows for – and then all the stuff they repeated to me.

Here is the thing. I still don’t know what IT IS. It had one miserable little picture that looked like a mind map doodle. But if I can’t walk away with a picture of what it is, why tell it to me? It is a vocabulary, so it is not a spirit, it is not immaterial. It is not subatomic. So show me!








Millennials: The Terminal Generation and Whining About Code Books

I saw two news articles that made me – almost – wish I could kick the bucket before the millennial generation or – God forbid – their children are in charge during my declining years.

One was that cereal is quite unpopular with millennials. Why? Because it is too much WORK. Yep, ya gotta wash a bowl. The other was Seattle (that bastion of San Fransisco wannabes) unskilled workers (baristas, food service, etc) demand to the city council that they force their employers to give them more stable work schedules.

Grow some balls, kids. When I think of all the screwed up last minute schedules I did in the food service industry without ever thinking there was something wrong with it, I say screw you, suck it up. You want a stable schedule? Go to school like I didn’t. Otherwise shut up and enjoy those low wages.

Got my code books in yesterday for medical coding. Uh – that’s about 3000 pages and that doesn’t even include all the coding books I am going to get.

My job, when I get it better pay decent!