Worn

I spent the larger part of the daylight hours today sitting a certification exam for medical coding. This is a piece of my educational puzzle that I've put off for three years. Now I have an employer who will actually pay for me to do this. That's a trip, along with having an employer who values technical skills of any kind.

I sure as hell hope I passed, because I'd rather not do it again.

I have friends who have somehow convinced themselves that medical coders are some kind of low-end bookkeepers snapping gum to keep themselves awake, and that it's an occupation about equal to a Wendy's fry cook in complexity.

Not.

Medical coders are the only data analysts I know of who have to tackle the business at both ends. Rather than just auditing and decyphering data, they have to create the data itself from abstruse (at best) to incoherent (at worst) clinical narratives. They get the delightful privilege of kicking the godlike physicians in the shins and reminding them that if they can't make a case for what they said they did to the coders, they are sure as hell not going to convince the data analysts and auditors at Blue Cross or Medicare. This means they won't get paid.

Oh, it's as easy as cooking fries, all right. To turn that narrative into information that billers can use, coders need to be familiar with two entirely different data systems. The hard-copy version of one comes in two volumes totaling the size of the Boston yellow pages. The other is in four volumes, altogether larger than the New York City yellow pages. The two systems combined include, as I recall, over15,000 individual codes. Imagine for a moment the number of mathematically possible combinations: Uh-huh. Did I mention that the smaller one gets updated four times a year? And that in a year or two, a major update of the larger one is due, which will be twice as large? Even coding software is hard put to keep up with this. The best products are in a state of permanent upgrade that makes even my anti-virus software look comparatively staid.

In the big book (called ICD-9), the codes related to diabetes alone fill almost an entire page, two columns of exceedingly fine print. It is no good being nearly right, because the people who pay the bills, here and in other countries, don't shell out for nearly right. In the smaller set (called CPT or HCPCS), coding options for pacemakers fill over three pages. Ever go to the doctor to have a skin lesion removed? Integumentary lesion codes have the better part of a large chapter all to themselves.

All this explains why I'm a bit worn and cranky tonight, having spent five hours unraveling 150 of these brain teasers with one five-minute break*. It takes a certain twist of the grey matter to like this, and I suppose I have it: it's cryptography with ka-ching at the end. In a normal day's work, one gets coffee breaks, trips to the head, lunch and chit-chat. Even the most absorbing work can come in overdoses.

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*Disclaimer. People taking this exam (the CPC) have the option of two breaks up to a total of 20 minutes. I was so slow getting my momentum back after the first break (like Wakefield on an off night) that I decided to skip the second and work until I finished or dropped. It was close.