BC Advantage (BCA):  Can you tell us a little bit about yourself and how you got started in the healthcare industry?

Elizabeth Montelongo (EM): I began working in the Billing and Coding field in 2000 and became CPC certified through the AAPC and CCS certified through the AHIMA. While attending the AAPC training course, my instructor recommended me to the Coding Director of a well-known teaching hospital in Los Angeles, California. After passing the required pre-employment tests and interviews I was hired as a Coder I. This gave me the opportunity to learn Outpatient and Inpatient coding. I am a quick learner; always taking the opportunity to learn new tasks even if they are not always related to Coding. Working in various specialties throughout my Coding career has allowed me to enjoy every aspect of it. The most rewarding part of my job is working with Physicians and accomplishing a positive outcome.

BCA:  You have many titles under your belt and you started out as an Outpatient Coder. You are currently working as a Consultant/ Multi Specialty Coder/Auditor/ ICD-10 Educator.  Do you perform all of these duties daily or focus on one role at a time? If you do perform all current job roles in one day, how hard/easy would you say it is for you to cover all the aspects when doing your job?

EM: I enjoy working on various projects which has allowed me to master various skills. Currently, I'm more involved with Auditing and ICD-10 education. Correlation of Clinical Documentation and ICD-10 provides the capabilities to work on both simultaneously.  However, my duties can vary periodically depending on the project that I am working on.

BCA: As an ICD-10 Educator, when training staff, what tools have proven most effective for you? Are there any main tools you would continue to use in the future once ICD-10 implementation once it goes into effect?  If so, what would those tools be?

EM: I provide educational trainings via various methods. Some have been in group settings and others more personalized meetings with one Physician at a time. The most effective training I provide is via Power Point presentations. Visuals always help audiences better understand what point I am trying to get across and keeps them focused on the topic. In an effort to reinforce my trainings, I provide customized tools that will assist the Physicians, Nurses, and Coders in their daily tasks. When conducting an educational training for a certain specialty group of Physicians I'm assertive and provide specific information that they need assistance with. Physician time is very valuable and taking them away from patient care to attend training takes a lot of work so I make sure to provide pertinent information that will be useful. Concentrating on the most frequently used diagnosis codes by specialty (top 50), has been my primary emphasis during recent ICD-10 training. I review the documentation and the elements needed to accurately code a condition in ICD-10, along with reviewing visits for medical necessity.  Making sure that information is not being carried over visit to visit as copying and pasting can become habit forming in the electronic health record.

BCA: With ICD-10 going into effect on October 1, 2015 do you foresee any major issues with the conversion of ICD-9 to ICD-10? If so what would be your advice to the ones that are still preparing their office for this transition?

EM: My advice is to be prepared with all the necessary tools that are available. Become familiar with the various ICD-10 code categories and always take the opportunity to attend webinars, seminars, and classes. Familiarize yourself with the CMS and the U.S. WHO website. These provide a bountiful of information.

BCA: When performing audits what is the difference in auditing inpatient and outpatient information?

EM: Inpatient and Outpatient visits have two separate distinct payment systems. Making sure to follow the specific guidelines is very important. Making sure to capture the necessary information before it is billed to the insurance is imperative. Providing the necessary feedback to the Physicians is an essential process to lessen the need to perform audits frequently.  For Inpatient admissions, I like to make sure that the condition being admitted for meets the criteria for inpatient care ensuring the proper DRG is reported. This is where the documentation must be properly documented in the patient's chart and properly coded as well. With the RAC auditors being able to review claims for the need of inpatient stays, it is important to educate physicians in medically necessary documentation.  For the outpatient stays, following the OPPS (Outpatient Prospective Payment System) guidelines is crucial. OPPS has payment status indicators and their descriptions correlate to each CPT/HCPCS codes. As an auditor, learning the various payment status indicators and their definitions will help identify if services are being paid correctly

BCA: Once ICD-10 goes into effect do you think there will be a major loss in productivity when performing audits? If so, what do you think would be a better way for a physician's office to manage their practice?

EM: Audits will always be a part of the coding process. This helps maintain compliance in all aspects and this process should be enforced when ICD-10 takes part. Written protocols need to be in place to help maintain an ongoing process. Maintaining a log of rebilled visits should be tracked and followed to review which CPT and ICD-10 codes are being denied and the reasons why. This eliminates denials and can be used as an educational source. Also, providing educational trainings on audit findings for Physicians and staff is a great way to review precise information that Physicians and staff need assistance with.

BCA:  With the implementation of ICD-10 in the U.S. the World Health Organization will be able to track information more correctly. In your opinion why is that important?

EM: It is important to track information correctly because this information is used to provide proper patient care. With ICD-10 in place there will be more specificity when reporting conditions. The outcome will be accurate treatment of conditions.

BCA: What kind of advice can you give our readers now that we are approaching ICD-10?

EM: Start becoming familiar with the ICD-10 code ranges. For example, if looking up an ICD-10 code for an eye condition, knowing that the condition will fall in the H code category will help eliminate the time spent looking for the code. Encoders will help us tremendously, but ultimately the ICD-10 book should be referred to for more specific codes that will lead us to the code also' combination codes and instructional notes. Ongoing education and training is necessary to ensure guidelines are understood and being followed.

BCA: Also do you have any advice to the people that are looking to obtain a career path like yours?

EM: My suggestion is to take the opportunity to learn something new when it is offered to you especially if you are a newly credentialed Coder. You never know what path it might lead you to.

BCA: Anything else?

EM: It is important to become certified in any field that you choose. In other words, learn a skill and master it!