Monday, March 29, 2021

Why Health Information Management is the career for me and can be for you!

by Chandra Fenton, MHA, RHIA

I enjoy telling students how I got into the HIM field 19 years ago and how it has benefited me ever since.  I will give you some background information and then explain why it has been a good career choice for me. 

I started working at one of the local hospitals through a referral from a friend verifying insurance.  I soon found out about an opening for Registration staff at a satellite office in the Dayton area.  I applied and got the job.  I really enjoyed this job, registering patients, working with the other staff and also with the physician’s office next door.  In this satellite office, we saw patients that came in for mammograms, x-rays, CT scans, MRIs and ultrasounds.  I felt compelled to learn what the diagnoses were on the orders for these tests, so I took a medical terminology class at the local community college.  One class led to another, and before I knew it, I was taking coding classes and applying for the HIM program at the community college in town.  While taking classes and learning, I was promoted to Team Lead of the Registration staff where I learned new responsibilities as an employee.  When it was time to graduate with my associate degree, I was offered a coding position at the Coding Department for Good Samaritan Hospital, coding Emergency Room records.  I was nervous about the change but excited to try something new.  While learning to code ER records, I continued my education through University of Cincinnati in their bachelor’s program for HIM.  Once I graduated from UC, I was promoted to ER Supervisor for the hospital network as they were centralizing the coding departments from all hospitals.  About two years later, I moved to Inpatient coding supervisor and loved every minute of it. 

I have also been very active in the local HIM Association, where I was able to network with other HIM professionals and hear their experiences in their fields that I learned about during school.  I sat on this Board of Directors from 2006 until 2020, experiencing almost all the positions on the Board.  While serving as President of the local association, I was able to be a part of the state association Board of Directors.  This was again something new for me that was exciting; new people, more networking, expanding my knowledge.  Last year, I decided it was time for me to volunteer more on a state level, so I ran for the state association’s board of directors, which I now serve as the Coding Director. 

I sort of fell into this career, starting from taking medical terminology courses at the local community college, but this career path has been very rewarding.  I have learned so much and met some great people along the way.  I have found that people in this career field love what they do and have been doing it for a long time, some are going on 30 or 40 years.   I get a sense of accomplishment by applying the skills I learned along the way, knowing how important the work I do is in helping the continuum of care of the patients we serve with accurate data and completeness of the patient record. 

While coding is my passion, there are so many different positions in the HIM field.  Whether you get certified as RHIT or RHIA, there are many paths you can take with your certification.  Just within my workplace, I have seen coders move into positions within our Reimbursement department, our Compliance department, our Quality department, our Privacy and Security department, even within our HIM Core IT team.  If you don’t want to work in a hospital setting, you can work for an insurance company, physician office, college, just to name a few.  Using your data analytical knowledge, you could work for local cities or states or even the federal government.

About the Author

Chandra Fenton, MHA, RHIA, is currently a 1st Year Director on the OHIMA FY 2020-21 Board of Directors, in charge of the Professional Coding Development strategy.  Chandra is a Coding Supervisor at Premier Health.

Wednesday, March 24, 2021

Coding Hemorrhoidectomies

The focus of this edition of “Spotlight on CPT” is on hemorrhoidectomy procedures.  Veins in the rectum or anus that have become enlarged and inflamed are called hemorrhoids.  Conditions that may cause hemorrhoids are obesity, pregnancy, prolonged sitting, or straining to facilitate a bowel movement.  Hemorrhoids, especially external ones, may be painful and are prone to bleeding.  If conservative treatment, such as taking fiber supplements or increasing fiber in the diet, increasing fluid intake, exercise, sitz baths, or topical treatments fail, then a surgical procedure may be necessary.

When coding professionals assign codes for hemorrhoidectomy procedures, they must determine if the hemorrhoids are internal, external, or both, and the method of removal.  Depending on that information, other vital information is how many columns of hemorrhoids are removed and if any other procedures such as fistulectomy or fissurectomy are performed at the same time. 

Internal hemorrhoid removal alone is first broken down by method of removal.  If the rubber band ligation is employed, then 46221 is assigned regardless of the number of band ligations performed.  If ligation is by a method other than rubber band, then a further distinction is made based on the number of columns removed.  Removal of one column codes to 46945; two columns codes to 46946.  Of note, both of these codes can be utilized if no imaging guidance is performed. 

A new code for 2020 is the removal of hemorrhoids by transanal dearterialization involving two or more columns.  Code 46948 is assigned to capture this procedure which would include ultrasound guidance and mucopexy if performed.  If only one column of internal hemorrhoid is removed in this fashion, the unlisted code 46999 should be assigned.

There are a few codes for the removal of external hemorrhoids alone.  Code 46320 would be for a thrombosed external hemorrhoid specifically.  This means that a clot has formed in the vein.  This type of hemorrhoid is especially painful.  If two columns of external hemorrhoids are removed, then 46250 is assigned.  Should only one column of external hemorrhoids be removed, then the unlisted code 46999 is appropriate.    

When both internal and external hemorrhoids are removed at the same time, the coding distinguishes between a single column (46255-46258) or two or more columns (46260-46262) and if additional procedures (fissurectomy, fistulectomy) are performed at the same time. 

Now, light has been shed on coding hemorrhoidectomies.


About the Author 
Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.