I'll never forget the time I had to appeal a claim that had been denied because a diagnosis of multinodular goiter does not justify excision of a lobe of the lung. The biller had entered the search term "lobe" and apparently picked the first choice.

Training and study is the key. The typing is basically data entry, but I once tried to explain what coding and billing was to a neighbor, who interrupted me and said, "Oh. It's data entry." I just said, "Yeah, it's data entry."

If you use code books alone, then you will be writing your codes by hand (on a coding sheet to be sent to billing) or you will be entering them directly on the bill. This may be the situation if you work in a physician's office or small clinic.

If you're working for a larger institution, however, you will have encoding software which you will use to look up and enter the codes on the coding sheets (and possibly onto the bill). Encoding software requires keying, but not typing lines of material.

Depending on your software, you might have to type whole medical terms and/or choose alpha/numeric choices from lists which are provided. You can often make your choices by pointing and clicking or by arrowing up and down or by simply typing the number or letter of the choice.

You may also have to type the patient's name, number, date of birth, medical record number, account, etc.

Coding uses keyboarding as a means to enter data and operate encoding software.

The important skill in coding is the ability to use code books and/or encoding software correctly so that you come up with correct codes. Once you know this skill and how to use standard medical/coding references, you should be able to code anything at all, regardless of whether you have ever seen it before.

Some schools tend to teach "rote" coding. That is, they teach students what codes to use for particular (usually low-level) situations. The student does not actually learn how to use the code books to find codes, but tries to learn by memorizing what codes to use. Then, when they have a new condition to code, they're stumped. they'll typically go to someone and ask "How do you code this?" They don't want a lesson in coding, but just to be given a code number. They want a fish, not to be taught how to fish.

Well, that doesn't work very well. It's more important in coding to teach how to use the code books so that the student can code anything they might encounter, and to use reference materials effectively so that you can do your work with minimal assistance. A general background knowledge of medicine, medical terminology, and so forth, is crucial to this, but the most important skill is in using the code books.

I'm not sure this can be taught in a 12-half-Saturday course.

Students have to be taught how to read the books accurately and completely, and have to be given coding practice that shows them the dangers of, for example, simply choosing the first thing they see because "the words match."

I am beginning to believe that this may be why graduates require several years of experience before becoming able to pass a certification exam. If they have learned to code, they should be able or nearly able to do this on graduation or shortly thereafter. At the most, they might need a period of experience in order to "put things together" or "gain confidence," but I am finding that they need the several years to learn how to code, because their course never taught that.

The schools are teaching them about coding, giving them some examples of coding in a generic sort of way, teaching them some code numbers, giving them courses in other things (Phys. Ed. college math, creative writing), and are often giving them coursework (often insufficient) in the basic medical sciences, but they're not teaching students how to code.

Choosing a good coding school can be a daunting prospect. A lot of them will look good because they teach all the "recommended" courses, but if they're not actually teaching you how to code, your entire experience with them can be a waste of time and money.