By Steven Krolak
(NEW ALBANY, Ind.)–Sandra Johnson remembers playing teacher as a child, in a classroom of make-believe students.
“Gaining knowledge, and sharing it, were my ultimate goals,” she said.
Today, as senior lecturer in the areas of allied health and health information management, she prepares real live students to enter a career that didn’t even exist in her imaginary classroom: medical coding.
A foreign language
What is coding exactly?
Simply put, it’s a system that reduces the delivery of medical treatment to a numerical matrix for the purposes of payment and record-keeping.
Imagine a hospital rendered as a paint-by-numbers tableau, and you can begin to get a picture of how this works. Essentially every single diagnosis, intervention and medication is given a number. These codes make it possible to deliver healthcare to billions of people, and to bill the entities helping to pay for that healthcare.
Johnson likens coding to learning a foreign language—one that changes the minute you think you have mastered it.
Actually three foreign languages: the International Classification of Diseases (ICD), now in its tenth iteration; the Current Procedural Terminology (CPT); and the Healthcare Common Procedure Coding System (HCPCS).
These systems are contained in manuals the size of phone books, and are updated annually.
Maybe “updated’ is an understatement.
As the industry grows and diversifies, coding becomes more complex and granular.
The ICD-9 contained 13,000 codes. ICD-10, now in use, contains over 72,000.
Johnson knows it won’t stop there.
“The 2021 code books will bring a whole new world to coders, including new codes for coronavirus and the vaccines that are introduced to prevent this disease,” Johnson said.
This growth, fueled by new diseases, medical technologies and insurance protocols, has driven many older coders into early retirement, providing newcomers with significant opportunities—if they can make the grade.
Helping them make the grade is Johnson’s job.
Empathy and expertise
For Johnson, teaching medical coding is an exercise in helping students wrap their brains around the volume and complexity of the undertaking, the importance of accuracy, and the need for timeliness.
Not to freak you out, but at some point your life may literally depend on how well a coder does her or his job.
“If it is not coded correctly, it will not be paid,” Johnson said.
So there is some real pressure to get it right.
Johnson navigates this situation by keeping her feet on the ground, and helping her students do the same.
In this, the most important quality is empathy.
“A teacher must demonstrate empathy—a caring, positive attitude toward everyone—and respect individuality,” Johnson said.
Keeping an open mind, understanding that she has not walked in their shoes—this kind of awareness helps Johnson to adapt her teaching to each student’s individual goals.
Johnson also hammers away at the idea that coding is multidisciplinary. It rests on prerequisites in anatomy, medical terminology, pathology, pharmacology, all of which the students have encountered before embarking on her course. By reinforcing the linkages between these disciplines, she gives students the bigger picture, and helps to overcome their shock at the size of the cresting wave they are about to surf, building their confidence in a “you got this” kind of way.
Finally, she puts across the idea that this is a career that requires specialized training to enter and constant continuing education thereafter.
This is the easy part, in a sense, because she is constantly updating her own credentials, and can lead by example.
“Medical coding is a lifelong learning process as new diseases appear and techniques rapidly change,” Johnson said. “I have three credentials to keep my status current, and I also have to attend continuing education classes and meetings.”
In this very real sense, medical coding is inherently a school of innovation, not by design, but by necessity: Those who can’t keep up with the industry’s relentless drive to become more streamlined and efficient will be left behind.
Johnson grasps this need to keep pace, and has crafted her own brand of classroom innovation to meet the challenges it presents.
She makes sure to introduce new material slowly, and sees that it is fully mastered before introducing more.
She reinforces the building blocks of coding—medical terminology—and offers quizzes after each lecture that carry over into the next area of coding, with practice coding and discussions after each lecture based on the specific areas presented.
In this way, students build knowledge that helps them pull together the various strands of the field.
“Each section of coding provides a building block that answers the questions: Where is the location of the patient visit? What is the reason the patient is being seen today? What is the treatment/therapy/medication prescribed for the patient,” Johnson said.
She also changes up her teaching methods to address the different learning styles she encounters in the classroom and to create an environment in which everyone feels encouraged to part. These include case studies, examples, interactive lectures and sharing personal and professional medical experiences.
And she aligns her test methods—such as multiple choice format—with those used in the certification exams.
Perhaps most importantly, Johnson leverages her own continuing education for her students.
“Medical codes in all areas are updated annually,” Johnson said. “I have to review these changes each year to edit lecture notes, update exams to not only include new codes introduced that year, the new treatments and vaccines, and any new or revised wording of a code description.”
The greatest gift
As someone rooted both in the classroom and the non-academic working world, Johnson brings perspective to her teaching.
Her students are incredibly diverse.
“They range from recent high school graduates to full-time working students with families to unemployed or retired individuals wanting to learn a new skill,” Johnson said.
She thrives on this diversity, and enjoys learning from her students as much as teaching them.
She often recognizes herself in them, and in their situations.
“I have been in their place as a student,” Johnson said.
She gave up her expected educational and career trajectory at 18 to start a family. She performed a variety of jobs over the years, including one as a medical assistant for an internal medicine clinic. At one point she was invited to teach an administrative skills course at Ivy Tech.
“From the first class, I was hooked,” Johnson said.
She returned to college to earn a bachelor’s degree in career-technical education, then a master’s degree in human resource development.
She is still in their place, in a career that demands lifelong learning.
Johnson understands that teaching extends beyond the classroom, flowing seamlessly into the area of mentoring and friendship. This is particularly true in a field that is directly related to an occupational outcome. She welcomes the opportunity not only to teach, but to function as a de facto career counselor.
Even in her undergraduate classes, she incorporates best practices from the working world in order to give her students an advantage.
For example, while today’s healthcare records are digital, relying on electronic encoders to assign codes to medical events, Johnson stresses the need to be conversant with physical code books.
“Although technology is great, relying solely on technology and not using the code books as a backup method could result in costly reimbursement errors,” Johnson said. “Healthcare facilities still prefer the medical coder who not only has successfully passed the CPC or CCS exam, but who is also trained in the use of the coding manuals.”
This attention to detail—both the detail of coding and the more nuanced needs of her students—has made Johnson a beloved teacher and trusted advisor.
It is no wonder she maintains connections with many of her graduates, whom she often bumps into at continuing education events.
“Seeing how far they have come in their chosen profession, seeing them continuing their education, becoming leaders in the workplace and being proud of their accomplishments—that is the greatest gift a student can give to this instructor.”