Career Step, LLC. December 2009

Career Step Quality Medical Coding Training • 4692 N. 300 W. Suite 150 • Provo, UT 84604 • www.careerstep.com • Ph: 800-246-STEP

Graduates . . . . . . . . . . . . . . . 2

CS 2009 Year in Review . . . 3

CB Challenge . . . . . . . . . . . . 3

Dear Cari . . . . . . . . . . . . . . . . 4

Notable Notes . . . . . . . . . . . 4

Student Spotlight . . . . . . . . 5

Graduate Spotlight . . . . . . . 5

Ergonomic Topic . . . . . . . . . 6

Coding Chat Schedule . . . 6

MedicalCODING

Bulletin

Follow My LeadThe Importance of Curriculum Before Practicum

Continued on pg. 3

“Why can’t I just skip to the practicum? I’m a really great typist!”

“I worked for a doctor’s office for a while. Can’t I just go right to the coding?”

“I think I’ll try the coding first and look up only the sections I don’t know well.”

If you’ve ever thought, actually uttered, or heard someone say any of the lines

above, it would benefit you greatly to read on and gain a better understanding of why the Career Step curriculum is designed as it is.

Sure, we’re all busy in one way, shape, or form. We’re moms, dads, spouses, employees, heads of household, pet owners, bill payers, meal preparers, chauffeurs to our kids, and so much more. You’ve undoubtedly earned one or more of those titles. At Career Step, our title is that of educator. It’s what we know and where we excel, and we want you to succeed in your education.

There is a rhyme and a reason to why our curriculum is designed in a certain order. An educational program’s curriculum

is what makes it work—it’s the heart of the program. Our curriculum works because it combines years of experience from trained, successful medical coders backed by a proven track record of successful graduates.

The reason you should work through the curriculum according to the program outline is staring right back at you. Do you see it? It’s your computer.

Can you recall the very first time you actually sat down and used a computer? Touched a keyboard? Learned how to maneuver around the internet? Perhaps you can’t pinpoint that exact moment, but it happened; after all, it’s what brought you here today. You certainly didn’t just sit down, turn the computer on (if you could even find the “on” button), and become incredibly proficient in advanced web browsing, document processing, and e-mailing overnight. These things came with time. Most good things do.

The same holds true with the Career Step program. A particular skill set is taught within our curriculum. We realize that

certain concepts, ideas, and medical language must be taught before moving on to the more advanced concepts. Remember, you didn’t learn how to unzip a file, share photos online, and instant message someone before you learned to turn the computer on or create an e-mail account.

Learning a foreign language works in a similar way. You learn the basic sounds, tenses, and usages before applying them to more intricate sentences. Medical language is just that: a foreign language. We wouldn’t expect you to transcribe a foreign language until you had learned it. We do expect you’ll hold yourself to the same standard.

December 2009 MEDICAL CODING BULLETIN2

GRADUATESDianna – Washougal, WashingtonI was definitely challenged, having no experience in the medical field. By the end of the course I felt familiar enough with the medical terms to feel I could do the job of coding. I found the folks at Career Step helpful and available when I had questions. And after graduation, my success was still of concern to Career Step, which I found comforting.

Ella – Fayetteville, North CarolinaI am so happy that I graduated from Career Step. It has given me the opportunity to pursue my ongoing career in the medical field. I started out 20 years ago as a medical biller. I have always been interested in becoming a medical coder but with obstacles that sometimes got in the way, it fell by the wayside. This is like a dream come true for me. I am currently employed in the medical field with a promotion potential to medical coder as soon as I pass my AAPC exam on November 9, 2009 with a great salary to go with it. I wish all future Career Step graduates lots of success.

Georgia – Abilene, Texas I am not sure if you are aware that I am 71 years young—and although I have had many years in the medical field, this was by far the most interesting and challenging. I feel the Career Step coding program will help me tremendously toward my goal in the field of medical coding for cardiology. My first medical job was as office manager for a thoracic and cardiovascular surgeon in 1968. He was responsible for the first open heart surgery performed in Abilene, Texas. This was during the time that Medicare first came in to being, and was a bit of a challenge. I was there for 10 years, taking a break from the medical field to open a business, and then going back as a medical transcriptionist for 4 years. I then spent 10 years with the state as a secretary, only to return to medical transcription for 6 more years. Retired again, only to start a new career in medical coding. Also, obtaining my second degree: Black Belt in Kuk Sool Won, Korean Martial Arts, at the same time. Needless to say, I like to stay busy. At this time, I have 3 more courses and 2 electives toward my B.S. degree in Holistic Nutrition.

Lawana – Alvin, TexasApproaching age 50, I wanted to make a career change in my life! Career Step made that possible for me. The medical coding course was very comprehensive and required a lot more time than I expected. But with great determination, I completed the course

and graduated with High Honors. This was a great accomplishment for me! I was so proud of myself and actually astonished that I made it! I now have the knowledge and confidence to be well on my way to a new career. Thank you, Career Step, for helping me to achieve my goal!

Lys – Wingate, North CarolinaI had no problems passing my certification test with AAPC.

Marian – Coronado, CaliforniaI honestly couldn’t have done this alone. I need to give a big thank you to Cari Greenwood, a student support counselor with Career Step. Cari was always there, offering her expertise whenever I was struggling. While my husband is deployed over in Afghanistan, I knew when it came time to prepare for my final exam, I could depend on Cari to offer advice and to cheer me on. I was so excited when I passed my final and even now, Cari and I continue to talk as I prepare for my CPC exam. Thanks to everyone at Career Step for this wonderful opportunity as I continue my quest to becoming a medical coder.

Sherry – Charleston, West VirginiaI am impressed with the quality of materials and how they were presented and was always answered with prompt replies when a question arose. I will definitely recommend this program to everyone.

Rochele - Aurora, ColoradoFirst of all, the wonderful people at Career Step are there to help and assist you in whatever way they can. A special thank you to Randy Johnson for his patience and friendly composure whenever I called for help and guidance and for his knowledge of the course material. I also found it helpful before getting to the practicum calling Randy Johnson, and being informed by him how to approach the practicum and how to pace myself on the practicum in order to complete it in a timely manner. The course material is composed very well by sections so when everything is put together it makes sense and is understandable. I also thought it was helpful to be able to go back over material if needed. I went back over the Evaluation and Management section and the second time I understood it. I thank the coordinators at Career Step for making the graduation process so very special! The graduation certificate is very professional and the information you sent will be a helpful guide in preparing one for the certification test and employment. I so appreciate your followup emails to see how I am

doing, how Career Step can help and giving me valuable resource material. Most important I don’t feel like I am “alone” on my own now that I have graduated. I know I can call Career Step or email for advice or ask any questions I may have. That in itself takes a lot of stress off of me and is comforting to know. Thank you both so very much, Randy and Jenae—you are truly a blessing!

Adriene – Midlothian, Texas Aimee – Midland, South Dakota Alicia – Arlington, WashingtonAmber – Northglenn, ColoradoAmy – Ottawa, IllinoisArlys – Cheyenne, WyomingArrina – Hurley, WisconsinBecky – Waxhaw, North CarolinaBarbara – Fayetteville, North CarolinaBarbara – Montrose, ColoradoCarrie – Centennial, ColoradoCarol – Littleton, ColoradoCassi – Copperas Cove, TexasDe’trese – Quantico, VirginiaDiana – San Diego, CaliforniaDeborah – Fayetteville, North CarolinaDonna – Aurora, ColoradoDonna – Melbourne, FloridaElizabeth – Fort Wainwright, AlaskaEvelyn – Fayetteville, North CarolinaFreda – Edgemoore, South CarolinaGail – Arvada, ColoradoHannah – Fayetteville, North CarolinaJared – Ballwin, MissouriJennifer – Lakewood, ColoradoJessica – Provo, UtahJulie – Greenbrier, TennesseeJulie – Moscow Mills, MissouriKaren – Corsicana, TexasKatelyn – Winfield, MissouriKathy – Rock Hill, South CarolinaKendra – Columbia, MarylandLoretta – Sacramento, CaliforniaMai – Aurora, ColoradoMarie – Fayetteville, North CarolinaMary – Aurora, ColoradoMary – Clayton, North CarolinaMayme – Littleton, ColoradoNicolette – Clover, South CarolinaPamela – O’Fallon, MissouriPatricia – Quantico, VirginiaPhyllis – Aurora, ColoradoRachel – Broadway, North CarolinaRebekah – Aurora, ColoradoRhonda – Spring Lake, North CarolinaRochele – Aurora, ColoradoRoslyn – Aurora, ColoradoRyan – Omaha, NebraskaSandy – Onalaska, WisconsinSharon – Monroe, North CarolinaSkip – St. Albans, MaineSonya – Rapid City, South DakotaTeresa – Hampstead, North CarolinaVivian – Fayetteville, North CarolinaWayne – Parkton, North CarolinaYoshiko – Thornton, Colorado

MEDICAL CODING BULLETIN December 2009 3

Career Step 2009 Year in Review

We invite and encourage you to work through the program in the manner in which it is presented. Don’t skip ahead, and don’t overlook something that seems trivial. The smallest of words sometimes packs the biggest meaning. Then, when you finally do sit down to the practicum portion, you’ll be able to apply the concepts and information you learned in the curriculum. Trust us, we’ve been where you are. Even the program creators had to start somewhere: the beginning. We wish you success in your journey and look forward to seeing you in the practicum section.

- Carol BryantCS Program Development Team

Continued from pg. 1

The air is getting colder, the kids are into the swing of school, and the

holidays are almost here. Another year is coming to a close, which usually prompts us to review the past and make new goals for the future. This year has been a big one for Career Step. We’ve seen a lot of changes, all designed to help us better serve you, our students, and help you reach your goals. In honor of the year, we present the Career Step 2009 Year in Review:

New Programs! The biggest events of 2009 were the launches of four new Career Step training programs. April saw the launch of a Medical Terminology course for our college partners; May, the launch of our CMT (Certified Medical Transcriptionist) Exam Prep course; late July, the launch of RMT (Registered Medical Transcriptionist) Exam Prep; and August, the launch of Inpatient and Outpatient Medical Coding and Billing. Like the Career Step Medical Transcription program, all of these programs were designed with a dedication to preparing students for the workplace through hands-on experience.

Defense MyCAA program. Through the MyCAA program, over 1,000 military spouses have been able to start training with Career Step with no out-of-pocket expenses! If you know a military family, invite them to visit www.careerstep.com/mycaa for more details.

We Moved! Career Step grew out of the offices we had occupied in Springville, Utah for over nine years. In May, we moved to a larger campus in Provo, Utah. The new facilities provide us more room to make sure we have all of the support and resources to help our students through the entire education process.

These are just a few of the changes we’ve had here at Career Step in 2009; we have more exciting things planned for 2010, and we appreciate your trust and support as we continue to build Career Step to better meet your needs.

- Amy KendallCS Marketing Team

New Website! In October, careerstep.com got a facelift! We redesigned our website to make it easier for prospective students, current students, graduates, and partners to quickly find the information they’re looking for. We also added audio and visual pieces about the company and the courses. If you haven’t seen the new look, check it out at www.careerstep.com!

Industry Forums! In August, Career Step launched two new industry forums. These forums are powered by Career Step and welcome students and professionals from across the industries. Join the conversation—visit www.medicalcodingforums.com or www.medicaltranscriptionforums.com today!

New Financial Aid! In May, Career Step introduced new financial aid options. We understand that it was a hard year for everyone, so we rolled prices back to 2008 levels, increased our tuition assistance options, and became approved for other funding sources, such as the Department of

Coding Bulletin Challenge

Respiratory System

Unscramble the words below:1. hsuopsaeg________________2. tcaaher________________3. useisns________________4. seilttpiog________________5. erath________________6. sgnul________________7. agamrphdi________________8. ypnxhar________________9. yxnarl________________10. mhdeoti________________

December 2009 MEDICAL CODING BULLETIN4

Notable Notes - Meet Jenae Walker

My name is Jenae Walker, and I work here at Career Step as

the Career Guidance Coordinator for coding students. I love my job, because I love—more than anything—helping others begin their own careers and find long-term, fulfilling positions that they enjoy. I come from a family of five, and I grew up in Valencia, California (about twenty minutes north of Los Angeles). Most people recognize Valencia as the location of Six Flags Magic Mountain, and yes, I do love roller coasters! I started my college education at UCLA, and, after a year, I transferred to Brigham Young University in Provo, Utah where I graduated with my Bachelor’s degree. Both are great schools, and I’ve loved the education I’ve received from both—it’s the snow and the change in weather I’m still getting used to! Shortly after I graduated, I started working as a recruiter, helping people find employment in a number of industries. After going through hundreds of resumes, interviewing, and networking

with employers and various employment agencies, I learned quite a bit about the process of finding the right job and the most effective ways to succeed in the job market.

Now at Career Step, I want to share the knowledge that I have gained with our students and graduates so that they can find rewarding careers in the medical field and finish their training, not only with the added skills necessary to become a coder, but also with lifelong skills they can apply in any future employment search.

As the Career Guidance Coordinator, I provide our students and graduates with advice on creating an effective resume, interviewing, networking, and applying for jobs. Not only do I personally review graduates’ resumes and make sure they are top-notch and employer-ready, but I also conduct personal consultations with graduates, in which I provide personalized advice for interviewing, networking, and conducting the employment search. Because coding, like

Dear Cari...Dear Cari,

I am trying to code a scenario from the unit test for chapter 1, chap-ter specific guidelines, in Diagnostic Coding with ICD-9 CM, Block 1. The scenario states, “A 42-year-old female patient was admitted to the hospi-tal with a diagnosis of urosepsis, gross hematuria. While in the hos-pital a urine culture was performed, the cause of the urosepsis was due to Pseudomonas.” The answer key includes code 041.7. I thought code 038.43 would be the correct code to use. Can you help me understand why 041.7 is the correct code for this scenario?

Thank you for your help,

Confused in California

Dear Confused in California,

Using code 038.43 would be inappropri-ate because this is the code for sepsis due to Pseudomonas, whereas this diagnostic statement indicates that the patient has urosepsis due to Pseudomo-nas.

The term urosepsis is a nonspecific term and does not automatically equate to a diagnosis of sepsis. Urosepsis can be used to indicate two different things: a urinary tract infection, or sepsis due to an underlying urinary tract infection. When the documentation does not specify which of these circumstances applies to the patient, the default diagnosis is a uri-nary tract infection, reported with code 599.0. (Please refer to the note regarding

the term urosepsis under chapter specific coding guideline, 1.b.3.)

If the documentation states that the UTI is due to a specific causative organ-ism, then the code for that organism is additionally reported. In this case the causative organism for the patient’s UTI was identified as Pseudomonas, which would be reported with code 041.7 (this is indicated by the “use additional code” instructional note found under code 559.0).

Thanks again for your great question and please let me know if you have others.

Happy coding!

- Cari Greenwood, CCS, CPCCS Student Support Team

any industry, can be difficult to enter without prior experience, I also help students find internships, volunteer opportunities, and other positions that help them get a foot in the door with the local employers that they are interested in. I send job referrals to Platinum graduates on a regular basis to help them network and find available opportunities, and I provide general advice about certification, AAPC and AHIMA memberships, and finding employment.

The job search can be frustrating and overwhelming, and we are dedicated to our graduates’ success in this endeavor. It is our goal, and mine personally, that when it comes time to begin the employment search, all of our students and graduates have every available resource and all the tools they need to succeed! I look forward to working with you!

-Jenae WalkerCS Student Support Team

MEDICAL CODING BULLETIN December 2009

Graduate in the Spotlight - Janet Derfler

I’ve lived in Oregon with my husband for about 25 years and keep plenty

busy just with my job, church, keeping fit (I love swimming, walking and bicycling), studying, home-related tasks and keeping up with friends and family. I work at a local hospital coding Urgent and Immediate Care Clinics. I have my CPC-A and CPC-H-A, and I am currently studying for my CCS certification. In 2006, I read an article about a local medical coder and thought I would like to do that. It was actually quite similar to the job I’d had for nearly 10 years, classifying books with codes. After Googling medical coding, Career Step popped up, and it looked like a quality course. After talking to Randy, I signed up for the course and have never looked back. I struggled a bit with the course

at times and it took me two years to complete (I was working full-time), but it was definitely all worth it. The course was so self-contained, and was conveniently online for my timetable. It provided immediate feedback continuously, fit my pocketbook, and ultimately proved to be a very practical grounding for my coding job. It was fantastic. I’d heard that finding that first job was a tough hurdle. Hospitals and clinics tend to fight for the same small pool of seasoned coders. But there are exceptions. Since I was willing to relocate, I basically “papered the nation” with online apps and resumes. After getting frustrated with all the rejects, I asked Randy about externships, but he told me to hang in there for a paying job first. I went to an AAPC workshop where I met a lot of people. One person gave me a heads up on an opening I thought was closed and they said it was still open. I reapplied, and the next week, I received a call for an interview and test. I went, and was offered the job three hours later. It

was the hospital closest to my home. This was three months after graduating and just weeks after getting my CPC-A. My position is per diem, which has its drawbacks—no benefits and I work nights (I’m a die-hard morning person), but the point is, someone gave me a chance! That’s the key. And working nights freed up my mornings for studying for the CCS. The CCS involves a lot of study, but is very interesting and exciting and is the master key to the hospital job market. My husband is working part-time right now, so I encouraged him to take Career Step’s new Inpatient and Outpatient Medical Coding and Billing course. He’s really enjoying it and doing well. Career Step is a door that has opened up a lot of opportunity for me.

- Janet Derfler

Student in the Spotlight -Rhonda Hubers

I live in Sioux Falls, SD with my husband of 8 years, Jim. We love to go to church,

play golf, eat out, go to art festivals, and play board games, lawn games, and cards. I have met with a group of friends for well over 16 years (my husband for 9 years) every Friday night to eat together and play cards. I also enjoy helping make meals at our many church functions.

I worked 24 years for a major credit card company until I was laid off at the age of 46 along with 121 others because our jobs were sent overseas. I was a project analyst and user acceptance tester for the last 17 years. When several of us were laid off, many of us discussed job possibilities and someone mentioned medical coding. I had never even heard of that before! With few jobs available

and hundreds of people out of work, I wanted to reinvent myself. So, I met with the Department of Labor and discussed my future job possibilities. I took several tests and passed them, and I was approved through the Department of Labor to obtain funding to return to school for retraining. At this time, they did not approve online courses, but my employment specialist worked it out and got me approved as the first person in this city to receive funding for an online course because she felt that I would be a good candidate. (What a blessing!)

I wanted a career in which I could be in charge of my destiny. It is my knowledge and my willingness to learn things that will drive my job possibilities instead of feeling trapped in a job. I feel with this training, I have many options available to me whether it will be as a coder or a registrar, working in a physician’s clinic or a small private office, etc. I started this course in March 2009. I have never had any medical background

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or science classes so this is all new to me! I really do enjoy this course, but I do find it very difficult and a huge commitment. However, I love a challenge and I persevere. I enjoy the forums and the information that others are so willing to share. I exercise the option to contact the student counselors, Randy and Cari, and ask them my many questions, and I appreciate getting their answers to help guide me back on track. After every exercise and test, you can be sure they hear from me! Randy and Cari have both been very supportive and encouraging to me.

The best study advice for me is to read it, write it (in this course, copy the text and highlight important ideas), and practice it. Repetition is the best way to get information to a point of recall in my mind. I look forward to completing my coursework and finally putting my skills to good use!

- Rhonda Hubers

4692 N. 300 W. Suite 150 Provo, UT 84604

MEDICAL CODING BULLETIN December 2009 6

Upcoming Chats

December 9, 20099:30-10 AM MST

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January 13, 2009

9:30-10 AM MST

The Ergonomic TopicEyestrain

Sitting in front of a computer for hours at a time is hard on your eyes. If you experience

blurred vision, dry eyes, glare sensitivity, head-aches, neck and shoulder pain, or even a vague eye discomfort that you can’t pinpoint but keeps you squinting and frowning at the monitor, you may have computer-related eyestrain. Symp-toms like this will get worse if ignored. To allevi-ate eyestrain, you need to identify the problems in your environment or method, and then make the appropriate changes.

Take a look at your monitor—I know, you do that all day—but really take a look at it, because it may be causing you grief. Make sure it’s at least 20 inches away from your eyes—24-28 inches away is even better—with the center about 4-6 inches below eye level (many of us actually look up at the monitor, craning our necks, which contributes to upper body pain, including headaches). Make sure the monitor is not too light or too dark. You should be able to look at it comfortably. Antiglare screen covers are a great idea if glare is a problem in your workspace. Give your eyes a break! Keep the 20-20-20 rule in mind: every 20 minutes, spend 20 seconds

looking at something at least 20 feet away. This gives your hardworking little eye muscles a much-needed break! Take note of blurred vision or a delay in refocusing—these could be symp-toms of computer-related eye problems.

Analyze your light sources. Bright overhead lighting can fight with the angle of the light coming from your monitor and lamps, creat-ing real problems for those sensitive to it. Keep the overhead lighting to a minimum, choosing indirect lamp lighting instead. Shine your desk lamp on your workspace. Keep window light off the computer screen. Try to avoid sitting with the window directly in front of or behind you—ideally, you should close the blinds.

An eye examination with a reputable doctor is always a good idea if you suspect problems. You may be prescribed computer eyeglasses or eye drops to help alleviate your eyestrain. Take good care of your eyes—you only get one pair!

- Jill McNittCS Student Support Team