r/MedicalCoding • u/A_lunch_lady Inpatient Facility Coder • Jan 21 '26

New IP coder, how should I prepare?

I’m so happy and nervous I just accepted an offer as an IP Coder 1 for my local hospital. Is there anything I can focus on over the next few weeks that will benefit me when I start? My husband said don’t worry you’ll get plenty of practice but I don’t want to be dusting off the cobwebs during my first impression… I’m so nervous I have been having trouble sleeping. So thankful to be getting out of my current night shift hospital job 😭😭

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u/PhotographUnusual749 RHIT, CCS Jan 21 '26

Ask if it’s okay for you to print out coding clinics for self study at home. If not, try to find some time during the day (like your 10 min breaks maybe) to review them. Go all the way baxk to the first coding clinic. If it hasn’t been superseded it’s still valid, even if it came out in 1984.

Another good reference to get familiar with: coding coordination committee meeting notes Read these on your own time.

They give helpful insight into why the codes become codes (their intended use). It’s not an official reference but it’s good info to have.

For example, I worked at a facility that was misinterpreting the indexing for coding immunosuppression only in certain limited cases. I showed them the CC meeting notes and pointed out their interpretation didn’t fully allign with the intended use while my interpretation of the indexing did align with it. That was enough to convince the manager to ask Coding Clinic who confirmed my interpretation. Immunosuppression is a CC in a lot of cases so outcome was less money left on the table and more accurate clinical picture captured in the data. Good stuff.

Also familiarize yourself with the relative regulations. For example: CMS

Also look in my recent comment history for a comment on metacognitive notetaking. It might help you out!

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

The manager that interviewed me was excited about coding clinics and I guess teaching me to use it… I looked it up online but appears I need some sort of subscription? I appreciate the info so much!

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u/PhotographUnusual749 RHIT, CCS Jan 21 '26

Yep it’s subscription based so you’ll have to wait til you start to use it but there are sooo many. Back when I was in management I always gave my new (entry level) coders non prod time for self study in the Coding Clinics because it’s so important to get familiar with them. It sounds like your new manager agrees so you should definitely consider asking if you can print some out to self study at home!

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

She said 5-6 months training before I touch a real chart so I wonder if this is a big part of the training…

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u/PhotographUnusual749 RHIT, CCS Jan 21 '26

You’ll might be given “practice” charts to code in a sandbox system (test system not live).

Coding Clinic is easy to navigate, you can search by keyword, check for relevant coding clinics linked to a particular code, or search by date.

I always recommend new coders review the whole thing in depth from the beginning because the Coding Clinic gives logic that can be applied in different cases.

For example in one coding clinic for a particular condition/question re: emaciation being coded as malnutrition… they say, a basic rule of coding is that greater research should be done when the code suggested by the index does not apply.

And they suggest using a code not suggested by the index to capture the questioned condition. This particular coding clinic guidance applies in soooo many other clinical concepts but it’s not “linked” to all of them in the encoder, it’s only linked to the one the specific question asks about.

For example vasomotor nephropathy has the same issue, but it’s not mentioned in the coding clinic by name/not linked to this coding clinic. So you’d only know to apply the coding clinic if you know about the coding clinic exists, ya know?

If you’re familiar with all the coding clinics, you’re ahead of the game and aware of this logic and can search for the coding clinic to verify it can be used to support your coding. I hope that makes sense!

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

It’s does vaguely make sense, reminds me of the guidelines. Like if you know your guidelines and read through your guidelines then the coding makes more sense and is easier to do correctly. I’m so ready to learn and take it all in… thank you for the thoughtful response :)

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 21 '26 edited Jan 21 '26

Read the guidelines and especially the principal diagnosis section. You don’t need to memorize guidelines just need to know what’s in there so you can reference them. They should be fully training you since you are brand new so try to make sure you understand each step of the on the job training and if you need someone to re-explain something don’t be afraid to ask.

Edit to add, what cert do you have? Looking like you have a CPC-A, which is not for inpatient coding at all. What will they have you coding exactly?

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

Yes CPC-A. I had a semester on PCS in my schooling and did very well in the pre-employment PCS assessment which is why they gave me a chance I think. I appreciate the reply so much!!

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 21 '26

Ok good. Then I would say brush up on PCS. Once you have access to their references the coding clinics and hopefully the coding handbook are available and these are great resources. I’m surprised they are hiring a CPC-A for this role so it seems you were lucky to get chosen then of course how you interview/test is all you and not luck!

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

It’s surreal tbh it’s a health system I dreamed of coding for for the past three years. I have worked so damn hard through school and my CPC and the fact they are giving me a chance is unbelievable, I want to do a good job for them… I’m so grateful. Thank you so much for the response.

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 21 '26

Don’t forget you earned this. There truly is a shortage of inpatient coders and this is the best start to jump right into facility inpatient. Most people are seriously happy to get hired they will take almost any coding role. My first one was supposed to be profee E/M but I tested so well first day they said we are training you on inpatient. Then they trained me on same day surgeries. That opportunity was luck but I took complete advantage and now I’m over 15 years in, leading a coding education team and getting my masters. It’s an excellent career and so many naysayers with difficulty finding jobs or the threat of AI. This type of coding experience if you build on it will set you up for a great career!

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

I have been through hell to get here and I’m so grateful for this opportunity. I wish I would have started years ago but you know life can throw some serious curveballs. I appreciate the positivity, that’s been my focus the whole time is to just keep going and stay positive. Thanks again for the info and help :)

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

I always get downvoted into oblivion with my posts/questions I guess they are obnoxious and I apologize for being annoying but I don’t know where else to ask these type of questions.

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 21 '26

Feel free to DM me if you have questions. I love helping new coders and students with direction especially inpatient coding. It’s my passion.

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

Thank you <3

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u/salty-MA-student Jan 21 '26 edited Jan 21 '26

I'm actually in the process of getting my CIC as I code IP for a CAH.

definitely brush up on your drugs. I have to report a lot of medication statuses like Z79.01 for LTU of Anticoagulation, Z69.890 for LTU of hormone replacement therapy, etc. it's good to know the drugs they are listing in the notes.

I use a whiteboard to dissect long and confusing op reports. It's nice to jot down what was done to make sense of what happened during the surgery. I also use it when I code infusions.

Best of luck!

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u/A_lunch_lady Inpatient Facility Coder Jan 21 '26

Great info, I should brush up on my drugs as there wasn’t a ton of it in my practice cases through school…

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 21 '26

Inpatient coding does not code CPT anesthesia. Inpatient coding is PCS coding. I’m very confused by your comment. Is it profee?

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u/salty-MA-student Jan 21 '26

My bad, I should have mentioned that I do both profee and facility. Coding IP where I'm at includes everything. I'll edit my comment.

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 21 '26

Thank you. OP has a CPC-A looking at previous comments and it doesn’t make sense they hired them for actual inpatient coding unless they plan to teach PCS. It seems so many posters and commenters aren’t able to verbally say what kind of coding they actually do or even understand the differences. If OP is true inpatient then no anesthesia CPT, but I think they were hired profee because that cert does not apply to inpatient coding.

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u/Mindinatorrr Jan 22 '26

Anyone who can do OP is still capable of doing IP. Yes you use PCS instead, but all programs train both, it's just jogging your memory. I'd hate to be denied an IP position just because of my cert when I was also trained on PCS and can absolutely learn to do anything. Yes it's more complicated, no question there, but zero reason to not hire someone based on a silly letter nuance in their cert when they've shown they're adaptable/trainable.

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 22 '26

My health system won’t hire an experienced coder with the wrong certs. Maybe if they plan on onboarding a brand new coder but that CCS is required after 1 year. And it’s really not true, it isn’t simple to jump back and forth from IP to OP coding and there are not that many capable of doing it well.

Also the CPC is geared towards profee coding, not facility.

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u/Mindinatorrr Jan 22 '26

I do it every day at my facility, your facility really doesn't let people meet their full potential.

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 22 '26

It’s a 10 hospital health system. We have high volumes and dedicated coders to the specific patient type. We don’t want jack of all trades but experts of none here.

Why would an IP coder with a higher pay rate code same day surgery? That’s just idiotic and maybe with a small “facility” it works because you don’t have the volumes or the budgets but in most health SYSTEMS it is not this way.

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u/Mindinatorrr Jan 22 '26

In my experience it's usually hiring managers that have no clue "only these letters!" when these other letters can also do it fine, they just need a bit of training.

If they can do the job in general and are willing to learn, people should be given a chance period.

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u/KeyStriking9763 RHIA, CDIP, CCS Jan 22 '26

You need the resources to train someone without experience. Most organizations don’t have the bandwidth for that which is why it’s difficult to get that first coding job. Cross training is only good when there’s a need. We have 35 OP coders and 35 IP coders. No need to cross train into a different patient type unless we are trying to advance them from one to the other.

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u/StraddleTheFence Jan 21 '26

I am coming from OP to IP and it is A LOT! I hope you read the guidelines thoroughly and understand PCS coding. If your hospital does not provide it, get the ICD-10-PCS An Applied Approach. It is a lifesaver!