After getting hired at Tufts Medical Center, I was overjoyed. I had finally stepped into a major teaching hospital. I arrived early every morning, excited to log in and code outpatient cases—emergency department records, minor procedures, clinics. Everything was new, and I loved the challenge. I treated every chart like an exam question, double-checking codes and studying guidelines in my spare time.
But as time passed, the honeymoon period faded. The charts became more complex. Productivity and accuracy were strictly monitored. There were monthly reports, peer reviews, and audits. I learned very quickly that enthusiasm alone wasn’t enough—I had to build endurance.
There were days when I missed my targets and felt the pressure. Days when I made mistakes. Days when I doubted myself.
I didn’t have the opportunity to code inpatient records yet—just ED charts and ED-to-observation admissions. One day, I coded an ED case and missed the connection between the diagnosis and the external cause of injury. The audit came back: “Missing E-code; incomplete coding.” I was embarrassed. But instead of shrinking away, I asked for clarification. I reviewed the record with a senior coder, found similar examples, and made myself a reminder: Never code trauma without checking the cause.
Coding ED cases came with its own set of challenges. It wasn’t just about missing E-codes for external causes; sometimes, I would overlook procedure codes or assign them incorrectly. I struggled most with coding minor procedures like laceration repairs, splinting and casting, burn treatments, wound foreign body removals, and anything involving the eye or ear. These weren’t areas I had mastered in school, and I felt unprepared.
The pressure intensified. I had to meet both productivity quotas and maintain at least 95% coding accuracy. Each time my manager called me into her office to review my charts, I felt a knot in my stomach. She would point out what I’d missed, explain how it impacted reimbursement, and remind me that repeated mistakes could put my job at risk. That weighed heavily on me.
There was no coding educator on staff. We were expected to figure things out on our own. Asking peers wasn’t ideal—they were already juggling their own workloads, and I didn’t want to burden them. Some days, I thought about quitting and finding another hospital to work at. But I also knew that no matter where I went, challenges would follow. Running away wasn’t the solution.
Instead, I made a choice to push through. I reminded myself: You graduated with high honors. You passed the RHIT exam. You can do this. I started keeping a notebook of every mistake and what I learned from it. I attended webinars, read coding updates, searched online for ED procedure tutorials, and watched clinical videos to better understand documentation. I studied how providers described laceration repairs, splinting techniques, and burn care so I could interpret the language more clearly—and code it accurately.
It stuck. That moment became a turning point. Over time, my accuracy improved. Slowly, I began to earn a reputation for attention to detail. That mistake, and what I did after, helped shape the coder I was becoming.
Slowly, I began to code ED records with greater confidence—and eventually, I genuinely enjoyed the work. Over time, my accuracy and efficiency improved so much that I was asked to relocate from the coding department directly into the ED. The idea was to place me closer to the action, allowing me to consult with doctors and nurses in real time whenever I had questions. It also eliminated the need for staff to carry paper records back and forth to the coding office.
This move was a major transition. I was no longer surrounded by fellow coders or part of the quiet, structured environment I was used to. Instead, I found myself working amid the constant motion and urgency of emergency care. It was noisy, fast-paced, and unpredictable—but it was also one of the most valuable learning experiences of my career.
Everyone in the ED became a resource. Nurses taught me the ins and outs of IV infusions, injections, and medication timing. Physicians took time to explain minor procedures—what they did, why they did it, and how to recognize it in the documentation. Bit by bit, I learned to interpret clinical language with more clarity and accuracy. I wasn’t just reading charts anymore—I was understanding the care being delivered.
Things didn’t stop there. Before long, I was sent to work in the ENT clinic because they needed a coder familiar with ENT procedures. A high volume of Medicare claims had been denied due to coding errors, and they needed someone who could step in and clean things up. It was another challenge—but also another opportunity to grow.
And that will be my next story to tell.
Lesson Learned:
Every obstacle is an opportunity to learn—don’t run from it. Face challenges head-on, and one day you’ll look back with gratitude for the growth they brought. Not everyone gets the chance to work in a learning-rich environment. The fact that you can work and learn at the same time is a privilege. Treat each day as a new opportunity to improve, refine your skills, and do better than you did yesterday.
Wishing you all the best on your coding journey!
Hoang Nguyen, BS, CCS, CCS-P, CIRCC, CCVTC
