Overcoming Early Challenges
When I graduated from a two-year college with an RHIT credential, I believed I had made the best choice for my career. Unlike a coding certificate program that could be completed in six months to a year, RHIT required attending an AHIMA-accredited program and earning an associate degree. This made me feel confident that I was well-prepared for the medical coding field.
After graduating and passing my RHIT credential exam, I was honored to receive the 1999 Student Achievement Award at the AHIMA Tri-State Annual Conference. Standing on stage, receiving the award, was one of the proudest moments of my life. What made it even more special was that several coding managers from prestigious Boston hospitals approached me, congratulated me, and handed me their business cards, inviting me to interview for a job. I was on top of the world, convinced that my career was off to a fantastic start.
The first hospital I chose for an interview was Mass General Hospital in Boston, one of the top hospitals in the world. During the interview, the manager was impressed with my academic achievements and positive attitude. She told me she wanted to hire me but first needed to evaluate my coding skills. She led me to a small cubicle, handed me three bulky inpatient records, and told me to notify the coder next to me when I was finished so they could call her back.
I confidently opened the first record—then reality hit me. I didn’t know where to start. The record contained handwritten notes from ER doctors, consultants, nurses, physical therapists, and attending physicians, all documenting assessments and treatments. Some handwriting was completely unreadable, and I struggled to understand the medical terminology and abbreviations. Unlike school, where case studies were neatly formatted in textbooks, this was real-world documentation, and it was overwhelming. At that time (around the year 2000), electronic medical records didn’t exist—everything was handwritten and stacked on top of each other.
I sat there for two hours, confused, embarrassed, and unable to code even a single record. When the manager returned, I admitted the truth—I didn’t know how to code these real-world cases. She was kind but firm, explaining that she couldn’t hire me since I wasn’t ready for the job. I walked out of the hospital feeling defeated, humiliated, and lost.
Determined not to give up, I scheduled interviews at two other well-known hospitals. Unfortunately, both interviews had the same outcome—they asked me to code real inpatient records, and I struggled to even begin. The complexity of surgical procedures, psychiatric diagnoses, and lengthy inpatient documentation was far beyond what I had learned in school. After three unsuccessful interviews, I felt like no one wanted to give me a chance, and I didn’t know what to do next.
That’s when I decided to apply for a lower-paying coding job at a psychiatric hospital—a place where most coders didn’t want to work. The majority of patients there had psychiatric disorders, drug abuse, and alcohol abuse issues, and some even wore helmets to prevent self-injury. I was the only coder at the hospital, and my ICD-9 coding book was massive. Every single record contained psychiatric diagnoses like depression, schizophrenia, suicidal ideation, and dementia, which were difficult to interpret.
To make things even harder, my coding manager was not supportive and often blamed me for incorrect coding. Reading handwritten psychiatric notes was incredibly challenging, and I struggled to assign the correct diagnosis codes. But instead of giving up, I saw this as an opportunity to learn. Whenever physicians came to complete their documentation, I politely asked them to help me read and understand their notes.
I still remember Dr. White, who once asked why every record I coded had ICD-9 code 311 (Unspecified Depression). I honestly admitted that I couldn’t read his handwriting. Instead of scolding me, he took the time to teach me how to read his notes using the SOAP (Subjective, Objective, Assessment, Plan) format. That was a turning point for me—I learned to decipher physician documentation and became a better coder because of it.
After a year of hard work and perseverance, I left that psychiatric hospital and landed a second interview at a major hospital—but that’s a story for another day.
My Advice to New Coders
If you’re a new graduate or have just earned your medical coding credential, take any opportunity you can to gain experience. Your first job might not be at a prestigious hospital, and that’s okay. Learn from every record you code, seek guidance from experienced professionals, and don’t give up.
If you’re still waiting for an interview or struggling to find a job, keep knocking on doors. One will eventually open for you. And when it does, you’ll look back and appreciate the struggles that made you stronger.
Wishing you all the best on your coding journey!
Hoang Nguyen, BS, CCS, CCS-P, CIRCC, CCVTC
