Boyd: Hi everybody. This is Boyd here at CCO.us along with our fellow medical coder, Barbara
Chippini, CPC, CCS. Hello, Barbara. How are you today?
Barbara: I am fine. Hello. How are you?
Boyd: I’m excellent because I’m talking to you and we’re talking about the Bubble
and Highlighting Technique which is now transformed into the BHAT Technique. So we’re interviewing
you today to ask you a little bit about how you got started with this because I understand
you’re one of the original people who heard about this technique back in 2000. Can you
tell us a little bit about your first time hearing about bubbling and highlighting?
Barbara: First time bubbling and highlighting, I took a course taught by Laureen when her
school was called A+ Medical Education [?] back in 2000. I have my original CPT Manual here.
I couldn’t get rid of it. It’s what got me into coding and –
Boyd: Unique because it’s a three-ring binder, the last time that it was actually done.
Barbara: Well, it is. Many people will not notice this. This is a three-ring binder.
It is the last time they published it in that and I kept it. I also kept it to see how CPT
has grown and how many pages this book was and how thick it is now for all the new coders,
and to see all the changes. There are things in 2000 that are no longer done now.
Boyd: So what did it look like back then? Has it changed that much since then, the whole
technique?
Barbara: Certain rules and guidelines have changed, but a lot of the things, the basic
structure has stayed the same. The surgery section and we would… Laureen would teach
us to highlight and bubble, and highlight certain sections. I’m hoping that you can
see this. These are circles that are around like codes and inside each bubble we would
put a note that is specific just for that area, that bubble, and we would go through
the entire section and just put the like codes. And it would help us keep focused when we
were taking the board exam or that was the instruction back in the day. It was very time-consuming.
I hated it as a student. I didn’t think that it would make much sense.
But after taking the CPC exam, I found that this was one of the most beneficial things
that I could spend my time on.
What we would do is each week, Laureen would teach us a different section. So part of our
homework was bubble and highlight, so that we were ready for her instructions so we could
put the notes that pertained to each bubble to get ready for the board exam. So over the
years, I taught for Laureen. And since 2001, I’ve been bubbling and highlighting her
book for all of her classes. And I also bubble and highlight for myself because I find it
still assists me in my day-to-day work as an auditor when auditing outpatient claims.
That I can go to my old books, see in the past years what was bubbled, what the notes
were; then go to this year, see what’s changed, change the notes. But also to keep those and
also I can lend them out to my fellow auditors.
If they’ve never worked, say, in the nervous system and they’re auditing outpatient claims
or physician claims in the nervous system, maybe they only did office work E/M codes.
But now they’re in the auditing world, I say, “Well, here’s the nervous section
and here’s the set of codes and these were the rules back two years ago. So you’re
going to be doing all the 2014 claims, you’re going to need these. And you’re doing 2015,
so they changed, so here’s my copy of my book for this year.”
So it’s a method that’s tried and true since the year 2000, since we started doing
it. And like I said, we do it every year going forward and we’re… it's 2016, you do the
math.
Boyd: We won’t go there.
CPT Manual Bubble and Highlighting Technique Explained - CCO BHAT™ System for Medical
Coding ManualsBarbara: It doesn’t seem that long and when Laureen told me that they were
now, you know, calling it “the BHAT cave” and did I have anything or would I be interviewed
for it and I said, “I’ve got one for you. I have the original CPT 2000 Manual from back
in the day.”
Boyd: Awesome. Well, thank you for keeping that in your archives, your personal archives.
Not a lot of people will go through that, so we really appreciate that.
Barbara: Some people keep their first reader.
Boyd: Right. I know I have some music books that I do that with, so I fully understand
that. Now, obviously you said that you would teach this to other students through the years,
this technique. Can you tell a little bit about what the student aspect of that, the
reaction of learning this technique and how they kind of deal with that?
Barbara: Sure. Again, it was quite like mine. They thought that is so time-consuming. Many
of the students have full-time jobs and they’re trying to fit this in because it was one night
a week. It was taught over 20 weeks, every week would be a different section of CPT and
then the ICD-9 and the HCPCS thrown in there. So it was 20 weeks, each week they had to
do this. But as I would say to them, the bubbling and the highlighting, you could really do
on your downtime. I did it on the train going to Philadelphia when I went to work. So that
part, you really didn’t need to focus on as much. It was just circling the like codes,
highlighting the differences in the like codes from the parent code above. You didn’t really
need to be reading it. You just needed to be able to eye where it was indented, find
the semicolon, highlight, highlight, highlight, circle. What I would tell everyone, circle
it first, then go through and highlight it.
And like I said, I would do it on the train every year when I would do Laureen’s new
book and my new book. Sit there on the train an hour and a half to Philadelphia, an hour
and a half home – highlight, highlight, highlight, circle, circle, circle, circle.
And then when we were ready to teach it, it was done and the students could put their
notes in it or I could when I was done bubbling and highlighting the two books, then sit down
and focus a few nights a week, and get hers ready and mine ready for teaching, transfer
all the notes. That, you really needed to pay attention to. But the bubbling and highlighting
was time-consuming. But each one of my students after taking the board exam – and Laureen
could probably say the same thing – when I asked them what they would find the most
useful or helpful in the class so we could expand next year, they said, “You know,
that darn bubbling and highlighting, I hated it but it kept my focused on board exam and
I didn’t get scattered. I could stay focused into ‘It’s not this bubble, I need to
be over here because this bubble says this and this note says this is where I need to
be.’”
Boyd: And my understanding is that it’s not just useful for the board exam, can you
tell us a little bit about your own experience and also of your students, of people who have
used this technique to go out into the coding world and use it in their own work?
CCO BHAT™ System for Medical Coding ManualsBarbara: Sure. Like I said, in the coding exam you
have to learn a smattering of all, but most of the time you’re in a specialty. So if
you’re in cardio and you’re a new coder there, you can go to the cardio section and
you would have different bubbles. So if I try to find them here, different bubble sections
like I think everybody knows somebody who has had a heart attack and maybe has had a
cardiac catheterization. So you could go to the cardiac catheterization section and there
are several different bubbles within that cardiac section. So, you would need to know
if you had a cardiac cath, you need to be here. But if they do something else with it,
we would have a note directing you to come over here and pick up this piece. But then
if they did something else, there’s a note to come back over here because if they put
a stent then you need to be over here. So they’re not all together. So by bubbling
and highlighting them, you could figure out where you needed to be. You could say, “Okay,
I’m picking up a code from here but I need to come all the way back here 3 or 4 pages
behind to get the piece that was missing.”
So in my day-to-day work, I still use that technique and go back and I say, “Okay,
this person had this done. The radiology piece is going to come from radiology, the surgery
piece is going to come from cardio but my diagnostic part is going to come from medicine.”
So I can put them all together and the notating directs you back to it. Sometimes you’ll
have a code in the beginning of the book and it says “code also with,” but it’s 3
or 4 sections later.
Boyd: Yeah.
Barbara: So you put a note in this bubble “don’t forget to go to path and lab and
add this one” or “don’t forget to go to radiology because there’s an intervention
being done there but the surgery piece is over here.”
Boyd: And for the students who are looking at this or potential students that we have
now being introduced to the BHAT Technique for the first time, what Barbara has just
gone over is now available in our BHAT cave, as we’re calling it, to learn how to do
this on your own. Let me see if I got them all straight now. We’ve got the CPT Manual,
we’ve got our ICD-10 Manual. I think we have some more that we’re working on right
now that it’s on these pages or you’re probably watching it. So that it’s not just
for the CPC exam but it's really across the board now that we’re expanding and using
the BHAT Technique. And available in our BHAT membership through CCO –
Barbara: In the BHAT cave.
Boyd: Yeah, in the BHAT cave.
Barbara: Yeah, in the BHAT cave. And it’s great that it’s expanding now into ICD-10
and also in the HCPCS. It was something that we had originally done in CPT but it helps
them focus when you’re taking any one of your board exams, your CPC or your CCS. You
have questions in all three of those books.
Boyd: Right.
Barbara: That can be applied across the board.
Boyd: Well, thank you for spending time with us. I don’t want to keep you here too much
longer. So, thank you, Barbara for sharing your experience using the Bubble and Highlighting
Technique, and now the BHAT Technique
Barbara: The BHAT Technique, love it.
Boyd: In the BHAT cave. So, thank you again for joining us here at CCO.us.
Barbara: You’re welcome. Thanks for having me.