CCO BHAT® System for Medical Coding Manuals

CCO BHAT® System with Barbara Chippini

Boyd:  Hi everybody. This is Boyd here at 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.

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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 Manuals Barbara: 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

Barbara: You’re welcome. Thanks for having me.

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17 thoughts on “CCO BHAT® System for Medical Coding Manuals”

  1. I actually came across this method early in 2015 it hadn’t been patented yet, I was completely fascinated by it, grabbed my cpt Manuel and started the process. It has without a doubt been the single biggest player in my education process. It’s absolute genius. I want to congratulate laureen for the recognition she so deserves. I have in turn explained and taught the method to many of my classmates. We all love it. Pure genius

  2. Can’t wait to sign up for some education through CCO and learn how to use the BHAT™ method in my code books! As an RHIT looking to gain multiple AAPC certifications, this is something that definitely wasn’t taught in a college program for HIT. Excited to learn and master the technique!

  3. When I took my CPC exam last year, I concluded that BHAT technique is highly beneficial because there are times that I get crossed-eyed for the thousands of codes written on my Medical Coding books. This technique could provide ample time during the exams since checking/reviewing each codes are both time-consuming. I was really worried for the first months before my exam but when I learned the technique from the CCO presented by Laureen (Thank you Laureen!) and I believe this is great! I directly grabbed my pen and colored pens to BHAT-in those codes. Actually, this technique is also effective especially for those OC people like me. ^_^

  4. I’ve starting using this technique. I like to make notes in both the tabular and alphabetical listings so I can be sure to not miss a thing. I’ve got to amp up my writing utensil collection.

    • Helen, I will tell you I love writing utensils! I used the Staedtler triplus® fineliners (0.3mm) to do the annotations in the 2016 ICD-10-CM Manuals. However, for 2017 I’m loving the Juice 0.38mm Gel Pens – they’re an import. Both are available on

  5. No one comes close to teaching this method! If it was not for the BHAT process, I am not sure if I would be able to contain all the information in my brain! While completing the BHAT process, you learn information as you go and will be able to recall a great deal of knowledge while preparing your manual!


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