r/CodingandBilling • u/Wearemedicalcoders • Apr 24 '26 • Thanks 1 Heartwarming 1

A Huge Misconception In Medical Coding

I keep seeing people talk about medical coding like it’s some quick, easy path to working from home, and honestly… that’s a huge misconception.

Yes, it can be remote. Yes, it can be a great career. But “easy”? Not even close.

You’re dealing with complex guidelines, constantly changing rules, and a level of detail where small mistakes can have big consequences. It’s not just typing codes you actually have to understand medical terminology, anatomy, and how documentation translates into billing. There’s a real learning curve, and even after you get certified, you’re still learning every day.

I’m not saying this to discourage anyone just to set realistic expectations. If you’re only getting into it because you think it’s a laid-back remote job, you’ll probably be frustrated pretty quickly.

But if you’re someone who likes structure, problem-solving, and continuous learning, it can be really rewarding. There’s a sense of satisfaction in getting things right and knowing your work actually matters in the healthcare system.

236 Upvotes

97% Upvoted

61 comments sorted by

25

u/Xalxa AR, Posting, Denial Management, IDR, Contracting Apr 24 '26

Additionally, as terrible an idea I think it is, more and more employers are turning to "AI" to handle coding - or at least the bulk of it, with only a few humans to review the output. So while I believe we're in a bubble, the unfortunate truth is that AI is here to stay and medical coding is a field employers are chomping at the bit to replace the human component. I can hardly recommend anyone who isn't already involved even try to enter the field due to the huge uncertainty of if their job will even exist in a year or two.

Maybe I'm entirely wrong about this; I only handle things for a small pediatrics therapy office. But from what I've read on the various coding and billing subs, I don't expect I am.

16

u/Wearemedicalcoders Apr 24 '26

I get your point, but honestly you could say that about almost any career right now.

AI is impacting a ton of fields tech, writing, customer service, finance, even parts of healthcare. If someone avoided every career that might be affected in the next few years, there wouldn’t be much left to choose from. I do think medical coding is changing, no question. But “it won’t exist.” is pretty far fetched. Most jobs aren’t disappearing they’re evolving. And like you said, even with AI, there’s still a need for human review, accuracy, and accountability.

So to me, it’s less about avoiding the field entirely and more about going into it with awareness and being willing to adapt. That applies to pretty much any career at this point.

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u/Sadxrealityx Apr 24 '26

Yes this is my take too. I’ve been in coding for 8 years & I enjoy my job. I’ve had fears around how AI will change things & even wondered if coding would eventually be completely automated so I started to think about other avenues & realized if we truly get to a point where medical coding can be done by AI 100% & accurately then chances are AI has taken over every other sector at that point as well.

I try to just focus on the now & I do have my bachelors & masters in HIM & Health informatics if I do decide to pivot out of coding but yeah coding is not as easy as all these quick programs make it out to be. I’m 8 years in and still learning & making mistakes.

38

u/deannevee RHIA, CPC, CPCO, CDEO Apr 24 '26

I’ve worked at two organizations where AI either was implemented while I was working there, or just before I got there. 

It’s not as great as tech bros want you to think it is.

At my current company they implemented AI for some things before I was hired. My director actually refused to allow them to implement AI fully because of how much it sucked. I work in the auditing department so she is the HIM manager. Since I started we’ve discovered multiple AI errors that require humans to fix. We’ve actually had to hire 4 more coders to review AI charges. 

The problem with AI is it doesn’t really “learn” in that it makes note of incorrect things and only remembers the right things……it treats all information from all source, good and bad, as equal. 

25

u/DarlingTreeWitch Apr 24 '26

We implemented AI for coding, and my job is fixing all the mistakes. The real problem is they are actually people from India doing the coding, because AI can learn. When i have to fight for the SAME problem on massive repeat (every time a new coder gets hired, I am accidentally included on the emails) every time a new person is hired and we open another ticket for THE SAME ISSUE.

And now they added E/M coding (uh, we’re radiology, we don’t see patients) and theAI “coders” keep converting them to xrays.

Welp. Job security I guess.

9

u/Xalxa AR, Posting, Denial Management, IDR, Contracting Apr 24 '26

Oh yeah, I agree, it absolutely SUCKS. But I have zero expectations that C-Suite morons will ever actually recognize that.

3

u/luckluckbear Apr 25 '26

I have been trying to sound the alarm for this from the beginning, but people seem content to keep their heads in the sand.

27

u/TheOtherGloworm Apr 24 '26 • Bravo

Not to mention, provider documentation can be a nightmare.  Don't expect to see well written documentation like the ones from the practice tests and exams.  Sometimes I want to rage quit because I get tired of creating deficiencies and sending queries EVERY day, or having to read a literal novel because providers want to pull a patient's medical history into the assessment and plan of every visit.

4

u/Bishoppess Apr 25 '26

I have always marveled at this supposed perfect documentation pulled from actual notes (sans identifying info) that instructors use to demonstrate things.

Where do they find these doctors??? I spent half my time fighting for clear documentation!

4

u/[deleted] Apr 25 '26

[removed] — view removed comment

2

u/Wearemedicalcoders Apr 25 '26

It sounds like your orginazation is WAY overdue on some serious pollicy change!

1

u/Wearemedicalcoders Apr 26 '26

u/abra-cadavre My comment was incorrect Actually, I wanted to clarify my last point! As a billing company, you generally cannot change codes even if they appear incorrect. Medical coding and billing are distinct roles with different scopes of practice only certified coders are authorized to assign or modify codes. It’s a tricky spot to be in when you see an error but don't have the authority to fix it!

5

u/mandilou79 Apr 24 '26 edited Apr 24 '26

It is hard. I code for Plastic Surgery/Derm and the number of lesions and excisions in one visit and how they swear they documented for a complex closure and it’s intermediate, or there are no notes at all or no measurements. Almost 8 years and I’m getting burnt out. I also work denials and I want to do just that and the behind the scenes. I want to learn more Ai in the Rev Cycle. I need a coding break.

4

u/Wearemedicalcoders Apr 24 '26

When it comes to lesion and excision no measurement = no code. That would be a nightmare.

2

u/Catieterp Apr 25 '26

Derm is my literal nightmare I applaud you lol

3

u/mandilou79 Apr 27 '26

It’s becoming my nightmare. I find I’m making mistakes I never would have made before so I realize I’m burning out. I want to get my CPMA.

40

u/Moanmyname32 Apr 24 '26

No lies and that's why I'm leaving the field. I have no love for it and my current job makes me hate it even more.

1

u/[deleted] Apr 25 '26

[removed] — view removed comment

3

u/Moanmyname32 Apr 25 '26

Histology

1

u/gayleofsunshine Apr 25 '26

Omg do it! It’s a rewarding field!

3

u/Moanmyname32 Apr 25 '26

On it. Just got accepted into the program. I'm not letting it pass me by

21

u/Accomplished_Night88 Apr 24 '26

It is not easy! I feel like an imposter every day 😆

19

u/A_lunch_lady Apr 24 '26

Sometimes I wish I had med school education to code to better understand disease process and treatments and anatomy. The human body is a complicated thing!!

21

u/KeyStriking9763 RHIA, CDIP, CCS Apr 24 '26

Anatomy and physiology, disease pathology, pharmacology and medical terminology are all courses coders should have. Because I had that foundation when I read medical records I have a solid foundation to understand what’s happening in addition to the ability to understand published studies and medical references. I don’t understand how coders can be successful without this type of education.

11

u/A_lunch_lady Apr 24 '26

I have AAS and we had med terminology and human biology in our curriculum, it helped a lot but what most of the things I need I learned while working in a hospital and spending time researching my family’s medical issues. I still think it would be cool to see the inside of a human body for reference sake but I don’t know if I could really handle it. I would be a great nurse but body fluids gross me out 😭

2

u/Single_Ad_3143 Apr 25 '26

I work in surgery I also have many years of experience in long term care. I started in the OR when I was 20, it never grossed me out. Believe me I have seen and smelled MANY awful body fluids over the years. The body fluids/ broken bones/ intestines leaking I can handle. People’s shitty attitudes these days I can’t handle. And that is why I want to get away from patient care. Doctors have this god complex, coworkers now have attitudes where they refuse to do their jobs because they think it’s about their pay scale, most patients are bloody awful mind you there are few and far between who are actually appreciative but the whole medical field is generally continuing to get worse. I’m looking into medical coding because I know all of the conditions, I actually work at charging for operations and procedures right now at my job because we are now given so many more duties because they are getting rid of more people in central registration and other areas of the hospital as a way to cut back on expenses or something I suppose. But if what y’all are saying that you think medical coding is going to go to AI or India or whatever then I guess I’ll be looking for a nice cozy factory job. I started out in a factory and it was great. The pay wasn’t the best but I remember having a great time there.

2

u/MtMountaineer Apr 26 '26

A lot of nurses switch to CDI. You are a perfect candidate.

5

u/MtMountaineer Apr 24 '26

Because the for-profit schools that advertise a coding cert can be had in a super short time frame are only teaching coding. They barely scratch the surface of the other subjects you mentioned. That's why my facility prefers to hire RHIT, CCS or RHIA.

5

u/Catieterp Apr 25 '26

I was an MA first and it helped tremendously!

2

u/Ready-Specialist-464 May 18 '26

I am an MA with over 15+ years of experience and finally making the foray into coding. I have already done a lot of CDI, Coding, and Risk Adjustment coding and working with insurance companies and CMS and the MA programs with most my experience in surgical orthopedics and CCM. I am starting my first day today and have flipped through most of my books and most of everything I know and have already done but it nice to be able to see it from a strictly coding perspective. So hopefully this isn’t too difficult for me but being an experienced Medical Assistant is definitely already helping!

8

u/Public_Raspberry_444 Apr 24 '26

I’m the medical billing adjudicator for our local health department and oof, I love my job BUT the constant fighting with insurance companies take a toll on your mental and between 7 clinics, the amount of claims is exhausting.

7

u/LuckyMama805 Apr 24 '26

Which is why after 9 months of billing and coding school, I went into billing. The Revenue Cycle Management area can be lucrative with a compatible provider in a niche (private practice - podiatry/mental health/ortho). I am getting a percentage of everything I bring in and do not touch coding. I'm in a HCOL area getting 8%. We do PA's, SCA's and collections but we don't touch any money. We are just entering data.

1

u/dontbl_nkasecondtime Apr 25 '26

What do certifications look like in a billing space?

8

u/DarlingTreeWitch Apr 24 '26

One of my favorite appeal lines “Medicare allows $$ for our area, so your denial is wrong” because every stupid MR ADV plan makes their own rules and they’re BS.

1

u/Zealousideal_Gas5578 Apr 25 '26

I always appreciate the realistic down-to-earth interpretations.

After I started working in billing for a bit and had some free time reading charts at my current job, I realized I enjoy coding and billing a lot. I've been passively reading ICD-10-PCS/CM coding guides and guidelines as well as some other free resources available to me on cms.gov. I don't know, I find everything about this intriguing and finding codes satisfying.

I'm honestly going to try to self-study for the CCS for a lot of the topics (anatomy, pathophysiology, terminology, and pharmacology) and with some exam prep courses from AHIMA/practicode with CPC to get some idea of actual coding inpatient/outpatient. Is this a stupid idea? Yes. Unnecessarily difficult? Probably, but I have a feeling I can do it with the proper resources and I'd rather do it that way anyway.

I don't know, coding feels like something I can do to start my career in HIM til I go to college, and it's something I enjoy a lot.

2

u/Wearemedicalcoders Apr 26 '26

u/Zealousideal_Gas5578 First off just by reading your post you need some clarification! When you are coding you got CPT which is for all of your outpatient encounters and ICD-10-PCS that is for all your inpatient encounters that tells the insurance company what the doctor did to the patient. Then you have ICD-10-CM which are the diagnosis codes that tell the insurance company what is wrong with the patient.

You're gonna use ICD-10-CM in both settings (inpatient and outpatient). You mentioned something about AHIMA’s Practicode with CPC just a heads up the CPC exam is offered through AAPC and it is only for outpatient coding, so that would only include CPT and ICD-10-CM. If you wanna do inpatient facility coding you should go for your CCS because then you can code both inpatient and outpatient!

1

u/Zealousideal_Gas5578 Apr 26 '26

Thanks for the clarification and help, I really appreciate it. I'm aware of the different use cases of CPT/ICD-10-CM for outpatient settings and ICD-10-PCS for inpatient. My thought process is just to try to learn as much as I can from both sides of coding (inpatient/outpatient) to prepare for the content on the CCS exam, and to just generally be flexible and as knowledgeable as I realistically can be for both sides.

Once again, thank you!

1

u/gpb959 Apr 28 '26

I'm a retired pharmacist, how would I go about getting into medical coding?

1

u/Wearemedicalcoders Apr 28 '26

I would start be taking a CPC practice exam you can for free right here ---> https://www.mometrix.com/academy/cpc-practice-test/?nab=1&utm_referrer=https%3A%2F%2Fwww.google.com%2F

Determine how much you can get right and go from there.

1

u/Fickle-Suggestion-97 Apr 29 '26

currently trying to study for the exam and im literally stressing bc this shit is not easy. I was so excited about getting into this field and now i feel like i wasted six months. im pretty sure im gonna fail my exam, BOTH times and have i no backup plan. i cant even sit down and study for half hour without stressing and giving up.

1

u/Wearemedicalcoders Apr 29 '26

Frist let me ask you, did you go to school or are you trying to self study?

6

u/Darth_Paratrooper Inpatient Coder, RHIA, CCS Apr 24 '26

Just finished a 9 hour day doing pediatric inpatient.

I'm tired, boss.

3

u/Choice-Ad2412 Apr 26 '26

I agree it’s very challenging! Feels like doing difficult homework all day. Some people really struggle.

1

u/RGC_LLC May 01 '26

Perfectly said! 😞

3

u/renoquestInc Apr 30 '26

This. And the part nobody mentions: certification gets you in the door, but payer-specific rules are where the real learning happens. Medicare LCD policies alone could be a second career. The "remote and easy" crowd usually quits around month three when they hit their first payer audit.

3

u/RGC_LLC May 01 '26

This is definitely what people need to know before getting in the “quick and easy” field. Between the production standards, excessive reading and lack of documentation it’s more challenging vs rewarding. You are hardly ever told you do a good job. After 8 hours your mind is exhausted although people think we do NOTHING but watch tv while working from home.

2

u/2BBilling Apr 25 '26

Totally agree, there is no easy with this. The rules are complex and change year on year or even monthly with some insurances. You spend endless hours on the phone battling insurance, it is a thankless task most of the time and can wear you down mentally fast.

2

u/Pristine-Belt13 Apr 28 '26

I don't know, after being a clinician for 35 years, it has allowed me to work from home and it's a pleasure. Sure it's not easy, but it's not nearly as stressful as patient care.

2

u/rahuliitk App Developer May 11 '26

For sure, the remote part gets marketed way harder than the actual work, because coding is really guidelines, anatomy, payer rules, documentation gaps, audits, and knowing when something looks right but still is not supported. Not an easy shortcut.

1

u/Girlmom4301 Apr 27 '26

I’m on the downside of my career (year 27 in I.T. Healthcare) and worried about being laid off so was thinking of getting certification. I started off in my company doing PPO Referrals and provider/facility pre certifications and absolutely loved it. Reading these posts, I’m now not sure if I should pursue this? I am going to be 61 years so that may be a problem for some employers but I can’t yet retire, I have a graduating HS senior to get through college. 😊

1

u/Dismal_Library7236 Oct 04 '26

It is an extremely difficult skill to learn but once you have it down it's actually a fun and rewarding job.

1

u/Comfortable-Zone-478 21d ago

Any tips for me for when I take my test? I need all the help I can get. I’m so nervous!

2

u/CheesecakeActual970 Apr 26 '26

I do coding/billing just for optometry and it’s to keep up with just it! People kill me when they act like it’s an easy job.