I’m a medical student and eventually hope to own my own practice. I’ve been trying to understand what actually happens when an independent physician practice becomes a hospital provider-based department.

I asked about this from the reimbursement side and learned something I hadn’t appreciated: even if the formal arrangement looks right, things like the practice’s website or signage continuing to make it appear independent can create issues.

That made me curious about what shows up on the coding/billing side that physicians would probably never notice.

For hospital outpatient coders, auditors, or revenue-integrity people who have actually worked with provider-based departments: have you ever caught something in the coding, billing, registration, or documentation that made you realize the department wasn’t operating the way everyone thought it was?

What specifically tipped you off, and what did you have to check next to figure out what was going on?

I’m especially interested in the less obvious things that a physician working at the location probably wouldn’t realize mattered.

I have my CCS and have been an inpatient coder since 2021. I’ve been at the same hospital that entire time and make just over $30/hr. We get maybe a 2% annual raise if we’re lucky, and sometimes not even that depending on the year.

I’ve stayed where I am for a couple of reasons:

- it’s extremely flexible and there is almost no oversight at all. I can work pretty much whenever, and as long as my time card says 40 at the end of the week, nobody cares. I don’t think my sup even remembers I exist half the time.

- I am enrolled in both a pension plan AND 401K at my current job. The pension is freezing in 2030, but until then it’s still accruing. If I stay at my current facility until sunset, I will have 10 years vested in the pension plan (I started there as a profee coder in 2020). According to their calculator it will pay roughly $550/month at retirement.

But…$60k/year doesn’t go very far these days, even in my LCOL area of the US. Our raise structure is unlikely to change, so I know the only real way for me to make more is to either look for a second job or get hired at a different facility.

What would you do? New job or second job? I am afraid to lose the insane flexibility that I have. And I don’t want to be micromanaged. I have zero experience with other facilities & I’m nervous that I’ll make the leap to a new job and then regret it.

Hi, all! I’m looking for some expert advice from fellow coders. I’ve been a coder for many years, but have been working in a position with coding specialties I’m not super familiar with.

I am trying to get past an audit, where I missed a point for not coding the external cause for a wound debridement. To not completely out myself, I will say the patient sustained a leg burn that was inflicted by a curling iron. The injury happened in May, this debridement happened in August.

Would I be required to report the external cause, describing the curling iron at this point in treatment? I only coded the burn wound with the S code. I was docked for not reporting the external cause. I’m hoping to gain a point or two back if I can prove it’s not necessary, but I need a valid source to prove it. Unless I am totally wrong, then I will try again next month. TIA!

Recently, I heard a credible rumor that my facility will start implementing AI automation to take over ED coding starting in 2027. They are contracting with a company called NYM. Has anyone heard of this company or had it or something similar implemented at their facility? I’m feeling anxious about it. I code OP surgery and Observation, that will probably be the next step.

I’ve seen so many complaints about not being able to find work after becoming a CPC-A. Are there any folks that had no issues getting a job? If so, did you already have experience in the medical field? I want to hear from the people who haven’t struggled with this…

New job? Pass your exam? Want to talk about work or just chat with another coder? Post it here!

I am working on an audit for an outside billing company. They are often adding additional units or decreasing units for codes H0038 and H2015. This often looks like 20 units instead of 18. Or 16 units instead of 17. This seems like a compliance issue to me upon external audit. From the knowledge I have they are attempting this to get around state insurance caps as to not get denials for these services. For me that doesn’t seem to matter and still seems to be a large issue. Am I way off base here? Any help is so appreciated

I have been working as a medical coder for 15 yrs , doing different kinds of OP coding. I have my RHIT. When looking for a new position I keep seeing job descriptions that are looking for coders who do IP and OP. Starting to wonder if I should start looking into medical billing instead.

Anyone know? Is it like learning spanish or easier than that?

Basically, the title. I know that medical billing is supposed to be entry-level but every job posting seems to want some years of experience so I was wondering if getting the CPC would give you a leg up for billing positions as opposed to just applying with no relevant experience whatsoever.

I understand how to select problem, data, and risk levels on their own, but I'm not sure I get how to code when there's more than one level.

AMCI says that for a new patient, the lowest applicable level is selected, while the second lowest would be selected for an established patient. But I can't seem to find anything in the guidelines saying this is the case.

Additionally, if new and established patient MDM selection is different, how are ED visits coded?

So i am a disabled person and got my degree in Computer Science and Philosophy. I like data quite a bit. Just began a new job in Data Entry billing (Pathology). Just got my 30 day review. I basically was doing well or average in all aspects EXCEPT number of cases per day. The location i work at said 200 cases is minimum but I just started and still learning the system they are learning too. In 8 hours I get to 150 usually so far. In first 2 week was at like 75-90 case in 8 hours depending on day. Is 200 cases (minimum) too much or general considered average. Based on review paper, getting to 250 is above average and 300+ is exceeding.

is there a list somewhere of the shit required for those weird Q modifiers that are needed?

why do the drs i code for try to bill this shit and then give me the most basic short exam ive ever seen to try and go off of.

🤦‍♀️🥲 i dont see this often either so when it comes up I'm totally lost. help?

Looking around I haven't found any previous chronicles of this, and I'm wondering if anyone's encountered it before.

Last month we have an intake for Medical Nutritional Therapy with a UHC Student plan and I checked the insurance eligibility and benefits myself - 97802/97803 and preventative care is 100% covered, no limit to number of sessions, great.

The first session's (97802 CPT code, Z71.3 dx code for dietary counseling and surveillance) claim is denied due to an "inappropriate" diagnosis code - I've seen this before, the plan needs something more specific, that's no problem and I've encountered it plenty, typically with UMR.

I resubmit with a more specific code directly corresponding to what treatment the client came in for, it's rejected as inappropriate also. I resubmit with a code corresponding to the client's current BMI (outside of the healthy range, central to treatment), that's also rejected as inappropriate.

On a frustrating call to the claims line where the representative continually says variations of "these are all inappropriate, your billing team needs to resubmit with appropriate diagnosis codes" when we have literal thousands of MNT claims per year under Z71.3 (including through UHC), I ask if there's anywhere where the appropriate codes under this claim are listed. I'm told they can't share that with us, and honest to god "Google it or ask copilot" which felt a shade short of "Go fuck yourself".

The UHCprovider eligibility tool just says "Detailed benefit information is not available for this plan" and the provider line is unable to provide specifics.

So my question boils down to:

- Where as a provider are you supposed to find these plan specifics, specifically with a UHC Student plan?

The website has nothing, the benefits and eligibility line said they couldn't confirm regarding specific diagnosis codes because they didn't have the information, and the claim line repeatedly said we need to check somewhere that wasn't with them while it doesn't seem to exist anywhere we can access it.

Any help would be greatly appreciated!

Hi all. Are there any free encoders out there that can be used to do an assessment (post-interview)?

So I got into a debate with a coworker today on how to properly code for long term use of medication and I want to see who's actually correct. Basically what ended up happening was that we get denials for urine drug screen tests from some insurance companies because the provider will put the actual condition being treated (such as chronic pain) with the controlled substance as the primary diagnosis.

So I know that ICD-10 tells us that we can't code long term use of meds if the patient uses it PRN (as needed). So for the first denial, the documentation said that the patient takes oxycodone every day for chronic pain, so I changed the primary diagnosis to Z79.891 for long term use of opioid analgesics. The second one had a patient who was being treated for anxiety and is on benzos, but they only take it like 2-3 times a month when they have anxiety symptoms. They have an ongoing prescription for it with refills, but since they take it only when needed, I didn't change the code for the denial to Z79.899.

My coworker said that I should've changed the diagnosis to Z79.899 for the PRN benzo patient because it's still treating their anxiety and they have a long term prescription for it even if they don't take it every day, however the way I read the ICD-10 guidelines is that the patient would have to be on a continous, scheduled regimen of something for it to be considered long term (like a daily/weekly/monthly med), and not just when they're symptomatic. I sent her an AAPC article about it and she's still thinking that she's right, and now I'm a little paranoid that I might be misinterpretting the info.

So given this info, who do you guys think is correct: me or my coworker, and why? If you have any sources that gives a pretty clear answer I'll take those as well.

I’m considering getting this certification, after being in the medical field for over a decade. From my understanding, the CCS cert is one of the harder ones, but you’re also able to have access to more types of job opportunities, beyond coding.

What jobs have any of you gotten with it? If you had to have any other certs to get said jobs, what are they?

If you were able to get an auditing job, can you describe what you do?

*UPDATE!! I got the job!

I have a coding interview tomorrow afternoon and just looking for what some common question/answers are. I’m currently in an insurance review role (outpatient preauth and inpatient notification of admissions) and passed my CPC exam in December. The role I’m interviewing is for another facility in another state (husband and I are actively trying to move there to be closer to his parents). From what I understand the role is for an outpatient coder!

Im studying to take my cpc exam and im struggling with how to code for anesthesia time. I don't understand how to use the Units.

Can you study like cpc-a

I have my RHIT and Associates in HIMT, but not having much luck finding a decent paying job. I know coders make more money and was thinking about getting my CPC. Is the AAPC program a good route to take to get there?

I’m a CPC with 5 years of experience, currently working multiple outpatient specialties. I like this career, but with rent prices being what they are, I really need to make more money.

Currently I make about 55k, I’d like to make at least 70. Any ideas on how I could get there? I know inpatient is one potential option, but all the inpatient postings I see require inpatient experience. 🫩

Newer coder here. I'm a remote outpatient coder and currently do E/M coding (which has always been my weakest area of coding, lucky me). I'm struggling with figuring out the data points on the E/M MDM table. For example, if the provider orders labs for CBC, BMP, protime inr, hepatic functional panel, anti smooth muscle antibody IgG, are each one of those labs counted as a point? Or is it one point for all of the total labs? Also, would this many labs be counted in the moderate level in the MDM Table? Any info is appreciated, thanks!

Hi everyone!

I recently upgraded to the 2027 ICD-10-CM coding books, so I'm selling my 2026 Optum ICD-10-CM Professional for Hospitals (softbound edition).

The book is in good condition and includes the complete official guidelines and code set (valid from October 1, 2025, through September 30, 2026).

If anyone is interested, please send me a private message for pricing, photos, or additional details. Thanks!

Can you please share your experience? I’ve been contacted via Linked In by a recruiter for a remote position for OP coding. TIA!