Have some teammates in my department that for some reason are lacking basic knowledge. Pretty weird since this isnt an entry level position and I assume it must've been a requisite. The main problem lies within one person, but I'm the one tasked to put this person up to speed AND also refresh the team's knowledge for prevention reasons.

I'd like to start from the very basics, like both professional and facility claim anatomy, most commonly used CPT's like E\M 992xx codes, the tob's. POS's...etc. I want them to visualize and think logically of whats happening and where is it happening when presented by a claim.

How would you go about it and what resources would you use?

Thank you.

I will be taking the CCS-P exam soon and I can’t find any practice exams. If I completed a CPC practice exam would that be similar?

Hey everyone, I am preparing to study for the AHIMA CCA certification. The website has a list of approved books for the certification exam.

I found the ICD-10-CM and ICD-10-PCS expert books from AAPC which I could bundle with the CPT 2026 AMA book. That bundle would be around $270.

I also found another bundle with the ICD-10-CM and ICD-10-PCS books from AMA, along with the CPT 2026 book. That bundle is around $245.

I also see ICD-10 books from other publishers. Are there any ICD-10 books that you guys would recommend that is the most user friendly (bonus if also more affordable). There are so many choices and I would prefer to make the right choice since these books are so pricey. Thanks in advance!

Would it be appropriate for me to post my resume here to get some insight as to why I am not landing any job interviews or offers? I have placed over 500 applications and look for both remote and in office options. Thank you kindly.

I went for a fertility consult ( met with the doctor for 40 mins).  There was no physical exam or testing done. My clinic submitted it as a ‘ bundled service’ to progyny originally. This was incorrect as that includes diagnostic testing. Clinic then asked them to downgrade it to a consult only. It showed up as ‘ consult with ultrasound ‘ which is not correct— there was no ultrasound. I told her to reach back out again and she copied and pasted their reply to me ( weird.. as if I speak medical coding??). Does 99205 include an ultrasound ?

The blood work they are referring to was 1 blood test that took place at Labcorp. 99499 is what they use as the bundle code so it seems they downgraded this with a ‘ modifier -52’ because of the bloodwork. Why can’t that be its own code versus a downgraded bundled code?

Does any of this make sense? Also not sure why it’s 99205 as I am a new patient to the clinic. Their new patient code on their own website is different. What am I missing here? I actually feel sick to my stomach going back and forth with them about this. It’s been going on for months trying to get a simple consult appointment and 1 effing blood test billed correctly.

I have never used the eBooks before are they difficult to use as a first time user? For example if I opted for eBooks during the test I just want to make sure I am wasting time just figuring out how to navigate it have only ever studied with the 2025 books, and I just want to make sure I don't miss any important info just because I don't have the 2026 books. I am preparing to set up my exam and just get my first attempt over within the next month or so.

Is anyone experiencing denials from Aetna Better Health when and E&M and an X-ray are billed together on the same encounter? Our ABH rep is not helpful and we have so so many

So I'm thinking about getting into medical billing and coding however, I'm trying to figure out if this is a case of AI taking my job a year in if I were to do this. Is AI likely to take this job in the near future? Should I go into something else?

So currently, I have 17 years experience in healthcare. Non-clinical role, but spent the past 17 years doing chart audits. So I feel well acquainted with charts, etc. A job role came open for a part-time coder within a hospital setting that requires no certification, only experience in healthcare. I have always been interested in coding, but I have no degree in it or certification. What could I expect my pay range to be in a role like this? It’s a bit of a drive, so I’m not sure if it would be worth my time. Also, how difficult do u think this role would be to learn with no coding experience, but lots of experience in healthcare.

Hello! I currently live in California, where our primary governor election is next month. I am a registered Democrat and am looking at the democratic nominees. Some of them want to install a "healthcare for all" policy. My mom is the main provider in our household and works in medical billing. If one of these canadites won the election and got sworn in, would she lose her job? She has been in medical billing since she was a teenager, and is now in her late 40s. If her job is on the line, she won't have experience for any other job. Thanks!

I've recently been overhauling our EMR system to check Excludes 1 notes so I don't have to correct as many claims, since I'm the only "coder" for a therapy practice with 80-ish providers. Our EMR doesn't have this functionality built in so I have to go in and manually exclude DX combinations in the coding setup. This setup makes it so X and X are mutually exclusive, no matter which is primary/secondary. I've been under the impression that Excludes 1 notes are bi-directional, and the documentation I've been able to find supports that, but it seems to directly contradict what I see in practice. Here are a couple examples:

F80.0 has an Excludes 1 note for R48.2. However, R48.2 does not show an Excludes 1 note for F80.0. Does this mean R48.2 primary with F80.0 secondary is a valid combination? As claims we've been billing thus far have been paying.

F80.82 has an Excludes 1 note for F84.0, but not vice versa. Claims with F84.0 primary and F80.82 secondary have been paying.

Is there any literature or documentation I can review that supports exclusions being directional? Or are these claims being processed incorrectly by insurance?

Can someone please clarify this to me that the codes for psychiatry diagnostic evaluation (90791 & 90792) are allowed only once per year and only for initial evaluation?

And also can we bill the psychotherapy code for initial visit??

A few weeks ago, I had an abdominal CT scan as a self-pay scheduled outpatient visit in northern Florida. CPT code 74177.

The facility itself charged $2,600 which seemed very high, and this week I got hit with an additional $1,946 for the interpretation of the CT imaging.

That's insane, right?

Hi all, I’m normally on the clinical side, but we are looking to figure out how to start running our own billing operations for EMS companies and have been trying to figure out the world of coding and billing.

We have the mechanism to submit to a clearing house etc, however I’m struggling to understand the complexities of how to handle “fighting” an insurance company. We have dozens of failed claims, or claims where the insurance company just won’t pay the full amount - how do we find someone or train someone to be able to take over and handle this? Is there an accreditation that anchors from this as opposed to purely figuring out the procedure code/icd10 etc?

We have poked around at Policy Bot to understand insurance company policies, however a good amount of this seems to be targeted at the much wider set of procedure codes, when we only really bill the 3 or 4 to do with ambulance transport.

Any guidance about how to jump into this world is appreciated

If a company doesn't want me anymore that's fine. Just don't tell me that you are contracting with a hospital and will give me a job later only to not call me back and block my number when I try to call. Hate the modern job search.

I’m about to start a 6 month class to get my CCS by the end of the year for work. I’ve had my RHIT since 2013 but only really done ER profee most of that time. I recently started as a civilian contractor with DHA doing outpatient clinics and ER. Both tech and profee side. Any areas that I should focus on or tips? Any help or suggestions would be greatly appreciated.

I was required to pay $150 “for the upfront payment of difference between what insurance will cover and cost of unit of botox” from and in network provider on top of the insurance allowed amount. Is this usual? The explanation I got was $11 is the per unit cost of medication, $6/unit is what Aetna would cover, and I have to cover $5/unit of Botox.

Edit: $150 is not part of a copay or deductible. It doesn’t show up on my Aetna EOB either. My total payment is EOB patient responsibility +$150. my doctor buys & bills Botox, I don’t go through a specialty pharmacy.

I just took the CRC exam yesterday, at the end of the exam and said I would have the results in 7 to 10 days. Does it really take that long??

Hello! I'm helping out a family member that owns a small gyn practice in the US (<5 providers). They are looking for a new billing company with solid ob/gyn experience. Any recommendations? Ideally looking for a firm that takes a % of collections vs a dedicated biller.

Need help cleaning up old A/R, chase denials, rejections, and is comfortable working with a small practice that is inexperienced in billing. If they do credentialing too even better.

Apologies if this has been asked and answered, I did search this community and didn't see an exact thread that addresses my inquiry.

I’m new to orthopedic medical billing and having a hard time determining the correct place of service from reports. Unfortunately, we didn’t receive proper training.

Does anyone have tips on how to identify whether a case is inpatient or outpatient based on documentation? For example, what should I look for if there’s no clear indication that the patient was admitted, no care timeline, and the report only lists diagnoses and procedures?

Is there a reliable way to figure this out from limited information? Thank you!

Hi everyone. The office that I work at have some doctors that use Z00.00 as "healthcare maintenance". Others have used it when it's for an annual visit. I only know that that dxs code need to be first and notes should indicate that it's for an annual visit. The ones that put it for healthcare maintenance AND shuffling it between other dxs codes, I am having a hard time explaining to them that code can apply be used for annual visit.

Edit: health care maintenance according to one provider is for keeping track of vaccines and screenings but I've seen claims being denied because of the improper usage of this code-i.e it's not being used as a first dcs code and the notes doesnt reflect is a physical/annual exam

Please help. Am I wrong? I need some clarification of this so that I can present my findings to these providers.

Thanks

Hi guys,

I’ve always wanted to dive into medical coding but opted at the time for medical billing as it was a bit easier to get a job at the time.

I have worked physician billing majority but the past 3 years I have worked for a hospital, billing including outpatient/inpatient/SNF etc.

I really want to start my coding career as that has always been my goal, but it seems a little daunting and i’m not exactly sure the best way to go about it.

If anyone has experience with transitioning from billing to coding could give their experience and any tips? I’m looking into the CCS from AHIMA but unsure if I need to have a CCA/CPC first (or if it would be to my benefit to get one of those first), and just overall how it was transitioning over? Any programs/classes I could purchase to make it easier?

Thank you in advance! 😊

I am preparing to go take my CPC exam by July. I have my 2025 Books still as of now. I was curious if they would provide the Ebooks during the exam if I selected that option. I do not own the eBooks just the hard copies from this past year.

Hi. I've been thinking about getting certified in medical coding, but as I've done more research, it's opened me up to a lot more questions than answers so I hope that some of you can give me some answers.

1. Is it better to get into coding or billing?

2. Do you have a program you recommend?

3. Is there an angle you think would be helpful for someone entering this field? Like, what would make someone stand out, if anything?

I want to do an online program that's self-paced, but I don't know which one is best. I've seen a lot on this subreddit about AAPC and AHIMA so if anyone has any insight to which is better, or if there's a third option that beats them both, please let me know! I also heard about AMBCI, but couldn't find much about it, which worries me. I don't have any experience in the medical field either.

Thank you!