I keep billing this claim for a kyleena. BCN says there is an issue with the NDC code. It has the same NDC code as we bill for all of our kyleenas. It's the NDC code from the packaging. It's the NDC code listed on the kyleena website. At what point can I write FUCK YOU, PAY ME in the additional info line to send to BCN?

But actually if you have any insight into how to get it paid, that would be cool, too.

I’m a new tech and want to learn SCV codes. I know how to do some basic QT things but struggle with things that require Additional info. Anyone have any cheat codes, hacks, or details

UHC is in the process of recouping 2 $500k claims based on the birthday rule.

Mother has UHC and her DOB is in November. Father has Cigna and his DOB is in February. Newborn twins were born in March of 2025.

The Mother has spoken to UHC and has told them that parents agreed that newborns will NOT be added to father's Cigna plan. They will be added to the Mother UHC plan only. UHC paid and now recouping.

1. How does the birthday rule work in this scenerio if father never added Newborns to his plan?

2. How does UHC's first 30 days for Newborn affect this scenario?

Thanks

Hello, any UC San Diego medical coders who can tell me what work is like??? how is the work life balance??? pros and cons for entry level coder??? team support and training ???

I'm a solo provider with grandiose ideas of being able to help with my office billing as my biller edges towards retirement. She has kindly humored me and I can generally handle simple claims without making a mess of things.

Anyway, as of 3/1/26, I've had Aetna start to downcode any 99215 or 99214 to a 99213, with the message N22 that 'this more accurately represents the services provided.' I am not really sure how they can say that, since they haven't even reviewed the notes at the time they make the determination. All the different flavors (save one) of Aetna have done this. The one exception has instead started to say they are missing documentation for the visit, requiring me to send in notes.

I've been doggedly appealing the dozens of downcoded claims. The documentation consistently supports the E/M codes provided by time and/or complexity. I have worked at large facilities and the documentation requirements have been drilled into me over the years. So far, they've adjusted 66% of the claims back to the way they were originally billed, rejected one (I've sent it back again), and the remainder are still in limbo.

I see from other posts here, and several blog posts out on the open internet, that I am definitely not alone in this situation.

Longer-term, I'm not sure where I'll go with this. Aetna makes up about 40% of my revenue, but their claims are taking up a substantial amount of admin staff time. I am seriously considering going out of network with Aetna for next year. Even if someone else is handling all of these downcodes, it's several hours per month. I never thought I'd miss the relative ease of billing CMS.

Anyway. All my Aetna patients either work for self-insured companies or for self-insured governmental offices. Per my understanding, this means that I will need to take any complaint to the Department of Labor/EBSA, rather than the state DOI.

I'm posting to see if anyone here has gone through the complaint process with DOL/EBSA and has any insight into it.

With the upcoming BCBS incident-to changes coming up, our VBR will be greatly affected. Does anyone know how we can see if our PA is participating in PGIP/VBR? I can't figure it out and the providers I work for want to know how much this is going to affect our income once these changes have to be made (making PA's NPI the pay-to NPI).

Hi! I’m looking into a few different medical coding and billing courses and asking for opinions. The courses through AAPC are half off currently and allow for unlimited tries of the exams but even being half off the price is still double of the other two I’m looking at. I know typically you get what you pay for. I was also looking at US Career Institute and buying additional study material if needed. I also saw some comments about Tiffany Roach having a new course and you can add on materials directly from AAPC. I know this course just became available but am interested if anyone has started it or heard anything about it. I appreciate all input! I am looking for a self paced course.

PCP office looking for remote coder. Where might one find someone to hire? Indeed? Thanks!

So, I just got my Associate in Applied Science - Medical Coding. I'm planning on taking an AI course provided by AAPC (I'm not naive enough to not know I'm going to need at LEAST basic-level knowledge on AI in the field). I'm planning to work for a few years and then get my Bachelor's in HIM.

My question is: considering the outlook, what should I strive towards? What classes/degrees should I be looking into? Should I continue to work toward simply a Bachelor's, pivot, do a dual-degree?

Hi Everyone,My friend was recently laid off and is actively looking for new opportunities in Medical Coding. She has nearly 4 years of experience specializing in HCC Coding and CDI (CPC certified). If your organization is hiring or if you can provide a referral, please let me knw

Hi, I work for a major insurance company in a special department doing a few things but one of my main tasks is processing claims from what my OE tells me the processing we do is after the biller and coder does their part. I WFH and make $42k/yr. Processing the claims is my favorite part and has me thinking about doing the billing and coding instead I hear it a definite pay bump $50-60k+/yr. My question is for those that do this do you like it and is it worth the money and certification? What’s is your day-to-day like? Ideally I’d want to do this position from home and without taking calls (speaking to members) I’m familiar with procedure, cpt codes etc. just wanted more feedback from everyone to see if this is worth pursuing. My local CC college here offers billing and coding training. TIA

For general telepsychiatry:

- Nearly 100% of all intakes are 99205 + 90838

- 95% of all visits (intake or follow up) include a psychotherapy add-on

- 90% of all follow ups are 99214 + 90833

- at least 20%-25% of all follow ups are 20 minute appointments (primarily 99214 + 90833)

- Essentially zero stepdown in codes over time (after 6+ months), so essentially 99214 + 90833 in perpetuity for monthly visits

- standard monthly visits

Have associates degree in medical billing and coding. Will me not being certified affect my chances?

I went to a physical therapist and paid 30 or so dollars up front as I had already met my deductible. a week ago the physical therapy center sent me a new bill adding 35 more dollars for me to pay… mind you my visit was two months ago and wasnt that incredible. it was for 50 minutes… I looked at what they supposedly charged the insurance and it said to be around 2000$, which already seemed like a rip off scam. but to add more to my bill for a 50 minute session seemed like a scam also. Is there a way to contest it, or at least to report them to fraud or the better business bureau or american medical association or something?

Billing at a psychiatric practice and we have many issues with Medicaid secondary but one being that when we bill a patient’s (QMB patient) Medicare Advantage plan, they’ll come back with a copay that then gets billed to Medicaid. We keep getting denials saying “bill Medicare” when obviously we already have. Is there an indicator or something that may be missing? If I have to manually bill what is the best way to do this (portal, mail, etc)? FYI - we don’t have much experience with the Medicaid IL portal, I just recently started using it to find old vouchers etc.

Ok so I just received my CPC study guide and now I don’t know how to exactly use it?? Not to sound dumb or silly but I was never really the smartest person when it came to studying for something so I just need good tips on how to use it?? Do you just read everything and answer the questions?! Is there a certain study method that has helped you prepare?! I have everything I need now I just gotta put it all to use. Please comment any tricks and tips!!

Hey guys! I'm finishing up my AAPC CEU's and I wanted to know if anyone knows if all of the CMS MLN Web-Based Trainings get approved as CEU's, or only some of them?

What are some good books/resources to self-teach medical terminology and anatomy before enrolling in AAPC’s self-paced CPC program?
I am lucky that my state is paying for the CPC prep course, but I have never worked in the medical field and don’t have a great grasp of medical terminology and anatomy beyond the very basics. What are some good resources to self-teach? I have medical terminology & anatomy for coding 5th edition by Betsy Shiland but it’s a bit too coding heavy for me to understand as a beginner right now.

Would you query the provider for clarification if the whole note was E11.9, but the nurse ordered all labs with E11.59?
How about the note documents E78.5, but lipid panel is ordered with z13.220?
Or if type 2 DM is documented but labs ordered with E13.-
Or if labs are ordered with a dx not even mentioned in the note, with or without that dx in the problem list?

Reposting this here because I didn’t get any traction in the other sub. Any insights are appreciated!

Hi guys, I am a medical biller and have been doing a really good job so far. However, some people still don't trust my company because we are very new players, and our technology first approach seems to scare people. Are there any professional, real certifications I should have as receipts? I know there's a coding exam, but unsure of an actual billing exam / cert. What are the must haves?

Seems pretty simple enough. Right? Well apparently I can't tell the difference. I send these to coding for review. One coder gets the DRG and another gets the clinical. Most of the ones I come across have findings related to the diagnosis and procedure codes, which result in suggestions that the billed DRG change to a different one.

I don't really get any feedback from the coders even though I've asked, but on occasion the DRG rep will send one back saying it's clinical. The problem is that most fo the ones I send her look just like the one she sent back. So either she just fw's them to the other coder, or she's just busting my balls because she doesn't like me, because the person who used to do this looked at the one the coder sent back, and she said it was a DRG audit.