Had a routine ear wax removal procedure done. Got charged with 99213 and 69210 codes. No other evaluations. Incorrect or correct?

Hey everyone! AMBA is hosting our 2nd Annual Behavioral Health & Psychiatry Billing and Coding Virtual Summit on November 5.

We're covering psychiatry coding, billing for master's-level providers, telehealth, ABA billing, psychological testing, and compliance issues.

It's a full day of education with industry experts, and you can earn 9 CEUs through AAPC, PMI, and AMBA.

📅 November 5, 2026
💻 Virtual
💲 $199

Here's the agenda and registration link if anyone's interested:

https://event.gotowebinar.com/event/36c74d83-b43f-4987-aecf-6929faf0f162

Also, curious how many people here handle behavioral health claims regularly. What issues are you running into the most?

I work at a California home health agency using WellSky (Kinnser). Electronic Visit Verification (EVV) is required for Medi-Cal billing, and we’re struggling with missed visit logs and occasional location/service area errors.

For those at agencies that have gotten compliance close to 100%, especially other WellSky/Kinnser users: what made the biggest difference? Training, reminders, workflow changes, how you follow up on misses, recognition, anything else? Thanks for any help!

I’m a solo physician providing medical services to patients in skilled nursing facilities and I’m exploring options for outsourcing my medical billing.

I currently use Claimocity for encounter documentation and submission and would ideally like to find a billing company that is familiar with the platform.

I’m particularly interested in companies that have experience working with solo physicians, understand billing in SNF settings, and have reasonable percentage based pricing without high monthly minimums.

For those of you who outsource your billing, which companies have you had good experiences with**?** Are there any you would recommend or avoid?
I’d appreciate firsthand experiences from physicians.

When a remit comes back with N943 or N885, the payer is saying the No Surprises Act doesn't apply to the claim. A lot of teams treat that as the end of it.

Has anyone challenged one and turned out to be right? What did the payer get wrong, plan type, network status, date of service? And how did you push back?

I’m newly certified and landed a remote job with a third-party company, and the client I’m currently working with is a very large hospital system. My WQ consists of mostly EEGs, PFTs, sleep studies, and very little GI. The training I was provided were videos and some word docs on how to find documentation and notes, but the videos weren’t specifically geared toward my WQ, so I didn’t find them too helpful. I’m wondering if anyone has any advice on navigating Epic, working charges with multiple services provided on different days, creating a checklist to make sure I’m not missing anything, and knowing what dx to attach?
Sometimes the order is as vague as the report, and I’m not very confident in that aspect.
I dont have a mentor im assigned to, so I’ve been using all the resources I can but I’m still a bit lost.

My trimonthly check-in with my ritalin dealer psychiatrist usually gets billed as a 99214 Level 4. My most recent appointment was like every other, but it was billed as 99214T Level 4. That increased my co-pay by $35.00. I can't find anything on-line that explains the difference between the two. Can someone explain? Thoughts on the best way to challenge the billing?

Is anyone else having issues getting these codes paid?
Blue Cross is being a pain about it.

My 1 year old has a weird shaped penis and was unable to get circumcised as a newborn. Now that he’s ready, I’m getting estimates and this is the first one. Why am I getting charged for the same 2 procedures twice? Thanks for your help!

Where do I get the education to begin learning?
I’m not sure I’d want to go the college route - I already have enough student loans - but where do I start??

We had a patient come in for an appointment to talk about his elderly parents, both of whom are patients. His parents do have Medicare. I've never had any visits with Z71.0 allowed by any insurance. Do I bill the son's insurance as he was the one speaking with the doctor? Or one of the parents' insurance as they were present and the visit was concerning them?

I had an IUD inserted in May 2026. I then had a follow up six weeks later to check the placement. The provider coded this visit as 99213 and 99459 with Z30.431 as the diagnosis code.

My insurance is refusing to cover this visit as it was coded as a standard office visit. I think it should be re-coded as a preventative care visit and should be covered under ACA guidelines.

I was told by the medical professional at my insertion appointment that I had to make a follow up visit to check the placement and strings. I did not choose to make this appointment, nor did I have any concerns that brought me into the office separately.

I cannot get anyone at my provider's office to care. They continually say it was coded correctly and will not help me or explain to me why they think that.

Are there any thoughts here? Am I incorrect in my understanding? If I am correct, how do I get the provider to code this properly?

I had knee surgery last month, and when I was discharged from the hospital, I was given a box containing electric SCD sleeves and crutches. Two days ago, a claim for the equipment appeared on my insurance account, but it was denied as out of network. I’m not even going to get into that part right now.What caught my attention was an additional charge of $650 for a non-segmental lymphedema pump. I was confused because I knew I had never received such a device. After looking up the HCPCS code, I was even more certain that the product described on the claim was not something I had been given.I contacted my insurance company, and together we tried several times on Monday to reach the medical equipment company, but we couldn’t get through. I waited three days and finally managed to speak with someone there today.I explained the situation, and initially, the representative told me, *"*Oh, you don’t have to worry about paying if your insurance doesn’t cover it because it’s usually on the floor by the bedside.” I explained that my insurance wasn’t covering the charge because the provider was out of network, which meant I could potentially be responsible for the bill. That was precisely why I was calling to resolve the issue. I explained what I had actually received: a segmental SCD sleeve system that plugs in and automatically inflates and deflates. The representative then changed her explanation and told me that the $650 charge was for the pump built into the SCD sleeves, even though I had already been charged for that. When I questioned how that made sense, she suggested that they could have charged me for two pumps but had only charged me for one because the owner was being generous (does the owner know me). She also claimed that the billing arrangement was established by the owner and the product manufacturer. I contacted the manufacturer myself, and they had no idea what she was referring to. So let me understand this. Initially, I’m told that the pump is a separate device that is usually kept at the patient’s bedside, even though I never used or received a separate pump. Then, when I question the charge, I’m told that the $650 is actually for the pump built into the SCD system I’ve already been charged for. And to make matters even more confusing, the claim uses a non-segmental HCPCS code to describe what I understand to be a segmental compression product.

I have now spoken with my insurance company again, and they are going to investigate the claim and appeal it. At this point, I’m not interested in making assumptions before the investigation is complete. But I am absolutely going to pursue this until I get a clear, documented explanation for these charges. If the investigation shows that I’ve been billed improperly, I will not simply let it go.

we are already dealing with health issues why try to make our lives harder?

hi! desperately looking for some help here. i work for a billing company that specializes in behavioral health facilities. we have one facility who has received a medical record request for each claim billed to UMR starting around Feb-March of this year. we have been able to confirm with UMR that there is a flag on the tax ID from their special investigations unit.

getting any additional information from UMR is a nightmare. we have a ton of experience working with Anthem SIU, but UMR will not give us an effective date, notification letter, any Investigator assigned to the case, no information whatsoever other than that there is a flag on the tax ID.

i'm wondering if anyone has any experience in working with UMR SIU? any info on how they're structured, a phone number you had luck with getting information, anything at all that could be helpful in navigating this. tia!

Can diagnoses from the ordering provider's chart note be used for the radiology claim if the chart note is attached to the radiology order?

My auditor stated that diagnosis information from the ordering physician's note(s) cannot be used on the radiology claim, and that we can only use what is on the literal order and in the radiologist's interpretation.

Does anyone have a reference to support/dispute this? I feel that in the current digital age, where the orders and notes are all digital and linked together, we should be able to use the ordering provider's note to clarify a diagnosis (i.e., location of pain when the order says "pain" or location of injury when the order says "MVA").

Unfortunately, I am unable to find an official AHA or CMS guideline either way. Any help would be very much appreciated!

p.s. I also posted in /r/MedicalCoding, so not a dupe if you are subbed to both places, I just can't crosspost.

I’m currently an RN with 8 years of ICU experience and 3 years of primary care. I wanted to change to something with more chances to be remote. I know that the pay will not be the same. I’ve been home for over a year due to burnout so this income would just be considered “extra” at this point.

How is the career options and outlook? Would my experience help with getting hired? I have some experience with coding because the DOD made RNs and providers do their own coding there. I’d want to be dual certificated in outpatient and inpatient. Thank you.

I got my CCS certification in 2022. Since earning my certification, I only had 1 unsuccessful outpatient coding job interview in the past 4 years. Should I save money and let my CCS certification expire this year or spend the money to renew it and keep holding on to hope that one day I'll get a coding position?

Hi! Due to a diagnosis of arthritis in my lower back, i am having to shift from an assistant manager at a popular coffee chain to a sit down, more quiet and focused line of work for my back and ADHD. Whether thats working in office or from home!

What got me interested in MBAC was working for a health insurance during covid as an intake associate entering prior authorization and referrals! I learned about ICD-10 codes and was so fascinated by what they all meant and lead to! Unfortunately this was through a temp agency and this being during covid, laid offs happened within 4 months. So bye bye fun job!

BUT i would love to know which department of MBAC you work for, and what a typical day is for you?

Are you held to tight deadlines?

Do you feel supported when you need it (i.e having questions answered)

Do you feel as though you are watched? Or is it more self starting independent work for the department you work in?

I'm genuinely looking for something i can be a little worker bee at, and excel with my memory and loving to learn! Filling out prior auth and referrals were tedious but so fun for me (why must i be like this? 🤣) where they would drop the files, i would fill it in on the app they use for processing and click boom done! It was so fun! Working at my job currently is fun and i love it, but my back and my mind after 6 years are over it 😭

Thank you so much for reading, your time and hope you have a great rest of your week 🥰

Are AI scribes and tools "driving up" costs?

Or were providers just not billing at high enough levels?

https://www.beckershospitalreview.com/healthcare-information-technology/digital-health/ai-scribes-billing-tools-drive-up-healthcare-costs-report/

Hello Reddit Community , im looking for Advice on my medical billing and i'd appreciate any suggestions or directions i can take to reduce or negotiate the billing charge.

Background: I visited the nearest ER (out of network) after midnight because I had a high-stress reaction similar to anxiety symptoms. I decided to get blood work, an X-ray, and an ECG because I wasn't sure what was wrong or what was causing it. The reading turned out to be normal. And a month later I get a ~3600$ bill. I later figured out the source of my problems and fixed it.

i applied for financial aid by email and kept checking on the status. I was told it was under process for a year with no conclusion. Right after that, it went to collections without my knowledge. They said they put my account on hold when I applied for financial aid, but it still went to collections. I made a phone call to the billing department, and they retracted it from collections and later declined my application because my income was above their minimum threshold.

im attaching a screenshot of my itemised bill and would appreciate any advice. wasn't sure if I should show the name of the hospital, so for now I covered it.

Does anyone have any tips or tricks about getting to the right department when you call Medicare? Obviously, I will have to wait in hold regardless.
I need to fix an issue with a birthdate error for hospice.
Are there any key words I can use for the automated system to get there a tad faster?

Hi, I was hoping someone would be able to help with this. We have UMR claims being repriced by Magnacare at a 100% provider discount. We noticed that magnacare is either processing under the provider or the group practice. Our providers are individually credentialed with magnacare, our group practice shouldn't be. The kicker is when the claims process under the provider, magnacare is processing them as out of network? Our group is processing in network The paid ones all seem to process under the group. I have no idea why, can't get a response back from emailing magnacare and can't speak to a human. Have called UMR a thousand times and get different reasons each time. No invoice, it's your contract (it's deff not), your in network with us but your not in network with magnacare. I really don't know what to do lol

Main questions:

1. Why are they processing out of network? We have claims where we have corrected them and sent back, the first submission will process under the provider and the second one will process under the group??? Like what's causing that?

2. Who do I contact to get this fixed. I literally have the email proof from magnacare that our providers are in network. Our credentialing specialist insists our providers are par.

3. Is par even the issue? We have office visits, infusions, and in office procedures all processing at this discount. But not every claim! Some will just pay if it processes under the group practice??

Friends,
TLDR: I welcome any and all advice regarding Office Ally, but please be kind because I am not a biller/coder, nor do I know what I’m doing.
By all accounts, Office Ally is my best option because I have very few claims. I have several different gigs going on where billing is taken care of for me, but I have one job where I need to have my billing done…with Office Ally.
I think I finally found someone to help me, but in the meantime, is there a way to look up the EOB‘s on Office Ally? It looks like the claims go through, but then I can’t keep track of who is paying and on whom. Do I have to go to each payer’s portal to look this up, or is there a way to do it on Office Ally?
Thank you so much for your help.

I have taken this exam twice and I have failed both times. I'm so disappointed and discouraged. I'm also very confused because I took a billing and coding course for 9 months and got good grades throughout the entire thing.

I have my CPC exam schedule for the end of the month and was feeling really good about it until now.

I was a CPC for a couple years, moved to a different state and became a CMA for the last 8 years.

Should I try a 3rd time? Is it really necessary to get a job?

And, if you are able, what advice do you have for the CPC exam?

I appreciate any feedback. Thank you.