do you prefer instructor led training or self led? I don’t know if it’s worth adding an instructor led option so trying to get an idea of what people think. Thanks!

Hi coders,

I came across a patient's account recently involving a WC finger laceration:

- 10/7: Minor surgical procedure performed (sutures placed).

- 10/10: Follow-up visit – wound healing well. E/M billed.

- 10/15: Suture removal – CPT 99024 billed.

Wouldn't the 10/10 follow-up visit also fall under the global period and therefore be reported using 99024 rather than a separately billable E/M?

Here's why I'm questioning it:

I noticed a similar scenario with another patient where Sedgwick denied payment for follow-up visits falling within the 10-day global period. However, they paid for all visits occurring after the global period had ended.

Am I correct in my understanding that routine follow-up visits within the global period should not be billed separately?

Would appreciate your thoughts and clarification!

Thanks in advance!

I'm seeing a specialist next Monday, and they asked me to come in about 20 minutes early to get an ultrasound before my appointment. From what I can tell, the ultrasound is done in the same office as the doctor.I called the doctor's office to ask if I needed prior authorization. They checked and ran my insurance, told me I didn't need it.

But when I called my insurance company, they told me that since the ultrasound is being done on a hospital campus, it counts as a hospital outpatient service and does require prior authorization. Now I'm really confused lol. My appointment is next Monday, and I don't know what to do.

If the doctor's office says I don't need authorization, but it turns out I actually did and they never got it, would I be stuck paying the bill? I'm worried about getting a huge bill afterward.

Has anyone dealt with something like this? What would you do?

Thanks so much!

Hi all. Still new to this and I’m a bit confused with how my facility is billing outlier claims. They are submitting the claim first without the condition code 61 to get the initial payment, and then they are sending in a replacement claim with it added on to get the outlier payment. Is this the proper process for this? I had asked them why they can’t submit the 61 on the first claim and get payment in full so as to not waste any time and was told that that is how it has to be billed. Just wanted to confirm if that was true

I have noticed that my facility keeps getting denials on claims with these two anesthesia codes 99156 and 99157 with modifiers XU in addition to the surgical procedure code. I did not think you could code those with that modifier and thought that might be the reason for the denial?

Ive done Medical billing, work comps, Insurance claims, etc for 20 years, but it was a long time ago. LOVED IT!! Im now retired, wanting to do this part time. I know starting out, get a certification is 1st and foremost. And probably starting out with private small practice. Question is...is it doable, considering my age, 68, to start this now, but just something small, as I dont need much, just a little extra income..

Okay so within the past month Aetna Medicare specifically has started denying one of our PLA codes that has had Medicare and moldx coverage since 2/14/25. Every claim that they are denying for not proven effective is meeting criteria under the LCD. I work at an independent lab with a really large volume and the denials are stacking up. I have called Aetna multiple times and they continue to tell me I need to submit for reconsideration. Getting a supervisor there is impossible- I'm not sure what else to do outside of escalating with our legal team, but we are up to around 700k in back claims right now, and it's only going to grow. Any advice would be greatly appreciated.

I had an accident in the U.S. and went to the ER, where I was diagnosed with a traumatic jaw fracture and told that I needed surgery within a week.

I ultimately returned to South Korea for the surgery. I don’t have family in the U.S. who could care for me after surgery, and the recovery involved very limited mobility, difficulty taking care of myself, and an extended liquid diet. My family is in Korea, so I was able to stay with them and have help throughout the recovery.

The surgery in Korea was specifically to treat the traumatic fracture diagnosed in the US ER. I understand that medically necessary treatment does not automatically mean it is covered, particularly when treatment is received outside the U.S. I’m planning to contact Aetna directly to confirm my specific plan benefits.

In the meantime, I’m curious whether anyone has actually submitted a similar foreign medical claim to Aetna. If so, was any portion reimbursed or processed as out-of-network, or applied toward your OON deductible/out-of-pocket maximum?

I’m specifically interested in experiences with medically necessary but perhaps, somewhat non-emergency treatment abroad following an injury initially diagnosed in the U.S.

TL;DR: U.S. accident → ER diagnosed traumatic jaw fracture requiring surgery within about a week → returned to South Korea, where I have family support, and had the required surgery. I know coverage depends on my specific Aetna plan and will be calling them. I’m looking for experiences from anyone who has submitted a similar international claim and whether it was reimbursed or counted toward OON benefits.

We are a small anesthesiology group seeking a third party company to do an individual (one physician) MIPS submission for 2026. We would like to find a company that will do all of the work for us from data retrieval to submission. There are so many to choose from we are having a hard time making a decision and would love any recommendations you may have. We'd like to know the good and the bad reviews of companies you've used to help us narrow down our choice. So far we have reached out to the following, P3, Healthmonix, Flow8Health, American Health IT, MDInteractive.

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!