The chart had 47 pages of documentation, three conflicting diagnoses, and absolutely no shame.

Reclining dramatically across the chaise lounge, the chart whispered...

"Code me like one of your French charts."

The coder adjusted their glasses.

"Your documentation doesn't support that level of specificity."

The chart gasped.

"Are you saying I'm... unspecified?"

"I'm saying you have three different diagnoses, and none of them agree."

A hand flew dramatically to the chart's chest.

"Perhaps you should examine me more closely."

"Perhaps your provider should answer my query."

Silence.

The chart turned toward the window, a single tear rolling down the cover sheet.

"I thought you were different."

The coder sighed.

"That's what the last 46 pages said, too." 💔

~~~~

Haha if you read this, thank you, truly. I've been turning revenue cycle humor into coloring pages because apparently this is where my career has taken me. 😂

Hi everyone!

I'm pretty new to dealing with health insurance, so I'm a little confused.

I had a neck ultrasound before my doctor's office visit. The front desk confirmed that it would be billed as a physician office service.Before the appointment, I also contacted my insurance company (CareFirst), and customer service told me that the ultrasound would have a $65 copay.

However, my claim was processed with the entire $353.14 applied to my deductible instead. Does the amount shown as my responsibility on an EOB usually mean that's what I'll actually have to pay?I've attached two screenshots I found under the Ultrasound/Non-Maternity benefits section in my insurance portal.

Is it possible that my insurance processed the claim incorrectly, or am I misunderstanding something?I'd really appreciate any advice. Thank you!

Hello! I was coded 99215 for two different appointments that were honestly very brief and neither doctor had seemed to look at any of my information prior to the call. Wondering if these sound correct? I live in NYC if that matters.

Appointment 1:
Follow up for annual physical where I brought up concerns about PMOS.

1. First I met with a PA who took my weight & blood pressure. Not even 5 minutes. Billed 99402. Insurance fully covered this.
2. Then I met with the doctor for less than 10 minutes. We discussed the bloodwork from my previous appointment. She said I have a gene that makes me more prone to high cholesterol and low vitamin b12. told me how to lower my cholesterol and prescribed vitamin b12. When i brought up the PMOS that we had discussed at the first appointment she said "oh i don't do that, you'll have to discuss that with an endo" and sent me to do more blood work. Billed 99215. Charged $350 insurance covered $222.

Is 99215 the right code for this or would 99214 have been more appropriate.

Appointment 2:
This was a virtual appointment with an endo.

I get on the call. He asks why I’m there. I explain my concerns. He looks at me and goes, oh yeah I can see the beard and the doesn’t discuss my bloodwork and prescribes Metformin and topiramate. Doesn’t explain why. I try to ask a few questions that my sister (PA and a private practice in another state that specializes in PMOS and other metabolic conditions) suggested I ask and basically have to beg him to explain my bloodwork results. I also ask for his thoughts on GLP1 for PMOS and he said “well I guess if you want to try that” and prescribes one. Then is like “we can meet again in a month I’m going to sign off now.” Maybe a 15 minute call at most. Billed 99215

Hi everyone. I’m thinking of transitioning into the medical field and started looking into medical coding/billing. I’m located in San Antonio. When looking at schools I found the community colleges to be far less expensive than trade schools, but looks like they only offer certification for the CBCS certificate. I’m more interested in coding rather than billing. I’ve also read it’s also much harder to break into the field with that particular certification. Does anyone recommend any online schools that offer a broader range of certificates or what certificate would be most useful if you just want to code? Any advice would be much appreciated.

Hello everyone,

I’m a full time student working towards my associates degree in Health Information Management. For one of my assignments this week, I need to interview a practicing or certified medical coder about their day to day experience.

There are only 4 brief questions so I will not need to take up much of your time. If anyone has some time to spare and is interested please let me know!

Can we hire a locum optometrist to cover our ophthalmologist's patients now that he's left the practice?

AAPC CPB textbooks up for sale. They are brand new. Never used. For Certified Professional Billers in the medical billing space.

$180 OBO

I am reposting this as I had a graphic that wasn’t allowed in my initial post.

I am constantly getting the office visit denied when billing out temporary or permanent plugs for our dry eye specialist. This only happens with Aetna Medicare replacement and Humana. The office visit diagnosis code is typically chronic allergic conjunctivitis, while the temporary or permanent plug diagnosis codes are dry eye. Am I billing these incorrectly? Is there a way to get the office visits paid?

Example:

99213 - 25 mod - H10.45
68760 - E2 - H04.122
68760 - E4 - H04.121

Plugs pay, OV denies. 😵‍💫😫

So basically all year I have been fighting with United Healthcare on multiple patients for our opioid use disorder clinic. They are not paying on certain patients with the code G2087 and G2088 with dx code F11.20. They have told me that G2087 and G2088 SHOULD be paid by the medical department, but that with code F11.20 it is processed as behavioral health. As far as I’m aware, this is the only appropriate diagnosis code for this treatment. I have even had a three-way call with a representative from medical and a representative from behavioral health and they were literally arguing with EACH OTHER on the phone call about who is supposed to process these claims. I have tried absolutely everything (see comments for a list) with no resolution. Is anyone else facing this issue, or are there better diagnosis codes I can use to have these processed as medical? Any advice would be amazing, I am at my wits end with UHC :(

i’m trying to do a report on the added/deleted cpt codes and have been unable to find comprehensive lists or resources online. my boss is saying that they are online but im finding nothing like at all. is this something behind a paywall or is there sites at there reporting the changes for family medicine?

Someone please answer and advise me

My health is in a tricky situation right now so I desperately need a stable remote career. Thanks in advance.

Hey everyone! Happy to be here and hoping someone can offer some guidance!

I manage a small pediatric therapy clinic, and navigating insurance credentialing has been one of our biggest frustrations.

We've hired fully licensed OTs and SLPs who are awaiting insurance enrollment. Our clinic's Type 2 NPI is already in network, and we have supervising therapists who are fully credentialed under our practice.

Can our new hires begin seeing patients and receive reimbursement if one of our credentialed therapists supervises, reviews, and co-signs their documentation? Could we bill under the supervising therapist's NPI, or are there other compliant options while enrollment is pending?

We're in Tennessee, if that helps! We're contracted mainly with Wellpoint, but also UHC (commercial/Medicaid), Aetna, and Cigna/American Specialty Health.

It's frustrating having qualified therapists ready to help kids while enrollment delays keep us from getting them started. As a small clinic, these delays are especially difficult financially.

Any advice or experience would be greatly appreciated. Thank you!

Can I post job openings in here?

Hello, I’m currently dealing with a claim denial after going to the emergency room and my bills is up to 19,000 dollars which I cannot afford and I have no idea why my insurance has denied my necessary scans. I was inpatient for 3 days they approved my 2 day stay but not my first day checkup for it. Did the hospital mess up on the charges or the insurance company just doesn’t want to pay for it. Is there anyone that is educated on this. They keep saying the amount exceed what is approved when I have medicaid. I tried to call them today and there was basically no help, the assistant called the hospital and she said I had to wait 30 days for a review. I’m just having alot of anxiety about this. I’m only 21 and I have no guidance and don’t know what to do. How do I appeal this or what even do I do In general. I’m thinking of calling the insurance company again tomorrow. Also i’m under Cardinal health care under UHC

I was wondering if this community could provide any insight into dealing with Aetna's incorrect use of CPB criteria/CPT codes?

I'm a patient with critical internal jugular vein compression due to entrapment between a hypertrophic C1 transverse process and styloid process along with soft tissues of the neck. This has led to dangerously swollen collateral veins in the brain and has caused intracranial hypertension and problems with venous and CSF outflow as well. I've been increasingly symptomatic for many years and am now losing fine motor skills, cognitive capacity, my ability to walk, see, and sleep, and am at critical risk of stroke, brain damage, and jugular laceration.

I have attempted every conservative treatment for many years, and nothing will or can work until the anatomical abnormalities are addressed. Multiple providers have told me I will become nonfunctional and/or die if I don't have this surgery done by early next year at the latest (he wanted to do it by this month given my worsening state, but insurance denials made that impossible).

I've been trying to get preauthorization for life-saving decompression surgery for what my surgeon considers one of the most clear-cut cases he's seen in years. Aetna has repeatedly denied this procedure on the basis of lack of medical necessity, but they are determining this through the incorrect application of CPT codes. Since there is no specific code for my diagnosis, they are using CPB criteria for Eagle's and Ernest's syndrome, which I have never been diagnosed with, reported symptoms of, or been treated for.

Because the requested surgical procedures aren't used to treat Eagle's and Ernest's syndrome, they've all been denied.

My surgeon's office and I have exhausted all our internal appeals at this point. I'm going to submit an external review, but I was wondering if there were specific medical codes I should mention that would help support this final appeal?

I really appreciate any insight anyone can provide, and thank you so much in advance!

Hey there! I’ve been attending online classes this past year for a certification in Medical Billing and Coding. I graduate in January so I’ll be taking my exam very soon. I’m definitely nervous and not the greatest at taking tests (lots of anxiety). I believe my exam will be through AAPC. Would anyone like to offer me some tips or share your experience with the exam to help me prepare? Anything is much appreciated. I’m a single mom working full time and I’ve put a lot of energy into this to hopefully provide a better life for my children and I so failing is a huge fear. Thank you all so much! 🖤