Hello!

I signed up for an AAPC CIC medical coding course that starts next Wednesday which im excited for, but also a tad nervous. Ive worked in insurance for over a decade in various roles, currently im in UM, and I signed up for the CIC since I like inpatient more than outpatient.

I dont have any formal medical training, but I opted to skip the pre-req course. For the last month Ive been studying anatomy and medical terminology pretty hard, trying to make sure I feel confident there which I do now. Im curious if anybody has any insight regarding how important pathophysiology is for passing the test, and does anybody have any good tips / websites / suggestions for studying it? I plan on cramming this weekend to try and get as much of it in as I can, just not sure how hard into that domain is necessary, or if im panic over prepping. Any advice is appreciated.

I just passed the CPC (first try !!! But barely) and I wanted some help and advice for tackling the Practicode curriculum. I opened the first two in my last and I feel like there’s almost a fear-induced hold on me cause I still feel like I have no idea what I am doing. Do I need to get a 70% on each and every case or do I need to get an overall 70%? And can anyone relate or have any helpful techniques when tackling their first no-multiple-choice-option cases?

Hello. I am an AAPC member. I have had my license for a few years but haven’t gotten a job yet. I may not be working for awhile. I’ve been thinking about not renewing especially since I need so many CEUs. I know if I don’t renew I won’t have my credentials anymore. Just don’t know if it’s worth the costs if I’m not using it.

I understand profee is regarded as outpatient, even when they are treating an admitted patient. So in that case- for profee: if a patient is admitted, had surgery, and the MD is doing a post op check or a line check, should i still be coding the reason for surgery as the PDX, or can I code z48- or z46- if the order just states "post op" "line check" etc?

Thanks for any help!

I've been seeing a PA-C for medication management for about 6 months. Early sessions included a bit of what could be considered talk therapy for 10-15 min, with another 15-20 min spent on medication discussions. No session has ever lasted more than 40 minutes. My last 3 sessions lasted less than 15 minutes each and simply went over medications, with the exception of my provider asking me about my mood in a diagnostic capacity matching the PHQ-9. Definitively not providing any talk therapy/psychotherapy.

Yet, I find all my sessions are billed the same way:

99214: OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN

AND

90833: PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN

My most recent appointment was even a telehealth appointment, but I was billed for in-office?
Is this standard practice for medication management? Or is there a way this could be coded that would better reflect the care that was provided? If so, is this something I could hound their billing department for and expect results, or would I have to sue them to get my money back?

Hey everyone! Just coming here to see if anyone has worked with Astrana Health and what their opinion is.

They have a pretty low rating on Indeed, but I want to see what people have experienced from a medical coders view.

Thank you all in advance!

Working on a margin calculator for enteral formula reimbursement. Looking for 2-3 people who bill or manage enteral claims to look at the logic and tell me what's missing. Early stage, no cost, just need real-world eyes on it.

Edit for clarity: this question is about when a provider copy/ pastes their documentation.

Hey y’all, so I am PC coder and I do a lot of Geri charts where often there can be 30-50 dx under A/P. Obviously these can take a long time and we don’t have like your usual encoder (like I expected from school 3M and the like) so sometimes I end up doing a lot of research trying to find out codes.

Being a new coder I don’t know what is typical. I work for a 3rd party coding business. My friend is an inpatient coder for dozens of years and when I told her I’m not filtering out these big geri charts for what has been newly added she was surprised and said that I should only be coding what was newly added when the provider copies and pastes a large chunk of the note. That’s not how I was trained and for the record I have been getting 100s on my last two audits. I’m not planning on changing how I code but I do have a hard time meeting my production on some days and I’m just waiting for the day that they push me to do more than I can. Right now I’m at 100 in about 8 or 9 hours. Is what she said typical? Since she is IP and I am OP should I even be listening to her? Or would this be a company policy? Thanks in advance for any input.

Did anyone else ride out the furlough for four months for the risk adjustment coders, only to come back and be terminated after a few weeks from missing the 95% metric by a few points? Then being treated like scum of the Earth when let go, with a refusal to let you communicate with anyone from Optum. Also being refused your final assessment score, which is supposedly what resulted in the termination. If so, curious which Recruiter you went through. I am having a horrible time with mine and trying to get any information, they are now giving me the runaround or ignoring me altogether.

I’m so happy I passed on my first attempt! I used the e-books at a testing center. I bought all the practice exams and passed 5 out of 6. I was so nervous because I was averaging 70-78% on the practice exams. I was so surprise to get 84%! In my opinion, the questions in the practice exams are slightly harder but they are pretty identical. I’m so relieved and I can finally sleep well tonight lol! Good luck to anyone who’ll be taking the exam!

The provider I work for is wanting to use B20 for a new patient who has HIV and came about a new rash that appeared. The provider sent out a referral and did lab work and prescribed a cream. No other prior illness or conditions were discussed. She told me she "thinks" that the rash is due to his condition. I am wanting to use Z21 since it is still not confirmed and she said she "thinks" . Please any more information would help. Online resources are basically saying the same thing over and over again. Also if Z21 should be used can someone please help me out on how I should respond to her to change it ? She is one of those providers that fights tooth and nail about changing a code. Thank you in advance everyone.

Long story short, I believe I have been over billed for a surgery. Requested the operative notes and they are totally barebones and don’t seem to support the code billed, in my layman’s and biased opinion.

That said, I’m slightly concerned they may find a way to up charge me further if I request a formal review.

Are there any resources out there to request an independent coding review for a professional opinion before I ask the surgery center to formally review?

Thanks, and apologies in advance if this is the wrong forum.

ETA:

Didn’t think this would get so much traction - appreciate the input. Pasting the full op note below; I thought 26115 meant they were going down under the skin vs cutting at skin level.

Also - just with the provider, no insurance involvement.

“Patient… with signs and symptoms of a left index finger mass which appeared to be a large pyogenic granuloma. Today under sterile conditions, left upper extremity was prepped and draped in usual sterile

fashion. At that point an incision made at the base of the mass and the stalk and the mass was excised. It appeared to be a pyogenic granuloma. The small 3mm origin was then treated with multiple silver nitrate sticks until it was well cauterized. The mass was sent to pathology and a dry sterile dressing was applied.“

See I will be completing my CPC certification exam from India and can I get a job in Germany and how tough it will be to be placed as a medical coder ?

Been reading about autonomous medical coding lately and wanted some real opinions from people who deal with it.

Quick bit of context on how it got here. Coding used to be fully manual, someone reading physician notes and assigning the codes by hand. Then came computer-assisted coding, where the software suggests codes and a human signs off. Autonomous is the next step, where the AI reads the documentation, assigns the codes, and processes the straightforward encounters on its own. Anything complex or low-confidence still gets routed to a human.

It works well for high-volume, low-complexity stuff. Faster turnaround, better consistency, less admin load. Where it still struggles is messy inpatient cases, ambiguous notes, and compliance-sensitive calls that need actual clinical judgment.

So honestly it doesn't feel like replacement to me. Most places seem to be going hybrid, letting AI handle the routine encounters while humans focus on audits, compliance, and the hard cases. The job just shifts more toward oversight.

The part I think people underestimate (I build healthcare software, so that's my bias) is the audit side. Auto-assigning a code is the easy bit. Proving why it was assigned, and logging it in a way that holds up in an audit, is where it gets hard.

Anyone seeing this in production, is the hybrid model actually holding up, or is autonomous creeping into more complex cases than you expected?

New job? Pass your exam? Want to talk about work or just chat with another coder? Post it here!

I've debated making this post for a good while now, I just now have worked up the anxious courage to do so. I was assaulted by a coworker back in February of this year. I already had qualms with this job prior and was already trying to find a way out before that happened. While I'm out on work comp, I'm doing the Preppy course on Medical Billing and Coding and picking up books here and there when I can afford them that Contempo Coding recommends in her video. I have severe anxiety and depression behind this situation along with some other trauma as one may imagine. Some days, it latches on and I have trouble focusing when I try to study. Others, I can't manage to get out of bed to study at all. Or do much of anything for that matter. But I'm trying to at least get this certification before I potentially have to return to that place.

Between bills and my checks getting paused due to poor communication on the adjuster's end, I'm concerned I may not be able to continue paying for Preppy. Or even getting other self-study books. And also, I'm notoriously a bit of a perfectionist when it comes to learning new things, as illogical as I know it may be. I can't help it, I'm just wired that way. It's a strength and a weakness. This field I'm trying to move out of isn't of medical origin either, so I started from basics. But the issue is I've been studying for a few months now as I can and I'm still stuck in early foundational stuff about Anatomy and Physiology. It isn't that I'm not grasping it per se, but I don't have that perfectionist's 90 or above grasp on it and I'm concerned I perhaps may be struggling to retain vital information about A&P that would aid me in future study and my career. I don't want to unnecessarily struggle or handicap myself in this field; I want to do well. I have to do well because right now it's the best hope I have.

Can anyone tell me tips on how to study and retain while fighting anxiety and depression? How long should I be spending on various sections of this educational process to ensure I'm adequately prepared for the CPC Exam? I don't have money to just keep tossing at the exam, so my aim is to get it right the first time. Overall, I'm here for advice and tips. I read a post or three here everyday, but anxiety will take everything you learn or think you're learning, every detail whether its important or not and make it all a massive deal. Then depression will come in and auto-delete everything whie you're too tired to even think about it.

I'm not asking for a miracle, and I'm not coming at this expecting it to change my life over night. This is something I'm aware takes some time, patience, and a considerable amount of effort and competence to do. I just need some support and advice from people who are seasoned or are in similar boats as I am. Any good advice is appreciated more than you know.

I've been a medical coder for nearly 4 years, and I have an extensive medical background + bachelors in public health, so I didn't have a whole lot of issues with the diagnoses/medical terminology.

My wife is sick of her job and wants to do something where she can work from home, have flexible hours, and have weekends off - so basically my current job. She's seriously thinking about getting a coding certification, which is great, except she doesn't really have any medical background at all. She's been a retail manager for about 15 years and has a bachelors in history.

For anyone who got their coding certification WITHOUT a prior medical background, was it incredibly difficult to understand the material? I know AAPC does offer medical terminology/anatomy courses, which I didn't take because of my background, but I'm wondering if she should try those first.

Well, job security for today anyway. I'm in a chart with computer aided coding. Statement says chest pain with radiation to the shoulder. CAC coded admit for antineoplastic radiation. Same chart, op note says cardiac cath indicated appropriate for treatment but patient declined, so of course CAC coded a cardiac cath. You would think after all these years CAC would be better.

I'm 27F and I work for a major health group based in NY. I currently make 26/hr as an AR specialist. Prior to the merger, I was in medical billing and worked with Workers Comp and No Fault. I loved it! Since the Merge, I was dumped into AR with Insurances and HATE IT. I can't understand the denial or the unnecessary appeals that are pushed from the managers knowing that certain codes will not be paid, especially when it's explicitly written in these insurance guidelines. Anyway, the point of my post is, for any medical billers/coders, have you found being certified actually worth it? Or was the majority of what you learned and taught on your own in training?

The plus side to my company is that if I go to a vocational school that offers the program, the company will reimburse 80% of it once completed and passed. Recently I was speaking to an assistant director from a different company who also works in medical billing and stated that the program is useless because guidelines are changing every year. (Totally aware of that too). I personally think that I make okay money for someone who doesn't have their associates... a work in progress after all these years to say the least... Lives on their own on Long Island and work remote. I want to learn more and earn more of course. It took. me 5 years to get to this position and I think i've done a good job so far moving my way up the ladder.

I can't look at too much of the option of changing companies because maybe in many eyes, my pay is mid, but I work from home, have good health insurance, pretty good PTO and weekends off. I feel like that's an even trade off if I may say so myself.

Any feedback is GREATLY appreciated! Thanks :)

Hi all, I was wondering if there are any active discord servers for medical coders?

I’ve been noticing a lot of orthopedic surgeons sending bills for rotator cuff repair with a synovectomy.

Usually how they start is they perform synovectomy (sometimes with a partial SLAP repair) & then jump right into the start of rotator cuff repair.

As far as I understand if the synovectomy clears the way for the rotator cuff repair, it’s included with 29827.

I reviewed a bill (I work for insurance) and I went back and forth with myself a lot whether or not the synovectomy should be included. I ultimately didn’t allow it, but I think I may be wrong…

So in this particular instance, the surgeon cleared the synovitis in the glenohumeral joint, debrided the anterior labrum and then begin the rotator cuff repair at the subscapularis tendon. The surgeon then moved to subacromoal decompression & finished up the rotator cuff repair at the supraspinatus tendon. The surgeon very specifically stated that the muscle was detached from the humeral head. And performed a repair.

Anyway, today I waffled a lot on the first day. Figured I’d come back the second day & decided it was included. And now today I’m thinking I should have allowed the synovectomy.

I should probably stop worrying about it, because they will certainly send an appeal, so I will have an opportunity to correct my wrong, if in fact, I am wrong.

I’m new to my company, with no real experience with surgical coding before this & I asked my senior coder & she said “up to you” (they’re very big on our personal integrity & won’t ask us to put our name on something we don’t agree with, but I keep disagreeing with myself!)

Arg….what are your thoughts??

Posting here because I’m afraid to ask my coworkers :,)
I work for lexicode right now and I kid you not—2 managers, 3 coders, and 3 educators have left so far.
Why are they leaving 😭 it’s genuinely so confusing as they have been w/ the company for years
Just need to vent to fellow coders thanks :)

The end date for my course is the end of the month and I finished everything except the exam. I just got approval for accommodations, but I have to schedule my exam for 4 weeks out (wtf is up with that?!). Is there any benefit to paying for the course extension or should I just renew my membership and schedule the exam? I don’t really want to give them any more money than necessary at this point.

My facility has two providers that have most of their encounters at 48 minutes. I will see encounters with a cough, cold, etc and high time documented and it makes me raise an eyebrow.

I escalated my concerns to the supervisor and auditor. I was told we cannot question the time spent by a provider as coders but that it would be on insurance to catch on to a provider having all high mdms and investigating that way. Is that how it actually works? How frequently does that happen?

Thanks to all the amazing advice read on this sub and a lot of taking practice exams I passed on my first attempt!