r/MedicalCoding

Did message the mods first to make sure all is good with posting this~

https://codebook.saturnitystools.com

My girlfriend is currently enrolled in classes and working on getting certifications for medical coding! She's doing super good and it's been an interesting journey. One issue is that she can't really afford the CPT book since they're wildly expensive, even used, and they change every year.

So, I basically built her a little tool that basically combines a few of the online databases into one place (Except a chunk of CPT since they're copyrighted by the AMA) but it includes HCPCS, ICD-10-CM, ICD-10-PCS, some CPT, and kinda combines them all into one place for easy lookup, it's especially nice since it lists NCCI conflicts and LCD coverage.

Every piece of information on there is directly taken from official sources such as cmv.gov, and all sources are listed. She wanted me to share it as it might possibly help others in the same boat have a good complimentary tool to their work process.

There is no sign-up or any sort of paywall, all entirely free and easy to access. Hope somebody can get some good use out of it:)

I started a new job in February. My new company pays to renew my CPC certification. They must have paid for 6 months as the renewal is now the end of June. It was previously in December. So now AAPC says I must submit all my CEUs by June 31st instead of December 31st. Can they actually do this? How is this fair?

I have a desk that goes up and down so I can stand but I want to sit sometimes and my back is killing me from this stupid gaming chair I’m using. Do you have a chair you love?

Hello, I am a doctor with a masters degree in public health epidemiology. I moved to North America and have been trying to transition to health care analytics or informatics but haven't been successful. Now am looking for tips on how to do this successfully. Do I need to enrol in a program etc or if so what are the recommended schools and programs I should apply to get myself in?

Sorry if not allowed, but the book really doesnt explain well.

Im working on the study guide for 26, and theres a question about astigmatism in here.

it says its a cat 1 astigmatism in the left eye, corrected with glasses. right eye normal.

the answer key says its codes H52.222 to code the astigmatism on its own, but also H54.52A1 to code that the other eye is normal.

The wording on the ICD book makes no sense to me, especially on how we get the A code, since the section says A- normal vision of the left eye. I understand the 1, for cat 1, but again ! specifies its cat 1 of the RIGHT eye, specifically. and to apply the appropriate codes to all of 54.4 codes.

Can someone dumb this down for me because im genuinely not understanding that. Is it having us code the A because glasses correct the issue? If so, still why the 1 since the RIGHT eye is the normal one, LEFT is the impaired one?

So we have a major problem with our primary care providers where a lot of them avoid putting a diagnosis of overweight or obesity in the documentation. They'll put in just a BMI code or just say things like "desires weight loss" followed by BMI code, or "weight management" followed by BMI code. It's driving me absolutely nuts because it's literally not codable.

I typically send them a query saying that a BMI is a secondary diagnosis and that the primary condition being treated that the BMI measurement is related to needs to be indicated. Sometimes they get it, but I will also get messages back saying "BMI is the diagnosis" or "they're being seen because they want to lose weight." They don't seem to understand that there needs to be some sort of weight-related diagnosis to report BMI, or even that they can actually just code obesity.

When I look in the ICD-10 guidelines, it specifically states "BMI can only be coded if there is a separate, reportable diagnosis (such as obesity or anorexia) documented by the provider." If I send them this exact quote taken from the guidelines, including the part where it says "such as obesity or anorexia", does that come off as a leading query? I don't want to get in trouble but I just want to be clear as humanly possible to them so I can stop sending 8 billion messages about this every day.

As medical coders, our core philosophy is defined by a hard truth 

"Guidelines don't fail Coders, documentation does." 

While guidelines provide the regulatory roadmap for how to code, the clinical documentation dictates the limits of what we can legally and ethically bill.

I used to be terrified of sepsis charts. Now I absolutely love them. 9/10 times when the patient has sepsis, there's my pdx. And the source of the infection is usually an automatic MCC too. Love those charts.

I used to be terrified of coding CABG or heart cath charts. Now that I know what I'm looking at, I love them. 9/10 times the procedure note is really easy to interpret and I can nail the coding.

I'm a little over a year into coding now and it's the best feeling in the world when things start to click and feel natural. What I love about coding is most days I feel like I still don't know anything, but every now and again I'll be coding something and be like "wait! I know how to do this?!" Very gratifying.

I can't wait for that to happen with spinal procedures bc I'm still so lost with those 😬

Calling all E/M experts! I’m an uninsured patient in TX currently auditing a $1,500 ER bill. I’m looking for a technical interpretation of the 2024/2026 guidelines regarding CPT 99283.

The Scenario:

• Chief Complaint: Skin infection/rash (later identified as reaction to mold exposure by the patient herself ).
• Presenting Complaint: Skin Infection for 1 month now with an abscess (now controlled) and ringworm.
• Provider Observation: Patient presents with 1: Tinea corporis;2: Folliculitis
• Diagnostic Data: No laboratory tests were ordered, no specimens (urine/blood) were collected, and no imaging or external data were reviewed.
• Management: A single visual exam lasting under 10 minutes, resulting in a standard prescription.
• Provider Type: Care was provided exclusively and independently by a Physician Assistant (PA), with no substantive face-to-face encounter by an MD labeled as: UNASSIGNED MD PHYSICIAN."

The Question: Per the latest MDM (Medical Decision Making) framework, can a visit qualify as 99283 (Low Complexity) if the "Amount and Complexity of Data" category is effectively zero and the problem is "controlled/minor"?

Does the lack of any reviewed data (Category 1) technically mandate a drop to 99282 (Straightforward)? Also, is it common practice in TX to bill a full physician rate when an MD never entered the room?

I’ve already contacted the AMA technical panel, but I’d love to hear how professional coders would defend or reject this level of service in an audit.

P.S. To make things worse, the PA was incredibly dismissive (hands in pockets, 5-minute talk) and the condition actually worsened after the visit. Now I'm in debt for care that didn't work.

I am a pediatric speech therapist in an outpatient setting so have some knowledge regarding medical codes and billing, certainly more than the general public but in terms of providers, probably not a ton as I only use a handful of different codes in my practice.

Can you please explain why I get separate bills from radiologists vs the facility? I recently had imaging done and I have a few separate chargers, which is understandable because I can see what the codes are for, but the problem is I had thought I paid for the bill over a year ago (because I paid for 2 of the 3 codes) yet today I just received a bill, a year later, from the radiologist.

I’ve been playing phone tag with the hospital, insurance and the billing companies. I guess the radiologists just changed billing companies so we are getting bills from over two years old. When I called the hospital billing department they said they have no control over the radiology bill, that I should call their billing department, which I did but they said they didn’t get the bill until recently to send to me. How can I hold the radiologist/that portion of the company responsible for such a late bill? Is that a thing? Am I being a Karen?

Is there any argument to not pay a bill because it came so late? Is this just health insurance hell pay to play??? I feel like a clown bouncing to all these different companies trying to figure out who should be responsible for charging me over a year late when I fully thought I had already paid off that visit.

I am a pediatric speech therapist in an outpatient setting so have some knowledge regarding medical codes and billing, certainly more than the general public but in terms of providers, probably not a ton as I only use a handful of different codes in my practice.

Can you please explain why I get separate bills from radiologists vs the facility? I recently had imaging done and I have a few separate chargers, which is understandable because I can see what the codes are for, but the problem is I had thought I paid for the bill over a year ago (because I paid for 2 of the 3 codes) yet today I just received a bill, a year later, from the radiologist.

I’ve been playing phone tag with the hospital, insurance and the billing companies. I guess the radiologists just changed billing companies so we are getting bills from over two years old. When I called the hospital billing department they said they have no control over the radiology bill, that I should call their billing department, which I did but they said they didn’t get the bill until recently to send to me. How can I hold the radiologist/that portion of the company responsible for such a late bill? Is that a thing? Am I being a Karen?

Is there any argument to not pay a bill because it came so late? Is this just health insurance hell pay to play??? I feel like a clown bouncing to all these different companies trying to figure out who should be responsible for charging me over a year late when I fully thought I had already paid off that visit.

AAPC Members; In what ways do you take full advantage of your membership? (Besides the occasional free ceu) What discounts are you using? In your opinion is it worth the price you’ve paid for it?
EDIT- Has anyone booked a vacation or used their membership for discounts?

For ER encounters, if a patient comes in with a fracture that the MD documents as "age uncertain", is that coded as an acute finding? I cannot find any literature on this. Coworker is stating to code it as "other disorders of bone" which does not sound right.
My thought process is that even if the fx may or may not have been not caused by an accident, it is the first time it is being addressed...

I am a contract employee. I’ve started a new assignment for a large health system in the NW. I’ve spent a few days with a trainer and I’m totally taken aback by inappropriate off topic things this person has decided to tell me. I don’t know this person. The employer mentioned they can’t keep anyone and I’m wondering if this person could be why or at least part of the issue. They continually bring up their lifestyle and sexual orientation. They even made a comment on how they are all that certain political affiliations have a problem with. This was all brought up day one of training. I didn’t know what to say. I just find it super uncomfortable. It’s not like we were at lunch, after a month of working together. Has anyone been in this situation and what did you do? It’s highly unprofessional in my opinion.

Is this pretty commonplace? It's for corrective eye therapy in a child, no operations or surgery just intense eye exam type stuff.

Hi everyone,

I’m trying to remove the “A” from my CPC-A. What type of documentation does AAPC ask for from the employer?

Do they need just a simple letter on company letterhead, or is there a specific template or format they prefer? Any details on what the letter should include (dates, duties, etc.) would be really helpful.

Thanks in advance!

Took my kid to the out of network Childrens Hospital ER in Texas for an earache with redness on the bone behind ear.

They did a CT scan with contrast to rule out mastoiditis and sent him home with prescription for oral antibiotics.

This was coded as a level 5 ER visit so I got a large bill as a I have a high deductible policy.

Before I try to dispute with the hospital, I called my insurer to see if they might do a coding audit or act as my advocate. They say that a coding audit is not something they do, they just process the claims as submitted, and if a kid goes into an in network or out of network ER with a skinned knee and it's coded as Level 5, they will accept that bill and process it.

Is that true? Or do they just not care because this bill is out of network and thus it's not their money?

Also, would I have any chance in winning an argument with the hospital directly that this did not warrant a level 5 code? The attending ENT never entered the room and her PA billed Moderate MDM and I'm being billed for the expensive CT scan in a separate line item.

I’ve been studying for about 2 months now and can’t seem to get anything higher than a 52% on the AAPC practice exams. Granted, I never knew how to study in school so maybe that’s why I’m struggling. Should I just give up and look for other healthcare jobs? I have a Masters in Healthcare Administration and I am struggling to find a job other than what I currently do which is a receptionist at an orthopedic clinic. Just feel super lost and needing some advice!

Hey guys I am new to coding I knew nothing about it 4 weeks ago it took me a week before I could even buy the books I needed so I had 3 weeks to study and 2 days ago I passed the ccs exam on my first attempt. I am probably crazy but I had no training I bought no courses I had to learn everything and I did it using AI. I used chat gpt and claude to help me study. they are not perfect and mess up a lot but when you are just starting off learning they can be accurate once you get good at coding you start catching all of their mistakes and have to correct them lol I know its a mess but I really didn't know what I was taking on I just did it.I took the outline off of ahima website that tells you all thats on the test and I told both claude and chat gpt to teach me step by step all the things on the outline. Claude made me this really cool interactive thing that had all the domains and all the topics under each domain. be specific and let them know what you need I personally learn best when Im applying stuff in real time so I asked them not only to teach me quiz me over each domain and for every individual topic give me a code to look up or some type of task that allows me to apply that guideline rule whatever. Do full practice scenarios they are the best way to learn sequencing etc after you make the same mistake so many times you stop making it. The best thing to do is to ask them to give you scenarios and guide you step by step on what to do. do as many of them as you need to feel confident. eventually you wont need the step by step anymore because you'll remember what to do. I have a very short attention span when it comes to learning so when I was trying to build a foundation and learn the guidelines/ rules and things on the ahima outline I asked them to give me the rule, an example of the rule, and a code to look up or a task that lets me apply that rule in real time. I didn't have any practice books test books or anything I was piecing little free test together off google so im not much help in materials outside the AI tools I used. I agree with some others who have said that there was a lot of stuff on the test that wasn't even covered on the outline so I never even learned anything about a few of the questions. I was like I never even heard of this. But this is the most important part do not give up on the test. its long af and I was mentally exhausted, sleepy, dry, the water I was sipping was doing nothing. But as my spirit continued to break with each question I didn't know or didn't feel confident on I would just tell myself I can't fail this test. I would sit back up and lock back in and I had to do this at least 10 times over the course of the 4 hrs. I borrowed the $350 from my mom to even take it so me failing was not an option because I didn't have another $350 to borrow. Lastly my test strategy. outside from doubting myself every other question there was a patch of questions I felt good in my responses back to back so that built back up some confidence for me and I started thinking maybe I can pass this. Do everything that you know right off hand first. you can flag questions so if its something thats going to require you to look up something thats more than 2 codes or you really have to search for or you just flat out don't know mark the first answer and flag it so you can come back to it and actually spend time on those once you get all your easy ones out the way. I went through the first 80 or so with only like 40 answered confidently so I had like 40 flagged that I didn't know or I needed to spend time on before I even went back for those I moved on to the scenarios section. I kept being told that people run out of time on the scenarios section and I just didn't want to do that so I took a good chunk of time on the scenarios I would say I spent the first hour answering questions and skipping the ones I didn't know in the multiple choice around 2 hrs on the scenarios section and once I completed those I spent the last hour trying to figure out ones I was stuck on or required a lot of research back in the multiple choice section. Even though I passed I regret not at least buying something to give me practice test the free ones were always very short they'd give me like 5 questions and id have to pay for the rest which I didn't do. a good chunk of the test is knowing the rules and regulations I remember one of the questions asked about if there's a data breach how many people have to be affected in order for it to have to be reported to the news and also how many days do they have to notify the people in the data breach. there were questions like how many days do you have to provide a patient with their discharge summary, when is an operative report due. so just make sure you brush up on stuff like that luckily for me I had just covered those things like a day or two before the test so it was fresh in my mind. this was a very interesting few weeks but im glad I did it now the next task is finding a job

I can't post the image, but the spinal cord image in the aapc study guide for the CPC exam, chapter 12 page 199.

It's showing the spinal cord and the nerves and all that. Two things of note.

They spell muscles as : muscles and muscels.

And they have "lumber nerves" instead of lumbar?

The image says it's stock from adobe so it could just be an odd typo but I would think aapc would've better the images a little better? Unless they know something I don't about muscels and the lumber spine?

Now I'm wondering if there's been more of these and I just haven't noticed?

Anyone else notice anything like that?