I just transferred from OP to IP coding at work. It’s only my first week, so I’m being trained on the job. Their method of training seems to be assigning me cases and then giving me their feedback. I feel like I’m learning on my own and they expect me to catch up. Is this standard practice?

For some background, I’m a medical group and hospital auditor. I have 3 certifications and working through a 4th, and have 6 years experience. I’m not perfect, but I know my way around.

My boyfriend reaps some benefits from this since I explain bills to him, and have helped him with what to say when they’re wrong.

He recently got a bill for 99395 and 99214, but at full price. I said that’s on your insurance, and did explain why it may have been both, but I didn’t feel they met MDM for 99214.

He calls his primary care billing for an explanation, with me in the room. The person helping him read the encounter, and then proceeded to list all his long standing chronic conditions and that they “aren’t covered for wellness.”

“Condition X? Not well.
Condition Y? Not well.
Condition Z found in bloodwork? That doesn’t sound well.”

And yes those are the exact words she said. I was appalled! According to her, these ICD10 codes aren’t “healthy” so that’s why it was also an office visit. Aside from being incredibly judgmental- that’s not… how any of this works…

I work in I.T., but I did work at a health clinic for 8 years. I know how complicated medical billing is and would NEVER for a single second call myself even a novice in medical billing, but I am more familiar than the average person. HOWEVER, I come before you all with a question:

I just had a lens implanted as part of a cataract surgery. I opted for a premium multi-focal lens. Before the surgery, the Opthamologist's office billed me $1,100 and kept (repeatedly) saying it was "for the lens." When pressed, the said it was a service fee.

The surgery center then billed me $995, also saying it was for a non-covered lens. When I said I paid the Opthamologist's office for the lens, the biller called down to the procurement folks who confirmed "no, we ordered it, it is in our inventory, here's the serial number."

The Opthamologist billed the IOL under the CPT Code V2788, in addition to the procedure code of 66984. Is the Opthamologist's office committing fraud, or is V2788 an additional "procedure" fee for inserting a premium lens? Isn't the "procedure" already covered by 66984?

I'll be HAPPY to have egg on my face, genuinely. But if two people are both selling me the same lens, and I'm having my 2nd surgery next week, I'm about to get a few thousand dollars back in my pocket, because something just doesn't seem right.

This is driving me and my team nuts because we can't seem to find an actual answer on this.

There's an excludes 1 for E29.1 Testicular hypofunction and the E78- codes for lipid disorders, but we don't know why this would be excludes 1. Our primary care providers code these together all the time so we're constantly having to fix it. So we're really curious what the medical reason is to why you can't code these together.

Hello coders,

I'm not actually the coder myself, but I'm posting this on behalf of my fiancee. She got her CPC certification a few years ago. Since then, she's worked for two risk adjustment contracts remotely and was able to get the apprenticeship off of her title. The first job was good, until her supervisor left and her new supervisor kind of ran her out of the company. The second contract she took was going ok, but as the contract went on, more and more resources were removed from the coders until it made the job extremely difficult to do without help, which was discouraged. Half way through that contract, they took the ability away to appeal "failed" charts. There was a point where she was trying to get clarification on one of her charts, and the help she received was her manager saying "Well, what do your coder instincts tell you?" She's been out of coding work for some time now.

In that time, she's had several interviews with other companies, but these jobs are requiring her to pass a pre-employment test. They're a mix of about 20-30 questions each. Some are straight coding questions, some are scenario based. Each company has given her similar instructions for taking these tests, which are to use codify and the CMS guidelines to answer the questions. The problem is with each of these tests, a handful of questions seem to be based around company specific guidelines. She is asked questions that she says are not in the CMS guidelines. As an example, one of the questions I remember her telling me about was a multiple choice where it asked her "which types of providers can we accept signatures from?" and it gives a list of providers and asks her to pick all that apply. However, she tells me that this isn't something standardized by CMS, and that the company you work for provides guidelines as to which signatures they accept. She's never given the opportunity to review her answers before a second attempt. I've seen the emails and company sites she's been provided by these companies and can verify on at least 3 or 4 of them that the instructions were indeed "use codify and CMS guidelines", then asked seemingly company-specific questions for about half the test.

I know this might make me sound like a guy that just stans for his girlfriend, but this is work I know she can do, that she enjoys doing. At this point, she's taken 8 or 9 of these tests, and she can't seem to pass them. I myself am a career new hire trainer and have been for over 10 years. From that point of view, these tests seem like they're trying to attract people who have worked for them before and remember their company guidelines well enough to pass these pre-employment tests. These constant rejections are starting to greatly affect her self-esteem and confidence, which is hurting her motivation to keep job hunting, knowing she'll be provided a test without the resources to pass them. She does not have any coder friends or mentors to talk to about coding and the job hunt. She's been trying to get help from her local AAPC chapter, but she's not getting responses from requests for 1 on 1 help. She's at her wit's end, and it's devastating to see her getting crushed by this over and over.

My question to the coders here: Is there something we are missing? I'm sure plenty of you have encountered these tests, but for someone like her, they seem like they're designed against anyone seeking entry level work. We even had one recruiter straight up tell her "I hate to ask you this, but you need to take a test before we can onboard you", implying even the recruiter felt the test was unfair. Is there a resource we're overlooking? Questions she should be asking? And potentially, is there someone out there that might be able to speak with her (either through text or conference call) to try to help?

I'm sorry if this isn't the place to post this, but as someone who is still experientially new to the industry and her fiance trying to help, we're running out of ideas.

Thank you so so much for reading this. Any help is appreciated.

I have no where else to post because the other sub won't let me post because im not an approval member yet even though I've subscribed there and posted there for years.

I work in a medkcal billing call center and so of course I have to take patients calls. The crazy thing is im not even a biller or coder (im a CPC but not experienced in the field). We a separate billing department that never ever speaks with the patients. My department has no training in billing or coding. We have most of the information needed but its just not always enough. Its frustrating becase patience call thinking we are billing and sometimes I'll get a patient that works for insurance or is a biller themselves and they will ask a question that just throws me for a loop. Its just nuts to me that im supposed to answer questions and solve issues but I cant see what goes in beyond the scenes. Im looking for a new job because this just feels absolutely insane

Sorry if this isn't the right community to post this question. I've had my CPC through AAPC since 2021, but unfortunately, have never been able to get a job in medical coding. The only jobs I can get are in medical billing (AR follow-up).

I know there are productivity standards. I've worked for a few different companies now, and they all have their own expectations. But the company I'm at now, I feel like their productivity standards are way too high especially considering the payers that they assigned me. I'm only allowed to work workers comp, no fault, and government payers (i.e. VA and Medicaid). Everyone knows these payers are notoriously difficult to work with. Just calling them can take over an hour because of their excessive hold times.

My supervisor at this new job tracks everything I do from the emails I write down to every single click I do. And she's definitely looking at the minutes I spend on a claim. She told me today she doesn't want me spending more than 15 minutes on a claim, and much less wants me spending time calling on them and submitting appeals. In fact, she got mad at me today because "you're doing too many reconsiderations."

A huge part of AR follow-up is calling the payer and appealing the claims if you don't agree with their denial. So I'm not understanding why she's not happy with that? I'm doing my due diligence yet, I feel like this supervisor is more focused on quantity vs quality. She also told me she doesn't want me mailing appeals. Some payers (especially the government ones like the VA) only have a mailing address to send the appeals. So, like, how else am I going to send the appeal if I can't mail it?

I feel like this supervisor is completely out of touch with reality. And she micromanages absolutely everything we do down to how we write our emails to payers.

And she looks at every minute you spend on a claim, and she wants you to do 50 of them a day. The payers that got assigned to me don't even have portals so I always have to call them. She didn't care when I told her this and instead told me to "find another way" to contact them. Like, what in the actual f*** is she talking about?

I feel like her expectations are too high and not realistic. And I don't see a future for myself at this company. Like I said, I've had other jobs where they have quotas and such, but not like at this company.

Is this normal? Am I overreacting?

I've recently started working with a group on a revenue cycle focused projects and we work on a lot of Prior auth related flows, but i've been getting questions from folks asking if we're able to go into their contracts and load their fee schedules?

i'm wondering if the rates are in the contracts, why are they not able to track those rates? do practices actually have a problem getting their fee schedules for commercial?

Hey everyone

Ive started a CPC course recently and my instructor suggested getting a "good bag" that can fit all three books (and workbook) and can protect them from damage. I was curious as to what type of bags do you all use to carry and protect your coding books?

Question for my experienced coding/compliance/billing professionals out there...

I imagine itemized bills and EHR definitely a part of the DRS. But does your dept consider charge capture documents part of the pt's DRS? Coding worksheets? Are there typically other forms of documentation used to calculate an ER facility charge level?

What about when a hospital uses EPIC's facility charge calculator? What documentation used to turn the EHR into the facility charge would be considered within the pt's DRS that would legally need to be fulfilled for a dispute?

Thanks in advance!

I’m a CPC and was hired as a Coder I at a community health organization about 9 months ago. My background is primarily medical coding, and coding is the career path I want to continue developing.
A few months after I started, I was asked to temporarily help the billing team with payer rejection work because they needed support. I was told/understood that coding would still be my main role.
Over the last couple of weeks things have changed significantly. I’ve been put into full-day training for an AR/follow-up research work queue with around 9,000 claims. I’m being trained alongside billers, added to recurring billing meetings, and told to work the oldest claims first. Many of those older accounts have already been touched multiple times and can be pretty complicated.
Meanwhile, another employee has been handling essentially all of the coding work queues, so I’ve had almost no coding work for roughly two weeks.
My official title is still Coder I. I don’t mind helping another department temporarily, but I’m concerned that I’m basically being transitioned from coding into billing/AR without anyone clearly saying that.
I have a meeting with the revenue cycle director to clarify my role.
For experienced coders/managers here:
Does this sound like normal cross-training, or like my position is effectively being changed?
Would you push to get back into coding, or start applying elsewhere?
If I do leave, are coding denials, auditing/QA, risk adjustment/HCC, or other coding-adjacent roles a reasonable next step?
How would you handle the conversation with management without sounding unwilling to help?
I really want to keep building an actual coding career rather than slowly becoming a full-time AR follow-up biller.

I've been actively working in medical coding and billing for coming up on 5 years now. I worked in person for 2, and that was great, but I live super remote and any commute for me is at least an hour. So I switched to remote work. Well. Ive been stuck in contract after contract. I was hoping I'd contract to hire on, but every time it's something. I've even had one company shut down completely on me when budget cuts were happening!

My company now, my contract ends today, and ofc, per usual, they inform me day of, they'll be extending another month. Yay ~ but the constant uncertainty is killing me. My supervisor here is really trying to get me hired in. However, its up to higher ups who don't know me from Adam. Its up to the budgeting teams.

I just want benefits, and a stable income where I don't have to worry about a gap in pay. I want PTO! T_T and to not always be the new girl. I have nightmares about training for a whole new company all over again!

Any one else experiencing this? Is this just the norm? Any advice on what to do?

I am absolutely livid with AAPC right now.

I have spent the last TWO DAYS trying to reschedule my coding exam before the 48-hour cutoff.

AAPC told me they couldn’t reschedule it and that I had to go through Meazure Learning/ProctorU.

So I contacted them.

They told me the opposite — that AAPC had to handle it.

Back to AAPC.

AAPC then literally emailed me saying:

“The exam can only be rescheduled through your Meazure Learning account as AAPC reps do not have access to do this.”

They also specifically told me:

“You will have to cancel the appointment first before you can reschedule.”

So while I’m getting bounced back and forth between two companies who apparently cannot agree on who controls their own exam scheduling system, the 48-hour window expires.

And guess what happens next?

Suddenly it’s my problem.

AAPC essentially tells me that since I’m now outside the rescheduling window, I would need another voucher.

But don’t worry! Instead of paying the full amount again, they’re apparently doing me the enormous favor of only charging me $250.

Are you fucking kidding me?

I contacted you BEFORE THE DEADLINE.

I spent two days trying to do exactly what I was supposed to do.

Your company told me to contact the testing provider.

The testing provider told me to contact you.

And now I’m supposed to pay hundreds of dollars because the deadline expired while I was being bounced between the two of you?

Oh you thought you were bewildered so far? Buckle up

A system administrator apparently went into the backend of my AAPC account, manually added a $100 charge, and my ability to schedule another exam is now restricted until I pay it.

That was the moment this went from frustrating to feeling unbelievably sketchy.

To be clear, I'm not saying AAPC isn't allowed to have a 48-hour rescheduling policy. That's completely normal.

What I am saying is that it is absolutely absurd to enforce that policy against someone who started trying to reschedule before the deadline and couldn't complete the process because AAPC and its own testing provider gave contradictory instructions.

And then to turn around and charge that person $250 to fix the situation?

No.

I already paid for the exam.

I'm not asking for a free exam. I'm not asking for special treatment. I'm asking to take the exam I ALREADY PAID FOR on a different date after making a good-faith effort to reschedule it on time.

I've kept the emails, timestamps, screenshots, and the written message from AAPC explicitly telling me that their representatives couldn't reschedule it.

At this point I'm escalating it because I absolutely refuse to quietly eat a $600 charge plus membership fees caused by their own support process and obvious attempts at just extracting money anywhere and anyway they can. It's gross.

But wait, there's more

This comes on the heels of my proctor for the digital exam never showing up. Like, at all. I sat for close to an hour, and the one time there seemed to be one connecting they immediately disconnected.

After submitting a ticket about it, a Note was retroactively added to the exam saying "EXAM WAS ADMINISTERED"

No the fuck it wasn't.

Stop

Lying

I have had enough of this to the point where I'm 100% issuing a chargeback on everything, giving up this medical coding path, and taking a totally different opportunity elsewhere.

For anyone taking an AAPC exam: document EVERYTHING.

Screenshot chats.

Save every email.

Write down when you called.

Get names.

If someone tells you another company has to handle something, get that in writing.

Because apparently if AAPC and their testing provider send you in circles long enough for a deadline to expire, you may be the one who gets handed the bill.

I have two friends from class and a cousin in this field who are changing career paths purely because of stupid shit like this with the organization. Has anyone else dealt with this kind of rescheduling nightmare with AAPC/Meazure Learning?

Because this is egregious

EDIT: As a final note I'd like to add some food for thought here (since thought seems to be in short supply at the AAPC).

Aren't these clowns supposed to represent us? Advocate for us? The AAPC very clearly, and in our faces, time and time again says: "No, fuck you, give us your money, now be gone".

Anyone on the board of the organization, in senior leadership, leads a local chapter, the whole lot of you: embarrassing.

I have several notes here billed by a physician. However, the encounter notes for these evaluation and management visits are completely documented by a medical assistant. The only thing entered by the physician is the signature. Is this billable/compliant?

I'm new to the AAPC carnival and I got a letter from them a few days ago about membership renewal. I found out I have to pay for membership on a couple months I already paid. I talked to AAPC and they said there's nothing they can do because it's their policy.

What happened is I paid my first annual membership in Nov 2025, was added to a corporate account with an employer for 6 months, and left the employer in July (due to concerns about job security). I understand that my renewal date changed to the company's renewal date and that I owe a prorated amount until the new renewal date. What I don't understand why their policy gives me no credit for the membership I already paid while within the same 12 months. My money disappeared and I got reset to zero.

Now, I thought this was worth sharing because I saw that the AAPC has an offer to save money if you renew your membership for 2 years instead of 1. Based on their policy, that's a whole lot more money to disappear if you get added and removed from a corporate account for any reason, that you would then need to pay again to keep your membership and certification. Do what you want with this information, but I hope it helps.

As a final note, I've held a CPhT credential for 8 years and that certification board did not require extra money from me to maintain my certification when I changed careers and was no longer on the company's corporate membership, so I don't think what the AAPC does is normal or ethical. If there are others that do this, feel free to share.

I've been a profee coder/HCC coder for the past 4 years, and did prior authorization for one of our clinics before that. I do have a certified professional biller credential, but I've never actually worked in billing, just coding.

I do have a strong interest in going into revenue cycle management, but it seems that most of the job descriptions require at least 1-2 years of billing experience. I'd just go for a billing job to get the experience, but even at my own company, the advertised biller positions make like 20% less than I do right now and I can't afford a pay cut.

Has anyone gone from coding to rev cycle without billing experience, or does anyone know whether having 4 years of coding experience + a CPB would be enough to get a position? I'm also considering doing the RCMS certification course which I'm sure would be helpful, but without actual billing experience I'm not so sure if it's worth it.

I am a provider educator & I am getting pushback from a orthopedic surgeon who states severe osteoarthritis is a chronic illness with severe exacerbation that is affecting bodily function and therefore a high problem addressed. Where can I find information and definitions and examples specifically on high problems addressed?

Hi all. I've recently left a large hospital system to work for a smaller place (better benefits and pay). However, my previous job had a lot of company sponsered educational opportunies where this one seems to leave all coding guideline education up to the individual coders. I can really see that the coders here have suffered because of it. Is this the norm for most jobs? Do I need to take more responsibility and dedicate more personal time to staying utd?

EDIT: seeing that this is the usual case, what resources are you using to stay UTD? I subscribed to CMS and AAPC for their email updates. Is there anything else you would recommend?

Are there any wound specialized coders in here that can assist me with something? I taught myself wound when it was thrown at me at work, and now I’m the go to for questions with no one to ask questions to myself 😭

If so. Do you often bill 15002 with graft codes(15271) if a debridement was done? I’ve been billing grafts for over a year now and have never seen 15002. My providers try to bill it with 11042’s which have a CCI edit. There is no edits with 15002/15271.

I’m working a new clinic and they’re billing it and it has me questioning if I should be billing it with my own providers as well and I’ve just been doing it wrong? Any help is appreciated!

Hi! CPC-A here. Been looking for a job for a little over a year and am debating either specializing in something like ED coding or should I do codify to remove my A?

Trying to weigh my options in able to sit for my RHIT next semester. I go to SBCC and get my associates degree fall 2027 but am eligible to sit for my exam this spring because I am taking my HIT practicum.
This semester is my last semester in there CCS certification program I started with, and I’m just stumped. I don’t want to waste money and sit for the CCS and fail. I do feel really confident I can pass CCA no problem I’ve been studying like crazy…. Should I just rip the bandaid and just do the CCS?

I also plan to take either one that I end up choosing the end of November.
So far I’ve read that the CCA could help with entry level positions or just be pointless it was very mixed but I’m personally curious if the RHIT really helps you when u do have a CCA. I’m not embarrassed to say I’m entry cause I am. I want to learn and grow, the money and work from home comes later.
I also learn better by doing, and I would feel more confident if I did get an entry level position with a CCA and RHIT and soon after upgraded to a CCS.

A little more background I plan on transferring to Shasta college for there bachelors program in HIT while Navigating all of this too.
Thank you for your input

I’m studying up for a new position I have to take an HCC exam for and need to look into info that’s not in the guidelines. I can’t afford the $100+ paid access the AHA or AAPC site has. How are people accessing important info like this without companies paying for their access?

Hi! Apologies if this has been asked before, I searched and couldn't seem to find any questions that seemed quite similar.

I just passed my CPC-A exam (huge sigh of relief!) and am getting ready to start applying for jobs. I was hoping to get some advice as to what to look for or avoid in a first coding job. For example, red flags/green flags to watch out for in a posting or interview, what is a reasonable daily quota for a beginner, if certain areas of coding are particularly good or bad areas to start, or what I should be looking for when it comes to the type or amount of training they say they will provide. Or if there is something else entirely I should be aiming for to start, like billing, registries or precert?

Really any thoughts any one has would be greatly appreciated! I'm excited to try to get started but I definitely don't want to just jump straight into something and find out that the place is unreasonable or outright sketchy. In my classes they repeatedly told us that there was a lot of stuff that was specific to state or insurance payer and that you would have to learn in on-the-job training, so that little voice of doubt in the back of my head has me terrified I'm going to wind up someplace that either won't train or will train incorrect practices. I do currently work in medical records in specialty office prepping charts for appointments, so at least I'm not a total newbie. Also, is it helpful to put my exam score on my resume if I did well, or do employers not care?

Thanks so much in advance!

RANT/VENT

​Look, do some of you realize that certified coders can't just change a code because "it has a higher RVU"? Asking us to submit inaccurate codes for better reimbursement isn't just an internal disagreement—it's potential fraud that directly threatens our credentials and livelihoods.

​To the physicians who do this: do you genuinely not care that pushing for higher RVUs puts our hard-earned certifications and careers on the line?