We’ve all seen the complaints that the market is flooded. Nobody can get a job, etc. This is what you are up against. Every month AAPC publishes newly credentialed members. This is one page. Between CPC, CPC-A, and various specialty credentials, there are usually 7-8 pages of new credentialed folks. All of them full like this. Every month.

I’m not posting this to discourage anyone. I’m posting it for awareness. But also to say, if you really want to do this, you have to have ambition and be tenacious. It’s not easy, regardless of what the scammy marketing tells you. Know what you are up against and if you want it, fight for it.

What are your overall feelings about AI and the impact on medical coding? As a medical coder, I know that medical coding keeps evolving every year with new codes, updates, guidelines, etc. That being said, AI is also slowly creeping in, and while I don’t think AI is smart enough to keep up just yet, I still feel that my role is at risk.

I got a Facebook ad the other day for UMA and I wanted to learn a new skill. Did some research to ensure this was legitimate before providing my information. Now I'm getting constant spam calls from different numbers all day. When I requested more information from them, I specifically requested the info via email because I don't answer unknown numbers like most people, but I haven't received a single email. Not only that, but all these phone numbers have an Oregon area code which is the area code my phone has, despite them being based out of Florida and me being based in another east coast state currently.
I've seen some mixed reviews on them but I at least thought they were legit and thought I was safe just trying to get more information, but I guess not!

Just curious if the workload at my job is the same / comparable to others... I am feeling so overwhelmed at times I do not know if it is the company I work for, personal pressure, the healthcare landscape changing, or a mixture...

I have to handle 6 providers denials and patient balances. I handle patient phone calls, rejections from the insurance company, and any denials and 0 payments applied to deductible. I feel like I work all the time, and get half the work done that I used to, years ago. It is harder to win on appeal, and even harder to convince the doctor to adjust at times

Feels like the provider inquiries and patient questions have sky rocketed, as well as denials, and hold times on insurance lines have increased too...! I feel like I am delving more into the coding aspect which is slightly out of my lane but it feels necessary to assist the providers.

Anyone else??? 5 years ago, I handled double the number of providers and my accounts looked better.

Hello! I’m a newbie here!

I’m looking for any and all tips or help I can get when it comes to working medical claim denials! For context, I’ve recently transitioned to denials but been in the medical field for a bit now. My team tells me I’m doing great, but I don’t feel like it haha! I started out as a receptionist, then roughly a year and a half into that, I got moved to a department where I basically dealt with patient billing disputes, explanations of billing, etc. I held that role and succeeded at it for another year and a half, then got promoted to denials… all that to say, I feel LOST! Everything I thought I knew from my last position seems to be null and void because I’m on the flip side of things. I know how to resolve simple denials, but a lot of coding related denials have me clueless. I also have a hard time understanding “when to adjust, when not to adjust”. Please help me! If there’s any online courses that could help, please let me know! I’m just at a loss and trying to learn as much as I can but I can’t help but feel behind. (( FYI, I am not trying to go back to college but wouldn’t mind taking a class or a course or something if it would help me ))

Edit to add: No, I am not asking a “specific question”. Ex. If you had a child that was going into denials and asked you for any advice or tips or any general information to help them succeed within denials, that is the sort of “advice” I would like to see here. Not unnecessary comments saying “what do you even need” or “how do you expect us to help”. If you can’t contribute positively, keep it pushing honey 🫶🏼

Hello, I am a new coder and I have a question RE: DRG vs. weight. I was coding a chart today where 2 dx could meet Pdx.

Which scenario is best to "optimize the DRG? (please excuse my examples, I have been thinking about this all day, I should have notated the specific dx/soi/rom/etc, so these are not accurate DRG, but aligns with my question)

Option 1: DRG 882 SOI 2 ROM 1 weight 0.9876 <-- I have always been told by a specific auditor to use the lower DRG, especially since this has a SOI of 2

Option 2: DRG 897: SOI 1 ROM 1 weight 1.2583 <-- different auditor told me to use this Dx as Pdx since weight is higher. Even though DRG is higher?

I do not understand coding to optimize DRG. Can someone explain? Thank you so much. I tried to post this in medicalcoding sub but I do not have karma to post.

This problem just cropped up this month and I'm looking to see if this happening to anyone else, or maybe someone can confirm if I'm crazy while I wait for my appeals to be reviewed.

Example Claim:

Line 1 - CPT 99213

Line 2 - CPT 92134

- Primary diagnosis can be the same or different

- No modifiers

Regence will deny 99213 stating it is incidental to the "primary" procedure 92134 and that the E&M code needs to be separately identifiable/needs a 25 modifier.

We have never needed to bill any insurance for this type of visit with a 25 modifier in the past and no other insurance is enforcing such a policy...yet

My problem is I can't get a straight answer anywhere:

- CPT 92134 has a global code of XXX. CMS and NCCI say global period rules do not apply to XXX codes, but also state you can't bill E&Ms with some XXX codes, though you can with other XXX codes with a 25 modifier, but also some diagnostic scans are exempt from these rules altogether, but they never get specific.

- Regence Global Policy (Policy # 101) seems to indicate all E&Ms need to be billed with a 25 modifier when billed same day with most non-surgical XXX codes.

- And of course Google will say I'm right and I'm also wrong depending on how I word the question.

Have we been doing it wrong all this time and just flying under the radar?

Learning about billing and coding. Where can I learn more about billing and the insurance? It can be complicated to navigate.

We have tried billing 64640x5 according to MUE, but traditional Medicare apparently only likes 3 units. We are also considering using a temporary CPT code. As for the replacement plans (UHC specifically) they are requesting records and then denying based on services not being supported by the records, even though the records clearly state there were 5 different nerves treated. Anyone having any luck or any ideas on how to make these pay?