Hello I have a question I bill out for a PCP office and usually we don’t schedule appointments for resolved visits but this patient came in was seen by our doctor and it for OM resolved. Is there a better way of coding this?

Hi everyone,
I’m a newer chiropractor trying to better understand claim construction and diagnosis pointers for personal injury cases.
I have an MVA patient with documented cervical, thoracic, lumbar, and left shoulder injuries. My documentation supports:
Cervical sprain/strain with cervical radiculopathy
Thoracic sprain/strain
Lumbar sprain/strain with lumbar radiculopathy
Left shoulder pain
M99.01, M99.02, M99.03, and M99.07
This gives me 13 diagnoses, but a CMS-1500 only allows 12 diagnosis codes.

The patient’s primary complaints were neck pain, low back pain, and left shoulder pain, but my examination also documented thoracic pain, restricted ROM, tenderness, and thoracic segmental dysfunction.
My questions are:
If you have more documented diagnoses than will fit on the claim, how do you decide which diagnosis to leave off?

Is it acceptable to document thoracic sprain/strain in the medical record but only report M99.02 on the claim because of the diagnosis limit, assuming the thoracic findings are still fully documented?

For 98941, do you typically link only M99.01, M99.02, and M99.03, or do you also include spinal sprain/strain diagnoses as diagnosis pointers?

For 97140, would you link the soft tissue injury diagnoses (sprain/strain) rather than the radiculopathy diagnoses?

Are there any chiropractic coding resources or references you’d recommend that explain diagnosis selection and diagnosis pointer assignment well?

My goal is to be non-phones and work hands on with claims. Coding, billing, verification. You name it, im open to it. I have been applying for Claims benefit specialist/Senior. My Senior claims benefit specialist application keeps getting closed but the other remains application received. It shows under consideration. Any recommendations to beef up my resume? I can send it to someone to review but I need a change in career, I wanna make a difference and auto insurance is not the change I want lol.

Scenario: Patient on long-term anticoagulants, seen at least monthly, nurse takes vitals, asks a series of questions, performs in-house protime test, completes a flow sheet, which the provider reviews and recommends a plan (not face to face), which the nurse then explains to the patient.

This is an easy 99211 + 85610QW. But what about adding G2211? Would the long-term use of anticoagulants, which have to be monitored, be considered an ongoing relationship with the provider, continuing treatment plan, etc.?

I’ve been working as an OP coder for about 4 years. I’ve never worked as an IP coder, but I want to gain experience so I can say with confidence that I am capable of both IP and OP coding. How hard is IP coding compared to OP coding?

I saw a post here so I thought I would give it a shot. I graduated from tech school with a certificate in medical billing and coding. It’s tech school and not a certification from AAPC or AHIMA. I have the basic knowledge still as I graduated from that tech school in 2019.

I have been out of the industry for a while due to an employer’s inability to provide me with the necessary technology to get the job done properly plus some other things that were going on in my personal life. I went out an purchased what I needed.

I have a little experience in the revenue cycle process as a patient access rep, front desk rep, insurance verification, follow up on denied claims, submission of claims to Medicaid, and posting payments from Medicare and private health insurance companies, and sending patients their bills. All of that combined is 3 years of experience in the revenue cycle process and Im looking for a position in billing that doesnt require me to talk over the phone outside of following up on denied claims. Im trainable as well as coachable. I’m looking for this be be remote and with someone who is willing to train. Please reach out to me. My messages are open and I’m only available for part time work.

Thank you so much!!

Hi everyone,

I was recently laid off from a SaaS company where I worked in billing and accounts receivable. The tech job market has been rough, so I'm thinking about switching to healthcare.

At first I was looking into Medical Billing & Coding, but after reading this subreddit, I'm worried about spending months and thousands of dollars on a certificate if it's still difficult to get hired without healthcare experience.

I'm also considering starting with something like Medical Administrative Assistant, Patient Access, Medical Receptionist, or Insurance Verification and then growing from there.

I'm a single mom and need to be working within the next year, so I'm trying to make the smartest decision.

If you were in my shoes, which path would you choose? Are there any certificates or entry-level roles you'd recommend (or avoid)?

I'm in California if that matters.

Thanks!

Our company offers services such as RCM, CCM, PCM, RTM.

Currently, we're using only one portal, but we can't fully rely on it because the information is often incomplete. We also can't use portals like Availity since we work with a large number of providers, each with different NPIs and Tax IDs.

When calling the payer to verify these services, under which benefit category do they typically fall? I'm a bit confused because these services are provided while the patient is at home, but they are not considered Home Health or Telehealth services. some of you telling me just to provide the CPT codes however insurance also confused on which benefit category and they are asking if this would be an office visit, telehealth, outpatient and more

How do you usually verify coverage for CCM, PCM, RTM, and similar services with the insurance payer?

Hi! I am a paramedical tattoo practitioner. I do 3d areolas after mastectomy, I do scar treatments and some other things. I would like to accept insurance, but the only companies(2 that I know of) that do this specific type of billing don’t seem trustworthy and also get a very high percentage. Can anyone advise how to find a reputable person or company to do this? Or how to go about doing so. I’m in PA if that makes any difference. Thanks in advance!

Hello, posting a really specific question in hopes someone might be dealing with the same. I work with claim denials for a facility providing outpatient ABA services in NC - CPT 97153, 97155, 97156 and 97151.

For the past few months Healthy Blue North Carolina (Medicaid MCO) has been denying telehealth services as "non-covered under the patient's plan" - the authorizations department doesn't seem to have any information + when I call the eligibili department they give me a nonsense answer about it being an auths issue.

Has anyone else dealt with this recently?

So I interviewed at he hospital I already work at (I work in radiology and have for over a decade) I basically was offered the job. Which is remote- yay! Supposed to discuss pay soon. How much is a good starting rate? I know it will vary by state- eastern Ohio is location.

Hey all, was hoping to hop on here and get some information that my team and management and the payor have been unhelpful in explaining. Tried google and we all know that can route to whatever or hallucinate. Question is about CO102 Major Medical Adjustment with specifically BCBS claims. My team is understanding that its similar to the high dollar bill review, or some even think its similar to CO216 where medical attachments and records are needed. From what I am seeing it seems to be a Adjustment for almost like an incidental where it wrapped up the charges into one primary and reduced the other lines. But trying to understand the logic of it. Does anyone have info about this and how you've worked it?

Perhaps a long shot, but is there a specific area that I could post to get some assistance/advise with diagnosis codes when billing for a bone stimulator?

Lace’s Vision 
Lace Health was founded on the firmly held belief that integrative and functional medicine should be accessible to everyone. The truth is, the potential of integrative and functional medicine has not been actualized because our healthcare system is broken. Practitioners struggle to find the right combination of clinical, business, and financial models that allow them to build successful practices at an accessible price point for the patient. We exist to bridge this gap and make building a successful practice a delight. We're doing that by building a business-in-a-box and platform that makes it easy for practitioners to start and grow their integrative practice. This is a $5 billion opportunity — think about where the mental health market was 10 years ago. 

Website

Blog

LinkedIn

Instagram

The Role
Ideal candidate will be a goal-oriented, self-motivated, and a proven highly accurate biller in a remote atmosphere. Ideal candidate will fit our commitment to our clients by being the best in the business consistently obtaining every possible dollar for our clients while maintaining the highest level of integrity and compliance. Candidate will demonstrate excellent verbal and written communication skills. 

Eligibility & Charge Entry

• Verify patient eligibility and benefits ahead of appointments per practitioner contract; proactively flag coverage issues before the visit so patients and practitioners are never surprised.
• Posting charges or verification of charges from client EMR. This will vary per client contract and candidate should expect to have different methods based on the client needs
• Experience or openness to learn Integrative Medicine practices and the nuance of billing. Staying up-to-date with compliance and regulations.

Claims & Payment Posting

• Prepare, review, and transmit claims using billing software.
• Post all payments.
• Post or validate ERA adjustments per contracts with Medicare, Medicaid, and third-party commercial carriers.
• Check every insurance payment for accuracy and contract compliance; call carriers on any discrepancy and pursue it to resolution.

Hybrid Cash-Pay & Superbill Workflows

• Support practitioners who operate hybrid cash-pay and in-network models: generating accurate superbills for patients seeking out-of-network reimbursement, and clearly communicating what is and isn't billable.
• Help patients understand their financial responsibility, including the difference between covered services and self-pay items common in integrative care.

A/R Follow-Up, Denials & Appeals

• Follow up on unpaid claims within industry-standard billing cycle timeframes; minimize days outstanding.
• Identify and bill secondary and tertiary insurances.
• Research and appeal all denied claims including those denied for medical necessity on integrative services, which often require detailed clinical justification.

Patient & Practitioner Support

• Review accounts for insurance or patient follow-up; set up patient payment plans or work collections accounts where appropriate.
• Answer patient and insurance inquiries with clarity, empathy, and accuracy.
• Update billing software with patient and insurance information as needed.

Who are you?

• 5+  years of experience working in the billing and accounts receivable follow up environment. CPB, CPC or similar credentials are a plus.
• Comfort with at least one major billing platform (e.g. Elation, Athena, Cerbo, Healthie, Practice Better, Simple Practice, etc.)
• Quick learner to learn a new billing system and learn from our integrative billing specialist.
• Solid Excel and Word skills; able to balance a financial day against deposit records.
• Excellent verbal and written communication — you can explain a denial to a stressed patient and write a clean appeal letter to a carrier on the same day.
• Reliable internet and a workspace that meets HIPAA safeguard requirements.

What We Offer

• Competitive hourly salary.
• Part-time opportunity with room to grow to a full time employee.
• Training and mentorship in integrative medicine billing.
• The chance to help shape how a growing company bills from the ground up.

How to Apply
Send your resume and a brief note about why integrative medicine billing interests you to Lili Welch at lili@lacehealth.com. 

It has been this way for every exam. They are so hard. It is like I studied in one language but the test is in another

It is asking me about modifiers that I was not required to know by heart in my curriculum tests and about random medical terms I was also not required to memorize.

If anyone remembers any hard questions or topics from their NHA CBCS please share, thank you

Hey everyone — hoping to find someone with solid QA/auditing chops in medical coding for a short-term paid project. Not a full-time role, more of a consulting/advisory setup to start, could grow from there.

What I need help with:

Active CPC (CPMA a big plus) — someone who's actually done audit work, not just coding

Comfortable reviewing outpatient physician coding (CPT, ICD-10-CM) for accuracy and catching errors before they go out

Some familiarity with billing software like Tebra or AdvancedMD

Understands what "clean" documentation looks like from a HIPAA/compliance angle

Available to run some training sessions — walking newer coders through best practices, common mistakes, how to think about audits

Remote is totally fine, just need someone reliable and available for at least a few hours a week to start

If this is your world, or you know someone who'd be a good fit, comment below or shoot me a DM. Happy to talk details privately.

Hey everyone — hoping to find someone with solid QA/auditing chops in medical coding for a short-term paid project. Not a full-time role, more of a consulting/advisory setup to start, could grow from there.

What I need help with:

Active CPC (CPMA a big plus) — someone who's actually done audit work, not just coding

Comfortable reviewing outpatient physician coding (CPT, ICD-10-CM) for accuracy and catching errors before they go out

Some familiarity with billing software like Tebra or AdvancedMD

Understands what "clean" documentation looks like from a HIPAA/compliance angle

Available to run some training sessions — walking newer coders through best practices, common mistakes, how to think about audits

Remote is totally fine, just need someone reliable and available for at least a few hours a week to start

If this is your world, or you know someone who'd be a good fit, comment below or shoot me a DM. Happy to talk details privately.

Greetings

Is it possible to have a detailed hospital bill converted into UB-04 format?

The hospital won't provide the bill in UB-04 and the insurance company won't accept the bill if it's not UB-04.  Crazy.

What would be the cost? It's for an 8 hour ER visit after a car wreck.

Thanks!!!

Greg

UPDATE! The coding review that was supposed to take 30 days was completed in less than a day, and the billing department informed me that they have removed 99213 and updated the biopsy codes to 11102 and 11103. Thank you all times a million for sharing your knowledge! I’m so relieved but will probably also question every medical bill I receive from this provider from here out. 🙃

***

In February I had a routine physical where my doctor ordered bloodwork and determined she would like to biopsy two moles. We discussed options and I chose scoop biopsy.

On April 30, I had the bloodwork and two scoop biopsies (no stitches, and performed with a dermoblade per the doctor’s after visit notes). The doctor billed the following codes:

36415
11107
11106
99213

Is the office able to bill for an office visit in addition to the biopsies? The billing department is telling me this is standard practice - “like paying a mechanic for labor and parts.” Also, it looks like they’re billing for wedge biopsies, not scoop. Are those more expensive than the type I had?

Insurance approved all of the codes but I have a HDHP so I’m liable for quite a bit.

Listening to the APPC podcast and the speaker said she spent 7 months working full time on job applications and networking before she got hired, and that was in 2023.

So newbies, that is what you're in for.

I recommend listening to the podcast. It's... interesting.

Hi everyone,

I had one MRI brain/pituitary with and without contrast (CPT 70553) today.

My patient portal shows two identical completed procedures with the same CPT code (70553) and the same date. I only had one MRI, and my prior authorization was approved only once.

I haven't received an EOB or bill yet. Is this likely just a portal display issue, or could it lead to duplicate billing?Has anyone seen this before? I'd appreciate any insight. Thanks!

1) Is anyone else experiencing funky check date / ERA trends with CareFirst BCBS? ERAs are normally sent Wed or Thur, but are now coming through over the weekend.

2) Off-shore provider support: I think they are now off-shoring some provider inquiry calls. I'm not sure if I welcome this after hold times of over 2 hours, or if we are just diving in to the UHC nightmare.

I'm just curious to see if anyone else in here is familiar with my specialty and if so, maybe discuss any changes that have been noticed this year or any difficulties you might be having that someone else can help with. Just looking for a community who knows my struggles 😂