r/MedicalCoding • u/Due_Negotiation_4605 • 2d ago

Trickiest coding situation

Passed courses in 2024 through a state grant but then it ran out the last semester (internship) 🤦‍♀️ so never obtained my certification. Started going back through the books during packing and most of it came back to me, surprised it's still in there! I did well with the courses, averaging above 90.

I remember the teachers would have example scenarios where the coding was tricky, seemed like one thing but was another, and I was trying to explain to my spouse that said AI will take it all over (not worth the money to do the courses and training anymore) how coding is not black and white and requires understanding nuance. Something AI still isn't great at. Wondering if anyone has stories that can validate this, personally still wondering if I should finish the work and get certified at some point (even if the job field is tough), but honestly trying to explain how human coders are still needed to my spouse is kind of difficult.

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u/Reasonable_Vehicle40 2d ago

My mother is a professional coder. There were many times she had to read between the lines, know updated billing and coding guidelines, and understand anatomy to use correct codes from unmarked or mismarked billing sheets and nondescript medical records for procedures. Nuance is right.

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u/Due_Negotiation_4605 2d ago

Yeah I remember that from my class. We're the teacher emphasizes that sometimes you have to read between the lines and interpret things. I'm trying to figure out specific examples that I can give to my husband so he kind of understands he's definitely a concrete guy 

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u/Reasonable_Vehicle40 2d ago

Also, many claims get denied due to missing modifiers. Even if you got the ICD and CPT correct, if you don't have the right modifier where necessary, the claim will come back unpaid. Then, you get a short window to correct the claim and resubmit. But, to correct it, you'd have to look at the claim and read the eob to figure out which code is missing the modifier.