Medical Coding & Billing

Welcome to Medical Coding & Billing

What medical coders and billers do, how the U.S. healthcare system pays for care, where coders work, and the path to certification.

How U.S. Healthcare Is Organized

Providers, care settings, the care team and place-of-service codes — the world your codes describe.

Health Insurance & Payers

Plan types (HMO, PPO, EPO, HDHP), Medicare Parts A–D and Medicare Advantage, Medicaid, coordination of benefits and reading an insurance card.

The Medical Record: What Coders Read

The documents in a patient's chart — SOAP notes, H&P, operative reports, discharge summaries — and how to read them to find what's codable.

The Healthcare Revenue Cycle

Follow a patient visit from scheduling to payment — registration, insurance verification, charge capture, coding, claims, adjudication, payment and denials.

Medical Terminology: Word Parts

Decode almost any medical word by splitting it into prefix, root, combining vowel and suffix.

Pharmacology Basics for Coders

Drug classes, routes of administration, and how medications show up in coding — long-term drug use Z codes, adverse effects vs poisoning, and drug billing.

Anatomy & Body Systems for Coders

The body systems coders meet most, the key structures in each, and the common conditions and procedures that go with them.

Cardiovascular & Respiratory Systems

How the heart, vessels and lungs work, the conditions coders see most (hypertension, heart failure, MI, AFib, COPD, asthma, pneumonia) and the procedures that treat them.

Musculoskeletal & Nervous Systems

Bones, joints, muscles, the spine and the nervous system — fractures, arthritis, back pain, stroke, migraine and the orthopedic and neuro procedures behind them.

Digestive, Genitourinary, Endocrine & Skin

The remaining core systems — GI tract, kidneys and reproductive organs, hormones and the skin — with the conditions and procedures coders see daily.

The Code Sets: ICD-10-CM, ICD-10-PCS, CPT & HCPCS

What each code set is for, who maintains it, how codes look, when they update, and which ones go on physician vs hospital claims.

ICD-10-CM: Structure & Conventions

How to look up a diagnosis code correctly — Alphabetic Index, Tabular List, code structure, placeholder X, 7th characters, and the instructional notes that change everything.

ICD-10-CM Official Guidelines

The rules that decide which diagnoses to code and in what order — first-listed diagnosis, signs and symptoms, uncertain diagnoses, combination codes, and chronic conditions.

Z Codes, Symptom Codes & Status Codes

When to use R codes (signs and symptoms), Z codes (encounters, history, status, screening) and how they're sequenced.

The Index Tables & Encoder Software

Use the Neoplasm Table, the Table of Drugs and Chemicals and the External Cause Index — and learn how encoders speed up lookup without replacing your judgment.

Coding Diabetes & Endocrine Conditions

Diabetes types, combination codes for complications, hyperglycemia/hypoglycemia, medication Z codes, secondary and gestational diabetes, thyroid and obesity.

Coding the Circulatory System

Hypertension and its combination codes, hypertensive crisis, heart failure, coronary disease, myocardial infarction timing, atrial fibrillation and stroke.

Coding Infections, Sepsis & Respiratory Disease

Organism codes, sepsis/severe sepsis/septic shock sequencing, HIV, COVID-19, pneumonia, influenza, COPD and asthma.

Coding Injuries, Burns, Poisonings & Complications

Multiple injuries, superficial injuries, burns and the rule of nines, poisoning vs adverse effect in practice, and complications of care (T80–T88).

Coding Neoplasms (Cancer)

Primary vs secondary sites, sequencing for treatment, chemotherapy and radiation encounters, anemia and pain with cancer, and current cancer vs history.

Coding Pregnancy, Newborns & Mental Health

Obstetric (O) codes and trimesters, delivery and outcome codes, newborn records, and behavioral health — depression, anxiety and substance use.

CPT Basics

How the CPT book is organized, how to find a code, guidelines, add-on codes and the unlisted-procedure rule.

E/M Coding: Office Visits

Choose the right office visit level — new vs established, medical decision making, time-based coding, preventive visits, and modifier 25.

E/M Beyond the Office: Hospital, ED, Consults & Telehealth

Hospital inpatient and observation codes, emergency department levels, consultations, critical care, nursing facility, prolonged services, split/shared visits and telehealth.

Preventive Medicine & Care Management Services

Annual physicals by age, Medicare wellness visits, counseling and screening services, chronic care management, transitional care and remote monitoring.

Anesthesia Coding

Anesthesia codes and crosswalks, the base + time + modifying units formula, physical status modifiers, qualifying circumstances and medical direction modifiers.

CPT Surgery: The Global Package & Multiple Procedures

Coding procedures beyond the office visit — the global surgical package, multiple procedures, radiology components, lab panels, vaccines and injections.

Surgery: Skin & Musculoskeletal

Lesion excisions, biopsies, wound repairs, debridement, incision and drainage, fracture treatment, joint injections, arthroscopy and joint replacement.

Surgery: Digestive, Cardiovascular & Other Systems

Endoscopy families and rules, hernia repair, cholecystectomy and appendectomy, vascular access, cardiac catheterization, PCI, pacemakers, and urology/OB-GYN highlights.

Radiology Coding

Diagnostic imaging, contrast rules, views, complete vs limited ultrasound, mammography, interventional radiology, nuclear medicine and radiation oncology.

Pathology & Laboratory Coding

Organ and disease panels, drug testing, CLIA-waived tests, repeat tests, surgical pathology levels and molecular pathology basics.

The Medicine Section: Vaccines, Infusions & Therapy

Immunization administration, injection and infusion hierarchy, therapy services and the 8-minute rule, psychiatry, ophthalmology, allergy and other Medicine-section services.

HCPCS Level II & Modifiers

Supplies, drugs and equipment with HCPCS Level II, and the modifiers that tell payers 'this service was different' — when to use them and when not to.

Modifiers in Depth

Every modifier family a coder uses — E/M, procedure, anatomic, global surgery, repeat, reduced/discontinued, assistant surgeon, payment and HCPCS informational modifiers — and how to sequence them.

Medical Necessity, NCCI Edits & ABNs

Why payers deny correctly coded claims — linking diagnoses to procedures, NCCI procedure-to-procedure edits and MUEs, LCDs/NCDs, and the Advance Beneficiary Notice.

Compliance, HIPAA & Fraud Prevention

Protect patient information, code honestly, and recognize fraud and abuse — HIPAA Privacy and Security, the False Claims Act, Anti-Kickback, Stark, and how audits work.

Coding Audits & Provider Queries

How internal coding audits are run, sampling, scoring accuracy, writing compliant provider queries and educating providers.

Claim Forms: CMS-1500 & UB-04 Field by Field

Fill out professional and institutional claims correctly — patient, insured, provider, diagnosis pointers, service lines, revenue codes, type of bill and value/occurrence codes.

Medical Billing: Claims, Remittances & Denials

Build and submit clean claims, read remittance advice, work denials with CARC/RARC codes, appeal, and manage accounts receivable.

Payment Posting & Reconciliation

Read EOBs and 835 ERAs line by line, post payments and adjustments, handle secondary claims, refunds and recoupments, and reconcile deposits.

How Providers Get Paid: Reimbursement Methods

Fee-for-service, the Medicare Physician Fee Schedule and RVUs, APCs for hospital outpatient, MS-DRGs for inpatient, capitation, and value-based payment.

Accounts Receivable & Patient Financial Communication

Work A/R aging, prioritize follow-up, call payers effectively, explain bills to patients, set up payment plans, and follow price transparency and the No Surprises Act.

Introduction to Inpatient Coding & DRGs

How hospital inpatient coding differs — principal diagnosis, secondary diagnoses, CCs/MCCs, ICD-10-PCS basics, MS-DRGs, and present-on-admission indicators.

ICD-10-PCS in Depth

The PCS sections, the 31 Medical and Surgical root operations by group, approaches, devices and qualifiers, and the key PCS guidelines with worked builds.

MS-DRGs, Case Mix & Clinical Documentation Integrity

How the grouper assigns MS-DRGs, CC/MCC tiers and exclusions, common CC/MCC conditions, APR-DRGs, quality indicators, and the CDI specialist's role.

Hospital Outpatient & Facility Coding

ED facility levels, observation services, the 3-day payment window, the two-midnight rule, Outpatient Code Editor edits, ASC rules and facility-specific modifiers.

Risk Adjustment & HCC Coding

How Medicare Advantage and ACOs use diagnosis codes to predict cost — HCC models, RAF scores, hierarchies, MEAT documentation, annual recapture and RADV audits.

Certification Exam Strategy

What the CPC (and similar) exams test, how to prepare your books, time management, answer-elimination techniques, and a 6-week study plan.

Coding Practicum: Real-World Cases

Work through complete encounters the way you would on the job — office, ED, outpatient surgery, inpatient and risk adjustment — from documentation to clean claim.

Data Skills for Coders: Excel, SQL & Reporting

Use spreadsheets and simple queries to analyze coding and billing data — productivity, denial trends, E/M distribution — and grow into revenue cycle analytics.

AI, Automation & the Future of Coding

Computer-assisted coding, autonomous coding and generative AI in revenue cycle — what they do well, where they fail, the coder's evolving role and safe, compliant use.

Job-Ready: Certification, Workflow & Your First Coding Job

Prepare for the CPC exam, practice like a working coder (productivity and accuracy), use encoders and EHRs, and land your first coding or billing role.