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Tag Archives: coders

New clinical criteria definitions in 2017 Official Guidelines up the ante for coders

New clinical criteria definitions in 2017 Official Guidelines up the ante for coders

by Laura Legg, RHIT, CCS, CDIP, and AHIMA-approved ICD-10-CM/PCS trainer

The new guideline for code assignment and clinical criteria in the 2017 ICD-10-CM Official Guidelines for Coding and Reporting does not mean clinical documentation improvement is going away; instead it just upped the ante for continued improvement.

Up the ante means to increase the costs, risks, or considerations involved in taking an action or reaching a conclusion. With the new coding guideline for clinical validation that went into effect October 1, the stakes remain high for the diagnoses documented by the physician to be clearly and consistently demonstrated in the clinical documentation.

It is not that the information was not there before, but now the issue is finally getting attention. When clinical documentation is absent, coders are instructed to query the provider for clarification that the condition was present. But what are we to do if the clinical indicators are not clearly documented? For HIM professionals who deal with payer denials, this has been a haunting issue for a very long time.

The ICD-10-CM Official Guidelines for Coding and Reporting are the foundation from which coders assign codes. Coders need to review the new guidelines in detail to understand the changes and implications for their facilities.

The Centers for Disease Control and Prevention published these new guidelines which can be read in their entirety here:


Taking a closer look

The coding guideline for section A.19 (code assignment and clinical criteria) has been labeled as controversial and, at this point, we have more questions than answers. Denials issued by payers due to the absence, or perceived absence, of clinical indicators by which the payer lowers the DRG is now being called DRG downgrading and it’s getting attention.

The code assignment and clinical criteria states:


Physicians and other providers document a patient’s condition based on past experience and what the clinician learned in medical school, which often differs from clinician to clinician. When you put a patient in front of a group of clinicians you will most likely get differing documentation. So how do we fix that?

The diagnosis of sepsis is a good example. There does not appear to be a universally accepted and consistently applied definition for the condition of sepsis.

In a patient record with the principal diagnosis code of sepsis, followed by the code for the localized infection, pneumonia, a payer denial could occur.

Payer denials often deny the sepsis diagnosis code stating that "the diagnosis of sepsis was not supported by the clinical evidence. Therefore, as a result of this review, the diagnosis code A41.9 [sepsis, unspecified organism] has been removed and the principal diagnosis re-sequenced to code J18.9 [pneumonia, unspecified organism] for pneumonia and to the lower paying DRG 193." This is now being referred to as a DRG downgrade. DRG downgrades can occur for different reasons including both DRG coding changes and clinical validation downgrades.


What is a coder to do?

What is a coder to do when a physician documents a diagnosis that may not be supported by the clinical circumstances reflected in the patient’s chart? Facilities and coding teams should develop guidance and be sure they fully understand the content and the impact of this coding guideline to coding practices.

Remember the section that reads: "the assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient."

This represents a catch-22. If the diagnosis is not clinically validated, both recovery auditors (RA), as well as commercial insurance auditors, are going to deny the claim. On the other hand, if coders or the facility decide not to report the diagnosis, they are in violation of the coding guidelines, which is also a major problem.

AHIMA’s 2016 Clinical Documentation Toolkit offers this advice:

The toolkit is available here:


Increasing clinical documentation

As the healthcare industry experiences an increased number of external audits, both federal and private, the need to up the ante on clinical documentation has become essential. The answer is not to let this guidance prompt lazy documentation, which has far reaching consequences, but to use it as a catalyst for improvement.

The goal of any clinical documentation improvement (CDI) program is to ensure a complete and accurate patient record, and this cannot be done without the presence of documentation supporting the clinical indicators and clear and consistent documentation regarding the condition. The provider’s documentation of their full thought process will accomplish this. If medical staff can come together and agree upon a definition for a certain condition, they can begin the process of being consistent with how the description is presented in the patient record.

CDI specialists and coders should not use the new guideline as an excuse not to query. Coders are not clinicians and, therefore, should not be expected to evaluate clinical criteria. Coding and CDI were separate functions, but, as audits from outside organizations expand, there is more emphasis on correct coding, DRG assignment, and the use of clinical criteria to support the reported codes, which means these entities need to work together.

The American Hospital Association’s Coding Clinic for ICD-10 instructs coders not to use background clinical information contained in their responses for code assignment. This information is only provided so the coders can make a judgment to query where there is incomplete documentation. Coders and CDI staff should review all chart documentation and data, and query when necessary to clarify inconsistencies in physician documentation.

Query the provider to support their diagnostic and procedural documentation by making a specific reference to the clinical basis of the diagnosis, and also by noting the absence of specific expected criteria such as radiographic findings, lab values, or patient manifestations.

External auditors in turn need to be following the same rules and coding guidelines as we do. Reviewers for facilities plagued by copious denials are finding auditors making up their own rules, using obsolete or outdated criteria, and clearly not understanding basic terminology used in the 2017 IPPS final rule.

DRG downgrading may be illegal, and some states intend to find out using state level legislation. Downgrading is, at the very least, disregarding the physician’s clinical judgment. We can’t forget who has eyes on the patient. Coders and CDI specialists should take documentation one step further and ask physicians to document their thought processes, the clinical indicators they are seeing, and their rationale for diagnosis determination.

Remember, coding is not based on clinical criteria. Coders cannot disregard physician documentation based on clinical indicators in the patient record, so, we will always need to ensure documentation is complete, accurate, and reflective of the patient’s clinical condition.


Editor’s Note:

Laura Legg, RHIT, CCS, CDIP, is an AHIMA-approved ICD-10-CM/PCS trainer, and director of HIM optimization at Healthcare Resource Group in Spokane Valley, Washington. For questions, please contact editor Amanda Tyler at Opinions expressed are that of the author and do not represent HCPro or ACDIS. – Briefings on Coding Compliance Strategies

How coders can build a successful relationship with their physicians

How coders can build a successful relationship with their physicians

by Sue Egan, CPC, CCD

All coders know that working with physicians is not always a positive experience.

It can be tough providing them education or getting responses from queries. Conversely, providers are busy and typically do not like anything to do with coding. When they hear coding they often take that to mean more work on their part.I have been working with providers for many years and the one thing coders always ask me is, ‘What is your secret for getting along so well with doctors and engaging them to change behavior?’

Building a relationship with your providers can make both of your lives easier. Outlined are a number of ideas that can facilitate building a strong relationship with your physicians.

  • Documentation clarification inquiries for the hospital are likely to support physician billing. Communicate to the physicians that if the hospital is asking for documentation it will better support their billed services as well. Complete and accurate documentation will hold up to increased scrutiny by payers.
  • Demonstrate why. When you ask a physician to change the way he or she documents in the medical record, show them why it matters. Show how accurate and complete documentation enables appropriate risk adjustments for the patients a physician treats. Remind physicians that good documentation can prove that the patients he or she treats really are sicker than others. This approach is more effective than stating the hospital will get a higher paid DRG.
  • Knowing when to step away will help you keep a positive relationship with a provider.
    • Regardless of how important the material is you want to educate the provider on, if he or she has a patient that has just passed away, now is not the time to share?they won’t remember what you tell them. Let the provider know you recognize the situation and will reschedule.
    • If you know a physician is overwhelmed or is having a really bad day, then recognize that now may not be a good time and offer to reschedule.
  • Be available. When approaching a physician for one-on-one education, be flexible in your availability. This could mean coming in early to meet with a doctor before his or her first case. If the physician can meet at lunch, do it. Recognizing the physician’s workload demands and being flexible will yield many benefits to the relationship.
  • Be prepared. Physicians will ask you a question once, maybe twice, where you can say, ‘I don’t know,’ but chances are they won’t ask a third time. Be creative in your response. Instead, try saying, ‘You know, I just read something about that, let me go back and make sure I am giving you the most updated information,’ or ‘I just saw something on this, I am not sure if it was CMS or carrier directed. Let me find it and get back with you.’ Once you lose a physician’s trust, it is very difficult to regain it.
  • Don’t waste their time. One of the biggest complaints I have heard from doctors is related to queries they deem as a waste of time. Make sure the query or question you are asking is
    • Addressed to the right physician/provider
    • Relevant to the patient care being provided
    • The information you are basing your query on is accurate
  • Walk in their shoes for a day. Offer to round with them, where you can provide live audit and education to the provider. See how their days really are. In most cases, you will be amazed at how much they get done.
  • Be a better listener. Some coding and documentation guidelines are not clinical in nature and providers can get frustrated by being asked to document things that aren’t clinically significant (e.g., family history for the 85-year-old patient). Sometimes your provider may just need to vent this frustration and while you may not have a resolution to offer, listening and understanding can go a long way in building rapport.
  • Ask questions. Ask your provider how they translate a patient visit into medical record documentation. Questions that might solicit opportunities for improved documentation may include:
    • What questions are they asking when interviewing the patient?
    • What concerns do they have?
    • What is the patient experiencing? You can utilize this information to point out how the documented note can better demonstrate the patient’s current condition and treatment plan.
  • Share the good as well as the bad. When a physician is doing a really great job documenting timely, accurately, and completely, give them a shout out. Or, when they answer queries timely, let them know. A quick note with a smiley face or even a gold star will be very much appreciated. Positive recognition given to one physician and not another often results in the physician inquiring how he or she can get recognition.
  • Sports and (other interests). While engaging physicians in discussions such as sports is completely unrelated to coding and documentation, it can pay off significantly. Many providers are very loyal to their alma mater’s college football and basketball teams. Relationship building can be accelerated when you engage physicians in areas of personal interest. Gaining an understanding of a physician’s college coach, conference, and team standing, and discussing this information with a physician can go a long way to building a relationship. But sports isn’t the be-all, end-all. If you know a doctor has a particular interest (cooking, piano, horror movies, or painting) learning a little about that interest can go a long way. Expanding your knowledge is a good thing and building your relationship with that provider is a great thing.
  • Empathy. It is important to remember that physicians are busy with competing priorities. Providers often get interrupted while they are dictating and/or documenting their notes, and when they leave something out of their notes, it is not intentional.


Recognizing that one of our major responsibilities as coders and documentation specialists is to make the physician’s job easier and their data as accurate as it can be is essential.

Avoid approaches that make them feel like they have done something wrong. Let providers know your job is ‘to make you look as good as you are.’



Editor’s note

Egan is an associate director with Navigant Consulting and has been working with providers, of all specialties, for more than 25 years. She works with providers to improve documentation as well as provide education and training related to CPT coding. Sue has lived in Charlotte, North Carolina, for the last 23 years, enjoys traveling with friends, and relaxing at home with a good book and her cats. Opinions expressed are that of the author and do not represent HCPro or ACDIS. – HIM Briefings

CSI Dallas/Fort Worth Texas Coders (HCC)

CSI Healthcare IT is actively seeking Traveling HCC Coders for a Large Project in the following cities:

Fort Worth, TX
Dallas, TX

*If you are close by to these cities and are willing to fly or drive, travel will be covered within the project. ALL Travel will be reimbursed (gas, etc)

Remote work unless you are have appointments onsite with clients
Certified Coder through AAPC
3 years of Risk Adjusting experience
Will be Educating, Auditing and Coding onsite
ICD-10 & HCC experience

If you are interested in hearing more about this opportunity, please reach out to directly with a copy of your resume to Meredith Smith,

Medical Billing and Coding Forum – General Discussion

Twelve Codes of Christmas: On the Seventh Day of the Coder’s Christmas (F40.00)

I have decided to start limiting my daily news intake to no more than 30 minutes per day.  This is mainly because the news has been so depressing lately and although I think it’s important to be informed, I think there comes a point when you just have to tune out before you decide to never leave your house again. 

I was looking through some old photos recently  and came across this old one of my dog Ginger.  Ginger is no longer with us, but I still have some great pics of her sweet little face.  This one struck me not only because of her expression, but also because of the bows.  No, I didn’t put bows in my dog’s ears on a regular basis.  I would take her to the groomer before the holidays and she always came back looking frilly and cute – with bows. It was always a test to see how long those bows would last before she shook her head enough or tried to pull them out with her paws.  Taking Ginger to the groomer was an event.  She was okay as long as we got in the car and headed north, because that meant she was on her way to see my parents and her favorite person – Grandpa.  But if we headed west, there were only two options: the vet and the groomer.  She wasn’t a fan of either.

So for the seventh day of Christmas, I dug out this picture of my Christmas pup for our daily carol and code:

  • I Heard the Bells on Christmas Day but Wouldn’t Leave my House (F40.00, Agoraphobia, unspecified).

Incidentally, Ginger was always up for leaving the house on Christmas if food was being carted to the car.  She always expected that once the food was packed up, she would be leashed up and we would join the party at a family member’s house!
Coder Coach

Twelve Codes of Christmas: On the Eighth Day of the Coder’s Christmas (F40.10)

What is Christmas – or any holiday celebration – like for you?  Is is a small intimate affair or is it a madhouse?  Do you get along with your family, or do you leave the celebration giving thanks for the fact that you didn’t choke anyone to death for another year?

I am blessed with a large and happy family.  A very loud and rambunctious group.  Our holiday traditions have undergone some adaptations over the years, but there are a few constants:  there will be lots of food; there will be many goofy white elephant gifts; and there most likely will be a pet or two present.

In case you can’t tell, I’m a bit of an animal lover.  And while looking through pictures to match my 12 Days of Codes, I found this gem.  This is Beau, my aunt’s cat.  And while I have a cat who is really more like a dog and can be found in the mix during family get togethers (and probably looking for a stationary lap to dominate), Beau has a tendency to do a cursory survey of the situation before retiring elsewhere.

So Beau, this carol and code are for you:

  • Have Yourself a Merry Little Christmas While I Sit Here and Hyperventilate (F40.10, Social phobia, unspecified)

Coder Coach

Hiring Process Of Computer Coders

Computer coding professionals have great career prospects to pursue. Termed popularly as computer programmers, computer coders are part and parcel of website maintenance jobs. Chief job responsibility of computer coders is writing computer programs. They use specific scripting languages for program writing.

Services of computer coders are mostly hired by web designers and businesses that own websites. There are people who are acquainted with the job of marketing script. However, they cannot take care of the maintenance-related jobs of websites unless they have knowledge about creating and producing marketing scripts digitally. It can be performed by only trained people who work as professional coders.

Rapid growth of businesses and cutting-edge competition market are some of the factors that allow businesses and entrepreneurs to hire the services of coders. There are people who look for the option to find a coder but they fail to proceed in absence of any guideline. The following tips would guide such people when they are up to find a coder.

Your first step towards finding a coder should be creating an advertisement. This advertisement should be published in local newspapers. For better result, you can also post the advertisement on online job boards. As soon as you would publish the advertisement, you would start receiving phone calls and mails from candidates.

However, you should ensure that you have comprehensive knowledge about the requirements of your website coding jobs before you make the advertisement public. While publishing or posting the advertisement, make sure that you mention your own contact number and mail address.

Now, you can shortlist the candidates before calling them up for interview. You can select coding professionals that you require in the most conveniently if you proceed in this way. There are some employers who want to find a coder on freelancing basis. For, this type of people, it is recommended that they should direct their efforts towards freelance marketplaces. Freelance marketplaces can help them find a designer, as well.

Steve Harmision writes about freelancing jobs and provides fruitful information about best freelance projects. To find a coder or find a designer for your project, please visit

Twelve Codes of Christmas: On the Ninth Day of the Coder’s Christmas (F90.0)

Today is my last work day before Christmas.

I have Christmas baking to do.

I have shopping to do for Christmas dinner.

I can’t wait to see family – both those from in town and from out of town.

Don’t you love this time of year?

Don’t you feel like a little kid again as the clock ticks down to 5:00?

Maybe I’ll get off early today.

I wonder if it will snow.

Is that a squirrel sitting in a tree and staring in at me?

How do I get myself to focus on work today?!

Today’s carol and code?  Maybe you’ve already guessed:

  • We Wish You… Hey Look!  It’s Snowing!! (F90.0, Attention-deficit hyperactivity disorder, predominantly inattentive type)

Coder Coach

Twelve Codes of Christmas: On the Tenth Day of the Coder’s Christmas (Y93.G3)

Today is baking day.  I haven’t had a lot of time in the last few years to do any holiday baking, but I decided to take a day to get some goodies baked up for “dessert” on Christmas Day.  We’ll see how many of these cookies make it all the way until Tuesday.

There will be my mom’s famous cut-out cookies, which are now my famous cut-out cookies – the recipe having been stolen by a homemaker friend with a passion for decorating cookies.  The true secret to the cookies is to roll them out using confectioners sugar instead of flour (diabetics beware!). 

There will be molasses cookies from a family gingersnap recipe.  What makes them molasses cookies instead of gingersnaps, is an airtight container and a slice or two of fresh bread.  The cookies absorb the moisture from the bread leaving a super soft and spicy treat. 

There will be Mexican wedding cookies.  But we never called them that growing up – we called them Grandmother Stanton’s horseshoe cookies for their shape and the fact that I had never had this cookie anywhere else before.

And there will be oven mitts.  Lots of oven mitts. I’ve been a baker since I was a little girl – my mom and I used to bake around Christmas time and by the time I was a teenager, the job was all mine.  And even though I am no stranger to cooking or baking and I know my way around a kitchen pretty well, I burn myself at least once or twice a year while taking something out of the oven.  It’s so bad, my boyfriend has quipped that he’s going to get me welding gloves for Christmas. 

So today I’m going off script and taking a break from the Christmas Carols for the Psychologically Challenged to bring you this occasion-appropriate activity code:

  • Y93.G3, Activity, cooking and baking

If you are tackling this same task today, be sure to watch out for those hot ovens!
Coder Coach

Top 10 Cringe-Worthy Things Wannabe Coders Say

My blog is over six years old!  Seriously, I just checked.  In the last six years as I’ve put myself out there as the Coder Coach, I’ve spoken either personally, over the phone, or via email to hundreds – okay, it’s really probably dozens – of coders and tried to answer their questions about what it takes to be a coder.  I’ve been amazed at how those answers have changed since then, from the evolution of technology, which allows most coders to work remotely to finally seeing ICD-10 come to fruition. So I figure it’s about time I published my top 10 list: the most cringe-worthy things people say when they tell me they want to be a coder.

Don’t get me wrong.  My intent is not to put anyone off, but over the last six years, this coding thing has really caught on and I wouldn’t want to steer anyone into a career that isn’t right for them.  So take a moment to read through the list and decide if you’re guilty of any of these. Since David Letterman’s Late Show is no longer a thing, consider this my replacement Top Ten List.

And before you get upset, please read the sign: I’m not arguing, I’m just explaining why I’m right.  In other words, I’m being a coder (occupational hazard).

Number 10:Which type of coder pays the most?

Answer:  A really good one.  Focus your efforts on landing a job and then mastering it.  If you choose your work setting solely for making money, you may find yourself miserable and (maybe) sort of well off.  If you choose to follow your passion, the possibilities – and pay check – are pretty much endless.  Employers are willing to pay good money for really good coders who don’t complain about how much they hate their jobs.  I don’t actually do any hiring, but if I did, I would hire the hungry novice coder with a good attitude and a willingness to learn over the experienced grouchy coder who seems to hate her job.

Number 9: Should I be a hospital or physician coder?

Have you ever seen the movie City Slickers?  The answer is in that movie when Jack Palance says the meaning to life is “one thing.”  Billy Crystal asks him, with great interest, what that one thing is.  The answer: that’s what you’ve gotta figure out.  You and only you can decide which setting is right for you and there is no right or wrong answer.  I love getting an inpatient hospital chart and trying to figure out the latest surgical procedures and how to code them.  I would rather poke my eyes out with a dull pencil than assign an E/M level to a physician’s chart.  I know other coders who love E/M coding.  It’s like being a cat person or a dog person.  You will probably find that you like one more than the other and there is no wrong answer (unless you are not a cat person, and then we can’t be friends anymore).

Number 8: No one will hire me with the coding credential I have; they all want something else

This is probably going to sting a bit, so brace yourself.  Why did you pay to get credential without first looking at local job postings and doing some research?  If you are reading this before going to school or getting certified, then do your homework before you pay any money to any educational institution.  All kinds of people will tell you anything to get your money.  Only local employers will be honest about what credentials they want.

Number 7: Where can I get free continuing education credits?

Free CEUs are out there, you just have to look for them.  Most AAPC local chapters offer free monthly educational sessions.  There are opportunities to summarize articles and get credit.  Coding Clinic offers a quarterly webinar that is free.  Other organizations offer free CEU credits.  Do an internet search and you may be surprised what you will find.  Did you do something, like attend grand rounds at a hospital, that you thought was very educational but you don’t have a certificate?  Contact the certifying body and see if they will grant you CEUs for it.

Number 6: I can’t afford to join AHIMA or AAPC

This one might sting too.  Find a way to make it happen.  As far as I’m concerned, when I hear this, it tells me you don’t want it bad enough.  Granted, I started very young and was still living at home when I first joined AHIMA, but make no mistake, I worked hard to get where I am today. Find a way to afford that membership and show people you are serious about a coding career.  And if you have a credential through and let your membership lapse, you likely lose the credential.  You worked hard for that credential – don’t let it go.

Number 5: This is my second (or third) career; I can’t afford to start at the bottom

This is a great second or third career for people who discover they missed their passion until later in life.  But here’s the reality: you still likely have to start at the bottom.  I’ve seen people find their way into coding by some very unusual means, but the ones who make it are the tenacious ones who won’t take no for an answer.  Pretty much no one starts out in their dream coding job.  You will have to pay your dues.  And please don’t think that means  I can’t appreciate your experience in your previous profession.  There are definitely things you can bring to the table, but remember that in coding, you are a novice.  I’m a great coder, but I’m pretty sure if I decided to change careers tomorrow and become an aerospace engineer, there would be a bit of a learning curve. 

Number 4: Will you mentor me?

It’s an innocent question and I’m flattered.  Really.  But I decided a long time ago that I would mentor from afar by penning this blog.  I don’t have a consistent schedule to be able to spend a lot of quality one-on-one time mentoring.  But if you email me a specific question, I will do my best to answer it.  My advice is to find someone local to mentor you.  Ask them if they can meet you once a month for lunch and come prepared.  What are the questions you want answers to?  What challenges have they had in their career that they wish someone would have told them when they were getting started?  This is a great entry into your local coding network.

Number 3: I went to school for (fill in the blank) months/years and I’m certified; I’m qualified to be a coder anywhere

No.  You’re really not.  I went to school too for two years and let me just tell you that even though I learned some good fundamentals, the real coding world is nothing like I thought it would be.  I learned everything I really needed to know about being a coder on the job, not in school.  I’ve now been coding for more than 20 years and I hold four different certifications and I have a news flash for you: I am not qualified to code anywhere.  I lack the practical experience of a physician office coder.  I find coding radiation oncology charts waaaaaayyyy outside my comfort zone.  And please don’t ask me to fill out an IRF-PAI for inpatient rehabilitation.  In other words, after 20 years, I am not all that and a bag of chips, so please don’t insult the world of experienced coders by thinking you have this all figured out.  I learn something new each. and. every. day.  Keep an open mind and be willing to learn – and admit when you’re in over your head.  Natural curiosity and a willingness to learn is a good thing.  Acting too big for your britches is not.

Number 2: How can I get experience if no one will hire an inexperienced coder?

I would give anything if people would stop asking me this question.  Because honestly, I don’t know the answer.  I don’t know what your background is.  I don’t know what your aptitude for coding is – and it is a skill that many people don’t possess.  I don’t know where you’ve applied or how hard you’ve tried to sell yourself.  And probably most importantly, I don’t have a clue what it’s like to try to get a job today because the atmosphere is so different from 20 years ago.  But this is what I do know.  Don’t limit yourself to coding jobs.  Find a job – any job – that will require you to have coding knowledge.  When you do an online job search, search on the code sets (ICD-10 or CPT) and not the word coder.  There are so many jobs out there that revolve around coding that aren’t traditional coding jobs.  Getting your foot in the door is one step closer to getting that traditional coding job – or something even better than you ever imagined.  And don’t forget to network.  If you want to work with coders, surround yourself with coders.  Who you know may be your golden ticket.

And the Number 1 Cringe-Worthy Thing Wannabe Coders Say is: I want to be a coder because I want to work from home

AACK!!!!  Not a good lead in!  And if this is the first statement out of your mouth when you go into an interview, you probably won’t get hired because here’s a huge industry secret: hiring managers hate hearing that’s why you’re there.  It’s like going on a first date with someone you just met and gushing about how badly you want to get married and have 6 kids. It’s just not done.  If this is the real reason you want to be a coder, please re-evaluate.  Coding is a great career if you love it.  If you don’t love it, you will be miserable for 8 hours every day.  And if you are miserable at home for 8 hours a day, that can be really depressing.  Also think about the child care aspect.  I often hear people say they want to work from home because they can’t afford child care.  Many coding contracts require you to have child care in place.  Coding takes intense concentration and you can’t babysit a kid at the same time.  Working from home is a great perk, I will admit, but it is not the reason I have the job I have.  I refer you back to Number 10 above: follow your passion.  If you’re lucky, you can make some good money while you do what you love… from home… in your bathrobe.

Coder Coach

Medical Coding and Billing Salary – Certified Medical Billers & Coders Earn a Higher Salary

The average annual medical coding and billing salary ranges from $ 25,000 at the entry level to around $ 44,000 at the senior level. Two factors that matter a lot toward getting a higher salary are: (1) national credentials like CPC or CCS-P, and (2) work experience as a professional biller and coder. Another factor that affects your hourly income is your geographical location. Billers and coders in larger cities earn more than those in smaller ones.

Read more at:

Medical Coding Exam Prep