Acknowledgments

This book is built on documents that other people made free.

The ICD-10-CM Official Guidelines for Coding and Reporting are published every year by the National Center for Health Statistics and the Centers for Medicare & Medicaid Services, and they cost nothing. They are, page for page, the best-written technical rulebook in American healthcare, and a coder who reads them once a year is better than a coder who does not, without exception.

The National Correct Coding Initiative Policy Manual is likewise free, likewise revised annually, and likewise unread by most of the people it governs. The chapters in this book on bundling, on modifier 59, and on the shoulder arthroscopy that triggered an audit are all downstream of it.

The Medicare Claims Processing Manual, the Medicare Program Integrity Manual, the annual IPPS and OPPS rules, the Medicare Physician Fee Schedule files, the local coverage determinations published by every Medicare Administrative Contractor, and the OIG Work Plan are all public, all searchable, and all more authoritative than anything written about them. Where this book and one of those documents disagree, that document is right.

The American Medical Association maintains CPT, and its editorial process — the panel, the public comment, the annual cycle — is the reason a procedure performed in Ohio and a procedure performed in Oregon can be described by the same five digits. This book is independent of the AMA, is not endorsed by it, and does not reproduce the code set. It could not have been written without it.

AAPC and the American Health Information Management Association built the credentialing structure that turned this work into a profession with a ladder. Chapter 39 is a description of what they built.

The pedagogical debt is to two texts that shaped how this field is taught: Carol Buck's Step-by-Step Medical Coding, which established the pattern of teaching a code set by walking a learner through the actual lookup rather than presenting the codes as facts to memorize, and Lovaasen and Schwerdtfeger's ICD-10-CM/PCS Coding: Theory and Practice, which pairs the theory with enough applied charts to make it stick. Both are excellent, both cost money, and this book's existence is not a criticism of either. It is an attempt to put a version of what they do in the hands of people who cannot spend a hundred and fifty dollars on a textbook and three thousand on the course around it.

The real debt is to the people who do this work.

To the coder in a five-physician family practice who is the only person in the building who understands why the claim was denied, and who is asked to explain it to a physician who is between patients and does not want to hear it.

To the denial specialist working a queue of four hundred accounts, who has learned that CARC 97 means one thing at one payer and something else at another, and who keeps that knowledge in a spreadsheet nobody has ever thanked them for.

To the hospital outpatient coder who reads eleven operative reports before lunch.

To the clinical documentation specialist who has to ask a surgeon a question in a way that is both compliant and answerable, and who gets one shot at it.

To the practice manager who found the credit balance, reported it, and refunded it inside sixty days because that is what the law requires and because it was the right thing to do, and who then had to explain to the owner why the practice was writing a check.

And to every person who has ever sat with a patient at a window and explained, patiently, in ordinary words, what a deductible is.

None of you appear in this book by name, because this book has no named characters. You are all through it anyway.