Medical Billing and Coding

The Revenue Cycle

How Healthcare Gets Paid, From Patient Encounter to Final Payment

A practitioner's textbook.

Forty chapters. Fourteen appendices. One patient encounter, coded and billed from the moment the patient signs in to the moment the account reaches a zero balance one hundred days later.

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Before you read a single code

Code sets change on a schedule. ICD-10-CM is revised every October 1. CPT is revised every January 1. HCPCS Level II is revised quarterly. The National Correct Coding Initiative edit files are revised quarterly. Fee schedules, DRG weights, APC rates, and coverage policies change at least annually and sometimes with no notice at all.

So: never code from a textbook. Not from this one, not from any of them. Code from the current year's code book or your encoder, and verify coverage against the payer's current published policy. What a textbook can teach you — what this one is built to teach you — is the structure, the reasoning, and the habit of looking it up. Those do not expire.

Every fee, allowed amount, relative value unit, DRG weight, and payment rate in this book is constructed for teaching and labeled where it appears. Every patient, provider, practice, hospital, health plan, account, clinical note, claim, and remittance advice is likewise constructed. None of them describes a real person, organization, or transaction.

This book is not legal, clinical, or tax advice.

CPT® is a registered trademark of the American Medical Association, which owns the copyright in the CPT code set. This is an independent educational work and is not published, endorsed, or approved by the AMA.