Question 1

1. Is coding or billing done first?

Accepted Answer

Coding is done first. After the provider documents the encounter, coders assign ICD-10-CM, CPT, and HCPCS codes for diagnoses and services. Billers then use those codes to create the claim, submit it to the payer, and manage payment follow up.

Question 2

2. Can one person do both coding and billing?

Accepted Answer

Yes, especially in small practices. One person can manage both coding and billing if workflows are clearly structured. Detailed checklists, routine internal audits, and denial reports help catch missed edits and maintain accuracy across both functions.

Question 3

3. What yearly updates should coding and billing teams watch?

Accepted Answer

CPT code updates are released every January, and ICD-10-CM updates take effect each October. Teams should also track payer policy changes and clearinghouse edit updates throughout the year to reduce claim rejections and compliance risk.

Question 4

4. What KPIs show that the coder–biller handoff is healthy?

Accepted Answer

Key indicators include a high clean claim rate, a low initial denial rate, and reduced AR days. Coding audit accuracy is also important, showing that documentation and code selection align before claims are submitted.

Question 5

5. How do CPT and ICD-10 codes work together?

Accepted Answer

CPT codes describe what service or procedure was performed, and ICD-10-CM codes explain why it was medically necessary. The two must align correctly. Mismatched codes often lead to denials, delayed payments, and revenue leakage.

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