The Journal

Notes from the field. I write about the things certification programs don't teach you, the mistakes I see coders making every day, and the mindset shifts that separate good coders from great ones.

Volume IV From the Field
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"I don't guarantee jobs. But I guarantee you'll leave this training significantly more capable and confident than when you arrived."

— Ann Reilly, Founder
Medical coding handbook open on a desk, highlighting complex guidelines and 'Excludes' notes

What's the Difference Between an Excludes1 and Excludes2 Note?

CMS just released the April 2026 ICD-10-CM update, changing several Excludes1 notes to Excludes2. Here's what it means for your coding.

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Healthcare compliance officer reviewing medical coding data on a modern screen

AI Attestation Is Now a Compliance Mandate, Not a Tech Trend

Human sign-off on AI-assisted coding is shifting from “nice to have” to a contractual requirement. Here is what AI attestation really means.

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Inpatient medical record and data visualization charts representing risk adjustment

Why HCC Risk Adjustment Is Showing Up in Inpatient CDI

CDI and documentation roles are increasingly asking for HCC/risk adjustment experience. Here's why this shift is happening and what it means for you.

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A cinematic view of a medical coder's workspace, representing advanced coding mastery

CPC-M Is Here. What Does That Mean for New Coders?

AAPC announced its new master-level credential. Here is what it actually means for employers and why you shouldn't panic if you are a beginner.

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Healthcare manager holding certifications

The Myth of the Coder Shortage: We Don't Lack Credentials, We Lack Training

Employers say they can't find coders, but what they really can't find are experienced coders. Here's why the "shortage" is actually a training gap.

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AI productivity paradox in medical coding

The Productivity Paradox: When AI Makes Coders Slower

If your inpatient coding team adopted AI tools but still feels bogged down by audits and rework, you might be facing the productivity paradox.

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Healthcare manager reviewing onboarding checklist

You Finally Got a New Hire. Now You Have Two Weeks to Keep Them.

The position was open for five months. You finally found someone. Here is what intentional onboarding looks like when your team is already stretched thin.

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Healthcare manager looking at computer screen

Your Team Just Got AI. Nobody Asked You If You Were Ready.

Hospitals are investing in AI at an unprecedented pace. The problem is that the rollout strategy rarely includes the frontline supervisor.

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Focused professional reviewing coding guidelines

When the Auditor Says You're Wrong and You Know You're Not

You coded it correctly, and you can prove it. This is the moment that separates coders who defend their work from coders who just let things go.

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Two professionals reviewing charts in dispute

What Not to Do When the Auditor Won't Budge

You submitted your rebuttal. You did everything right. And the auditor came back and said the recommendation stands. Now what?

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Medical coder surrounded by AI search results

Why Internet Search and AI Alone Will Set You Up to Fail

AI invented a code that doesn't exist. Google returned an outdated answer. Then both wound up being the perfect illustration of why you can't rely on either.

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Medical coding professional with ICD-10 codebook

Why Google and AI Alone Won't Get You Far — Part 2

Pitfall #2: Missing the instructional notes and guideline nuances that Google results never surface — and that AI confidently gets wrong.

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Person at a crossroads with glowing pathways

The One Thing Stopping Many of Us from Taking the Next Step

Consequence paralysis. It's not just the overwhelm of choices — it's the fear behind them. A candid reflection on choosing progress over perfection.

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A non-traditional career path through healthcare

The Unconventional Career Guide

Not every path into medical coding looks like the brochure. Here's a real guide for people arriving from somewhere unexpected.

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Medical coder studying specialty reference materials

The Gap from Basic Medical Coding to Specialty Coding Is Real

Your certification got you in the door. Specialty coding requires something entirely different — and no one warns you how wide that gap actually is.

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Student mapping out an exam preparation strategy

Studying and Exam Prep: Starts With a Plan, Not a Study Guide

The study guide is a tool, not a strategy. Here's how to build a plan that actually moves you toward passing — not just feeling busy.

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Quiet morning reflection symbolizing renewal after loss

Rediscovering Yourself After Grief

Grief changes who you are. Coming back to yourself — to your work, your purpose, your ambition — is its own kind of skill.

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Executive reviewing revenue cycle metrics

Retention, ROI, and Resilience: A Smarter RCM Strategy

Why RCM leaders should build their coding teams from within. A strategic case for mentorship, retention, and the ROI of growing coders internally.

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Series: Ethics and Medical Coding in the Age of Quotas
Medical coder weighing ethical decisions

Ethics and Medical Coding in the Age of Quotas

When production pressure meets clinical accuracy, something has to give. It shouldn't be your integrity. Part one of a four-part series.

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Coder reviewing documentation under pressure

Ethics and Medical Coding in the Age of Quotas — Part 2

The real cost of quota-driven coding isn't always visible on an audit report. This is what it looks like from the inside.

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Compliance officer reviewing coding policies

Ethics and Medical Coding in the Age of Quotas — Part 3

Leadership's role in creating ethical coding environments — and what happens when that accountability is missing.

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Medical coding team building a culture of integrity

Ethics and Medical Coding in the Age of Quotas — Part 4

Rebuilding ethical coding culture from the ground up: practical frameworks and the long game of doing it right.

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