Medical Billing and Coding Interview Questions and Answers

Medical billing and coding interviews follow a fairly predictable pattern. Most employers run one or two rounds: an initial phone or video screen with HR, followed by a detailed interview with a coding manager or supervisor. Some add a coding assessment as a separate step.

You'll face questions in three areas: technical knowledge (do you understand ICD-10-CM, CPT, modifiers, and coding software?), behavioral competencies (can you handle the pace, stay accurate, and communicate clearly?), and compliance awareness (do you understand HIPAA, ethical coding, and regulatory requirements?).

For remote positions, interviewers often ask about your home office setup, your experience working independently, and your ability to manage time without direct supervision. Remote coding is common in this field, with AAPC reporting that roughly 64.8% of coders work remotely at least part-time.

Most interviews last 30 to 60 minutes. Bring your certification documentation, a copy of your resume, and specific examples from your training or work experience.

Technical questions test your working knowledge of coding systems, guidelines, and processes. Here are the most common questions with guidance on strong answers:

"Walk me through how you'd code a patient encounter." Describe your process step by step: review clinical documentation (physician notes, operative report, lab results), identify the reason for the visit and all relevant diagnoses, determine the procedures performed, select appropriate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes, apply any needed modifiers, and verify sequencing rules. Mention that you'd query the physician if documentation is incomplete or ambiguous.

"What's the difference between ICD-10-CM and CPT?" ICD-10-CM codes describe diagnoses (the "why" of the encounter), while CPT codes describe procedures and services (the "what" was done). ICD-10-CM is maintained by the CDC and CMS and contains roughly 72,000 codes. CPT is maintained by the AMA and covers evaluation and management, surgical procedures, radiology, pathology, and medicine services.

"What would you do if documentation is unclear or incomplete?" This comes up in nearly every interview. The correct answer: you'd submit a physician query, a formal documented request for clarification. Emphasize that you'd never assume a diagnosis or assign a code based on incomplete information. You understand the difference between a compliant query (asking for clarification) and a leading query (suggesting a specific diagnosis, which isn't appropriate).

"Explain how you'd use modifier -25." Modifier -25 indicates a significant, separately identifiable E/M service performed on the same day as another procedure. It's one of the most frequently used and audited modifiers. Explain that you'd verify the documentation supports a separately identifiable E/M service beyond the work inherent in the procedure.

"How do you stay current with coding updates?" Mention the annual ICD-10-CM and CPT code set updates (effective October 1 and January 1, respectively), CMS transmittals and MLN Matters articles, AAPC or AHIMA continuing education units (CEUs), coding webinars, and professional forums. If you subscribe to specific resources like AAPC's Codify or CMS.gov updates, name them.

"What's an NCCI edit?" The National Correct Coding Initiative establishes code pair edits that prevent improper payment for procedures that shouldn't be billed together. Explain that you check NCCI edits to make sure code combinations are compliant and that you understand when a modifier (like -59 or -XE) can bypass an edit when documentation supports distinct services.

"What coding software have you used?" Be specific. Name EHR systems (Epic, Cerner, Meditech), encoders (3M, Optum360, TruCode, Codify), and any practice management or clearinghouse systems you've used. If you've only used software in a training environment, say so honestly, but emphasize your comfort level and willingness to learn new platforms.

Behavioral questions assess how you handle real-world situations. Use the STAR method (Situation, Task, Action, Result) to structure your answers with specific examples:

"Tell me about a time you caught an error before it caused a problem." This tests attention to detail. Describe a specific instance from your practicum, training, or prior work where you identified a discrepancy, such as a mismatched code, missing modifier, or duplicate charge. Explain what you did to correct it. Quantify the impact if possible ("prevented a $3,200 overpayment" or "caught the error before claim submission").

"How do you handle a high-volume workday when you're behind on production?" Employers need coders who can balance speed with accuracy. Explain your approach to prioritization: which encounters you'd tackle first, how you manage focus during long coding sessions, and any strategies for maintaining accuracy under time pressure. Be clear that you wouldn't sacrifice accuracy for speed.

"Tell me about the last claim denial you encountered." Walk through the denial scenario: the reason code, how you investigated the root cause, what action you took (resubmission, appeal, documentation request), and the outcome. If you haven't worked with live claims yet, use an example from your training program.

"How do you handle disagreements about a coding decision?" Emphasize that you rely on documentation, official coding guidelines (ICD-10-CM Official Guidelines, CPT Assistant, Coding Clinic), and established policies rather than personal opinion. Show that you can advocate for the correct code while remaining professional.

Compliance questions evaluate your understanding of HIPAA, ethical coding practices, and what you'd do in difficult situations:

"What would you do if a physician asked you to upcode a visit?" The correct answer is straightforward: you wouldn't upcode. Explain that you'd code based on the documentation, refer the physician to the coding guidelines, and if necessary, escalate to your supervisor or compliance department. Upcoding violates the False Claims Act and can result in severe penalties for both the coder and the organization.

"How do you ensure HIPAA compliance in your daily work?" Discuss specific practices: logging out of systems when stepping away, not discussing patient information in public spaces, using secure communication channels, following your employer's policies for handling PHI, and reporting any suspected breaches. For remote workers, mention your secure home office setup and VPN usage.

"What's the difference between upcoding and unbundling?" Upcoding is assigning a higher-level code than the documentation supports to increase reimbursement. Unbundling is billing separately for procedures that should be reported as a single comprehensive code. Both are forms of fraud. Explain that you use NCCI edits and coding guidelines to prevent both.

Many employers require you to pass a coding assessment as part of the hiring process. This may happen before the interview (as a screening tool), during the interview, or as a separate follow-up step.

Assessment formats vary. Some employers use standardized tests from AAPC or HIA (Health Information Associates). Others use proprietary assessments tailored to their specialty. Common formats include multiple-choice questions on coding guidelines, scenario-based questions where you assign codes to sample medical records, and timed coding exercises that test both accuracy and speed.

To prepare, review the core ICD-10-CM and CPT coding guidelines. Practice coding medical records using your training materials or AAPC's Practicode tool. Focus on commonly tested areas: E/M coding guidelines (particularly the 2021 office visit changes), modifier usage, ICD-10-CM sequencing rules, and NCCI bundling edits.

Most employers set a minimum passing score of 85-95% accuracy. They may use the results to determine your starting pay level or team assignment. If you don't pass, some employers allow a retake after a waiting period.

Research the employer. Understand what the organization does (hospital system, physician practice, billing company, insurance company), what specialties they cover, and what coding systems they likely use. Check their website, recent news, and any Glassdoor or Indeed reviews.

Review core coding guidelines. Refresh your knowledge of ICD-10-CM Official Guidelines, CPT conventions, modifier usage (especially -25, -59, -76, -77), and E/M documentation requirements.

Prepare your STAR stories. Have 3-4 specific examples ready that demonstrate attention to detail, problem-solving, communication, and handling pressure. Draw from your practicum, training exercises, or prior work experience.

Test your technology. For video interviews, test your camera, microphone, and internet connection beforehand. Choose a quiet, well-lit location with a professional background.