Ok, you have hit a sore spot for me. I have also been in the profession for a long time and currently work as a quality data analyst. We need to remember our roots. Even though finance has crept into our profession over the years, the coded data lives far beyond the claim getting paid. And don't get me wrong, I completely understand that claims need to get out and get paid, however, when analyzing coded data for research, planning, quality, etc., it needs to be consistent regardless of payer. Hence, is why we have coding guidelines. Now that being said, our coding team still resides in HIM and we have built payer specific rules in our billing system. The department also has a position called billing editor with HIM credentials that reviews rejections, denials etc. If there is a clear mistake in the coding, then that gets fixed in the coding/abstracting system. If it is a payer specific requirement, then the claim will get updated in the claims system (i.e. they want one code before another code). HIM professionals are in the spotlight with conflicting priorities in this area but have the skills to navigate this opportunity.