Full Name: (required)

Practice/Organization Name: (required)

Your Email: (required)

Phone:

I am a: (required)
Choose your occupationPhysicianPractice Administrator/ManagerBilling/Operations ManagerCoding/Billing StaffHospital Administrator/ExecutiveCompliance OfficerHealthcare AttorneyNon-Physician ProviderOther

Specialty: (required)
Choose your specialtyDermatologyGeneral SurgeryInterventional PainNeurosurgeryOrthopaedicsOtolaryngologyPlastic SurgeryUrologyVascular SurgeryOther

Have you attended a KZA workshop and/or worked with a KZA consultant?
YesNo

If yes, who was the instructor or consultant?
Select a consultantKaren ZupkoJen BellJennifer CabreraDeb GriderMichael Marks, MDJennifer O'BrienTeri RomanoCathy McDowellI'm Not Sure

What is your suggested coding question? Please provide as much detail as you can.

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