Q: A 64-year-old established female patient visits the orthopedic office for ankle pain and swelling. She stepped off the curb yesterday afternoon to get the mail and missed a step, her sandal caught the edge of the curb and she rolled her right ankle. Physical examination shows notable swelling in the right ankle. Full range of motion, although patient complains of discomfort on extension and flexion. Able to weight bear. X-rays negative for fracture. Based on medical decision-making rules, what would this be coded as?
CMS recently published diagnosis code update files for discharges and patient encounters beginning on April 1, 2025, and through September 30, 2025. Learn about the revisions featured in the updated files.
On November 1, 2024, CMS released its final rule describing calendar year 2025 policies and rates for Medicare’s Outpatient Prospective Payment System and the final rule was published in the Federal Register. This article is a comprehensive overview of all the major highlights, allowing coders to stay informed about key updates and navigate the changes throughout the year.
Medicare or a private payer will ask physicians to put a modifier next to a CPT procedure code listed on their claims when the procedure code isn’t detailed enough to precisely tell what service or procedure was provided. We previously covered three modifiers commonly used by pain management practices. This article reviews three more modifiers commonly used by pain management practices. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
A study published in the Annals of Internal Medicine found that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed. This article covers why e-visits may be difficult to bill.
Q: Consider a patient who is readmitted for postoperative pain control after a lung transplant two days prior. How would coders report this type of surgical complication in ICD-10-CM? In general, what are the guidelines for coding pain as a surgical complication of transplantations?
Cheryl Ericson, RN, MS, CCDS, CDIP , explores why CMS will begin collecting data in 2025 to measure performance on the Hospital Harm from Acute Kidney Injury (HH-AKI) electronic clinical quality measures (eCQM), particularly for those who may be less familiar with eCQM.
For fiscal year 2025, ICD-10-CM Chapter 19 saw an addition of 18 new codes for poisoning by, adverse effect of, and underdosing of immune checkpoint inhibitors and immunostimulant drugs. To properly apply these new codes, Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , breaks down the purposes of these medications and explains how the coding guidelines address the complex range of side effects these drugs can cause.
Although advancements in treatment and early detection improve survival rates, the incidence of cancer diagnoses, including lymphoma, continue to rise. To reflect the growing number of cases and the complexity of neoplasms, new ICD-10-CM codes were introduced for fiscal year 2025. Learn how to capture each diagnosis with greater precision. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently published an update to the fiscal year 2025 ICD-10-PCS code set, available for discharges occurring from April 1 through September 30, 2025. Although CMS made no changes to the guidelines, the update includes 50 new codes, 12 deleted codes, and two new tables.
There are no CPT or CMS rules that prevent an emergency department clinician from reporting fracture and dislocation care services when that service is provided. However, a decision to do so can have significant ramifications. Learn about some of the factors that must be considered.
The worldwide outpatient clinic market is projected to grow considerably in the next few years. Learn what key factors are driving the increase in demand for outpatient services.
When a procedure code isn’t detailed enough to tell your payer precisely what service or procedure was provided, Medicare or the private payer asks physicians to put a modifier next to the procedure code listed on their claim. This article reviews three modifiers commonly used by pain management practices. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Although ICD-11 has not yet been adopted in the United States, various countries have implemented it to enhance their health data analysis, improve public health strategies, and foster international comparability. This article covers how other countries that have adopted ICD-11 are using their data.
After the Medicare Payment Advisory Commission reviewed draft recommendations for 2026 payment updates, which included increases only for hospital inpatient and outpatient services, the commission was urged by the American Hospital Association to revise the recommendations. Learn what AHA is recommending instead before the commission meets again tomorrow morning.
Penny Jefferson, MSN, RN, CCDS, CCDS-O, CDIP, CCS, CRC, CPHQ, CHDA, CRCR, ACPA-C , explores the complexities surrounding the classification of hospital admit types and the challenges caused by inconsistent definitions. By being aware of admit types, coders can ensure accurate reporting, benchmarking, and quality measurement.
When denials are not justified, coding compliance auditors participate in the preparation of appeals using the content of the medical record and official reference materials that justify the coding that was submitted. Discover more about the important role coding compliance auditors play in denials management. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Anemia is a complex condition to manage clinically and document accurately, yet proper diagnosis, documentation, and coding are critical for ensuring appropriate patient care and reimbursement. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores the clinical aspects of anemia, including its definitions, types, causes, and management, while addressing the challenges in clinical documentation and coding.
Q: A patient with severe emphysematous bronchitis is hospitalized due to acute RSV bronchitis. He is noted to have a history for cerebrovascular accident with residual oropharyngeal dysphagia occurring in the past year and on day three of the hospitalization, he aspirated some of his breakfast during an episode of severe coughing. The patient’s RSV swab is now showing negative, so viral bronchitis is considered resolved, but patient continues to require treatment for secondary aspiration pneumonia, which is their main concern at this point, as well as acute hypoxic respiratory failure. He will require oxygen continuously. How would this diagnostic note be reported in ICD-10-CM?
