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.
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.
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.
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?
Genetic medicine is an emerging specialty coders will be faced with, and a basic foundation of the science and consequences of genetic anomalies will be helpful going forward. Realizing coders are not expected to be clinical, Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , shows how it will still be useful to know the basics.
If denials are not going anywhere anytime soon, increasing at an alarming rate, and causing organizations to close, how do hospitals ameliorate this issue? Hospitals, including coders, can work to stem it by understanding the different types of denials, the problems they pose, and the tactics required to fight them.
Following questions from Congress on what steps the government should take to eliminate remaining barriers in accessing addiction treatment, the American Hospital Association noted two out of eight policy and regulatory barriers that currently impact inpatient facilities. Learn what the consequences could be if these barriers were addressed.
Because multiple organ disfunction syndrome does not have a specific ICD-10-CM code, coders face the challenge of capturing the full complexity of the condition. Nevertheless, understanding the various organ systems involved and recognizing the specific dysfunctions can help coders accurately report the condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A female patient previously had an inpatient stay due to severe enteritis secondary to the use of Keytruda for colon cancer that she was diagnosed with six months earlier. While she has had positive results to the medication, she presented to the ER last week due to severe abdominal bloating and cramping with diarrhea and stools with large amounts of mucous. She was dehydrated and hypokalemic upon inpatient admission and has a history of depression. Her discharge note indicates that her potassium levels and dehydration are normalized. How would this encounter be reported in ICD-10-CM?
