CMS recently released an updated MLN fact sheet reminding providers when a transcatheter tricuspid valve replacement for symptomatic tricuspid regurgitation can be covered under the coverage with evidence development policy. Included are the ICD-10-CM/PCS codes that must be reported for inpatient cases.
Like previous federal government shutdowns, the one that ensued when Congress failed to produce a continuing resolution on the budget by October 1 has implications for providers. You should reduce the chances of harm by planning to address them now.
As clinical validation becomes an area that payers and regulatory bodies are investigating heavily, the need for steadfast collaboration between coding professionals and CDI specialists has never been greater. TaraJo Vaught, MSN, RN, CCDS, CCDS-O, explores how these two teams can bridge the gaps between them and enhance their clinical validation practices to drive better outcomes across the board.
The American Medical Association recently issued its 2026 CPT code set, which includes 288 new codes, 84 deletions, and 46 revisions. Review the changes to ensure proper procedure coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Chronic conditions are among the most frequently encountered diagnoses in the outpatient setting. Accurate coding of these conditions is critical not only for proper reimbursement but also for compliance, quality reporting, and patient care continuity.
Payers are further along in the AI process as they use AI to scrub claims against their policies, which many believe is contributing to the recent uptick in denials. As organizations attempt to catch up with technological advancements and defend themselves against payers’ new tactics, departments such as coding, CDI, and revenue cycle should be prepared for increased AI integration and determine the best ways to utilize the technology.
Changes are being made to the ICD-10-CM conventions, general guidelines, and chapter-specific guidelines for fiscal year 2026, which will be effective October 1, 2025. This article summarizes some of the changes coders need to be aware of.
Skin substitutes continue to play a critical role in the treatment of chronic wounds, and there are more products available today than ever before. Although Medicare Administrative Contractors have slowly started to spell out their coverage criteria for skin substitute grafts used to treat certain conditions, progress has been slow.
According to the National Multiple Sclerosis Society, almost one million people in the United States have been diagnosed with multiple sclerosis (MS), a chronic autoimmune neurological disorder. Discover how to code the diagnostic tests for MS, the varieties of the disorder, and treatments for it.
Our experts answer questions on the proper use of the new diabetes code for cases in remission, documentation and coding solutions for denial proofing sepsis claims, and best practices for clinical validation queries.
