A recent cross-sectional analysis published in JAMA Psychiatry examined the breakdown of what percentage of mental health outpatients received their care in-person, via telehealth, or a hybrid. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Accurate provider documentation is the foundation of compliant coding, appropriate reimbursement, and defensible claims. Yet, in a rapidly changing healthcare landscape, even highly skilled clinicians can find it difficult to stay current.
After a few years of confusion about how providers should document time for level-based evaluation and management services, the consensus can be summarized as “make it make sense,” according to a review of guidance issued by all seven Medicare administrative contractors.
CMS released its 2026 Outpatient Prospective Payment System final rule on November 21. The document finalizes many proposed policies, including increasing the payment rate, expanding the agency’s method to control unnecessary increases in the volume of outpatient services, revising the Ambulatory Surgical Center Covered Procedures List criteria, and setting the payment rate for the intensive outpatient program.
Transcatheter aortic valve replacement is a minimally invasive procedure developed to treat patients with severe aortic stenosis who are considered high-risk or unsuitable candidates for traditional open-heart surgery. Learn from Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, as she walks through the procedural coding for both inpatient and outpatient settings.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, discusses how without some form of a narrative in documentation, hospital coders cannot sequence individual diagnoses. If there is no story provided, records can be rife with opportunity for a recovery auditor or payer to construct an alternative version of what happened during hospital visits, resulting in denials.
Review a recent OIG audit which found that Medicare improperly paid $22.7 million to suppliers for durable medical equipment, prosthetics, orthotics, and supplies during inpatient stays from January 2018 to December 2024.
Coding purpura and thrombocytopenia is often more straightforward than coders initially expect, as these diagnoses typically require minimal direction from official guidelines. The real challenge lies in correctly interpreting provider documentation and validating the terminology used. Without close attention to clarifying terms, coders risk misclassification or unnecessary queries. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Q: What considerations should coders keep in mind when referring to problem lists for determining the principal diagnosis and proper sequencing of all documented conditions in the inpatient setting?
