As coding teams collaborate across regions and contribute to shared quality and artificial intelligence evaluation initiatives, a common framework for measuring coding quality becomes essential. Without common evaluation principles, coding decisions may be difficult to compare, benchmark, or use for AI evaluation. Shera Stack, MSN, RN, CRC, and April Russell, MBA, CCDS-O, COC, CPC, CPC-P, CRC, consider how a common approach built around agreement, accuracy, defensibility, and truth provides the foundation for meaningful quality assessment.
Q: How can queries play a role in clarifying malnutrition and cachexia diagnoses while ensuring the patient’s condition is reflected in the medical record accurately for proper coding?
Pediatric coding requires a fundamentally different lens than adult coding, as children represent a uniquely complex population with evolving physiology, age-dependent clinical norms, congenital influences, and a heavy reliance on caregiver-reported history. With this in mind, Renee Beus, MSN, RN, NCSN, outlines why pediatric coding cannot always follow adult frameworks, highlights common documentation pitfalls, and identifies what organizations must prioritize when building reliable pediatric coding and CDI programs.
Hypertensive heart disease results from untreated or under-treated hypertension, causing a range of physiologic changes affecting the left atrium, left ventricle, and coronary arteries. Nancy Reading, BS, CPC, CPC-P, CPC-I, delves into the progression of hypertension to heart failure and shows how accurate code assignment and sequencing of the two conditions rely on the reason for admission and the relationships established among the patient’s conditions as documented by providers.
CMS recently published the fiscal year 2027 ICD-10-CM Official Guidelines for Coding and Reporting to accompany the ICM-10-CM update, effective October 1. Coders should note the clarifications and revisions added to several areas of the guidelines, specifically as it relates to sepsis, cancer treatment, hypertension, genetic disorders, and Z codes.
Q: How should a coder handle the documentation and coding of a fragility fracture when the underlying cause, such as osteoporosis, has not been clearly established?
Lysosomal storage disorders are a group of rare, inherited metabolic disorders caused by genetic mutations that affect the normal function of lysosomes, or the structures within cells that contain enzymes responsible for breaking down and recycling various substances, including fats, sugars, proteins, and other cellular materials. Review some of the major categories in which commonly encountered lysosomal storage disorders are classified. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Practices that perform allergy testing take note: A uniform allergy diagnostic testing policy for Medicare Part B patients will go into effect in 38 states as soon as September 27.
The AMA recently announced that the 2027 CPT code set includes 299 new codes, 74 revisions, and 80 deletions coming to a variety of services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
