New research has found that outpatient follow-up after psychiatric hospitalization among patients with first-admission schizophrenia was associated with a significantly lower risk of readmission, according to a study published in Frontiers in Psychiatry.
CMS recently released a transmittal regarding the quarterly updates to the OPPS. The transmittal, which was originally published internally, was republished for the public regarding updates that went into effect on October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Laboratory services are often overlooked as potential suspects for fraud because they are typically not considered high-cost services. But the sheer volume of laboratory services billed more than compensates for their low cost. These charges represent hundreds of millions in healthcare spending.
Practices that treat conditions such as carpal tunnel syndrome and osteoarthritis of the knee must review a new uniform policy that covers a variety of painful chronic conditions. Start now by training staff and reaching out to patients who are no longer covered.
Hepatic encephalopathy is a neurologic complication of severe liver disease in which impaired liver function allows toxic substances that are normally metabolized and eliminated by the liver to accumulate in the bloodstream and reach the brain. For coders, understanding the relationship between hepatic encephalopathy, the underlying liver disease, presence of a coma, and liver transplant complications is essential for accurately capturing the patient’s clinical picture and assigning the most appropriate ICD-10-CM codes. Note : To access this free article, make sure you first register if you do not have a paid subscription.
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.
Terry Tropin, MSHAI, RHIA, CCS-P, focuses on the less extensive changes of the fiscal year 2027 ICD-10-CM update for conditions that received only a handful of new codes but are nonetheless important for accurate and specific code assignment. Although these additions may be easy to overlook among the larger expansions to the code set, they provide new opportunities to capture conditions and clinical circumstances with greater precision.
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?
Three newly released compliance audits highlight significant gaps between high-risk diagnosis codes submitted for Medicare Advantage risk adjustment and the medical records supporting those diagnoses. Across the three organizations, OIG found that 533 of 700 sampled enrollee-years lacked sufficient medical-record support for certain submitted diagnosis codes and estimated approximately $202.2 million in overpayments.
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.
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.
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.
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.
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.
Artificial intelligence (AI) is changing medical coding workflows. AI-assisted technology can help coding professionals work more efficiently. But there is an important distinction between identifying a possible code and determining whether that code should actually be reported.
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.
