Review a study based on ICD-10-CM data from the National Vital Statistics System that shows life expectancy for the United States population increased to 79.0 years in 2024 while the mortality rate decreased by 3.8% to 722.1 deaths per 100,000 of the standard population in 2024. Also determined were leading causes of death.
Coders and billers may struggle to understand what the term medical necessity really means. Unfortunately, these two words can easily lead to misinterpretation and misunderstanding of what needs to be clearly communicated in a variety of healthcare areas. Learn common definitions of medical necessity, report types utilized in inpatient settings, and a query process in case more clinical detail is required. Note : To access this free article, make sure you first register if you do not have a paid subscription.
A diagnosis of cancer becomes a pre-existing condition that will follow a patient for the rest of their life, but clinical records do not always provide the level of detail required to work within the framework set forward in the coding rules when it comes to reporting active neoplasms from personal history. Nancy Reading, BS, CPC, CPC-P, CPC-I, explores ICD-10-CM guidelines for such neoplasm scenarios.
Q: Why is pediatric malnutrition frequently underdocumented, and how can collaborative workflows improve documentation and coding accuracy as well as reduce queries?
Insurance companies are increasingly challenging the translation from the medical record to prebill coding, making the financial impact of denials and downgrades one of the most pressing issues facing health systems today. Given the wide-ranging harm occurring from delayed and reduced reimbursement, Dawn Valdez, RN, CCDS, CDIP, highlights how coders and CDI specialists can play a key role in decreasing denials and downgrades as well as successfully disputing these actions.
The CPT manual includes many types of biopsies: fine needle aspiration (FNA), core needle, and skin (tangential, punch, and incisional). This article focuses mainly on FNA biopsies and its complicated guidelines, while also touching on core needle biopsies.
The 2026 Outpatient Prospective Payment System final rule isn’t for the faint of heart. CMS finalized many of the major changes from the proposed rule, although the agency did pull back on certain key areas. With big shifts in compliance and reimbursement taking effect, coders have their work cut out for them.
A number of Medicare telehealth flexibilities extensions in place until January 30, 2026, lapsed during the partial U.S. government shutdown that began January 31, 2026.
Emergency department visits resulting in outpatient treatment increased sharply, while visits leading to inpatient admission did not—particularly among Medicaid patients—according to research recently published in JAMA Health Forum.
A prognostic study published in the Journal of the American Medical Association raises concerns that AI models designed to predict hospital outcomes may appear far more accurate than they truly are due to a subtle but serious methodological error known as label leakage.
Q: How do ICD-10-CM T codes work together with Z, F, and Y codes to fully capture drug-related conditions, and in what order should these codes be sequenced?
From concussions and cerebral contusions to complex intracranial hemorrhages and traumatic brain injuries, major head injuries encompass a wide spectrum of clinical presentations and outcomes. Because of their complexity and potential for lasting impact, complete and compliant ICD-10-CM coding is essential to reflect the full clinical severity of these conditions. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Addressing the reliability of documentation, coding, and clinical reasoning underlying PSI flags is not simply a clinical safety imperative; it is a strategic business imperative. Priscilla Marlar, MHA, CSSBB, CPHQ, and John W. Cromwell, MD, suggest that achieving high reliability in quality data integrity starts with understanding the nuances of clinical documentation language and how those nuances are translated by CDI and coding teams into hospital billing codes.
Due to all of the possible scenarios that come with a pregnancy, the reporting of ICD-10-CM diagnosis codes must reveal the specific risks patients have so that procedures, services, and treatments can all be supported. Follow Shelley C. Safian, PhD, MAOM/HIM/HI, RHIA, CCS-P, COC, CPC-I, as she outlines best practices for specifically reporting high-risk pregnancies.
A neonatal intensive care unit offers very specialized medical services and treatments to premature and critically ill neonates (i.e., babies 28 days old or younger). Review which ICD-10-CM and CPT codes may be used for providers assisting in this type of care.
A study recently published in JAMA Network Open examined trends in outpatient mental health care among Medicare fee-for-service beneficiaries before, during, and after the COVID-19 pandemic.
CMS released the fiscal year 2026 ICD-10-CM files for use for discharges and patient encounters occurring from April 1 through September 30, 2026. Take time to review the updates. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Part B providers are facing a radically different reimbursement landscape in 2026. In the 2026 Medicare Physician Fee Schedule final rule, CMS moved ahead with many of the changes it floated in the proposed rule, including fundamental changes to how the conversion factor is calculated, relative value unit valuation, payments for skin substitutes, and more.
