A recent study published in BMC Public Health, found that patients in Colorado diagnosed with long COVID increasingly sought care from outpatient and specialist visits over hospital and emergency department visits.
Treating providers can perform audio-only evaluation and management visits via telephone for patients who are at home thanks to the three-month telehealth extension through to March 31, 2025. But remember to follow the rules for audio-only visits in the final 2025 Medicare physician fee schedule.
With the prevalence of diabetes mellitus among the population expected to grow, an overview of the disease may help you keep track of how to code instances of it. This article will cover the different types of diabetes mellitus and a few tips when coding it.
This article wraps up our coverage of modifiers commonly used by pain management practices that are required by Medicare and private payers when a CPT procedure code on a claim isn’t detailed enough to precisely tell what service or procedure was provided. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Because discrepancies among payers’ diagnostic standards can lead to documentation issues, coding errors, and denials, revenue integrity professionals are encouraged to increase collaboration between CDI, coding, and clinical staff when addressing varying criteria. Discover further how coders play a key role in analyzing criteria, identifying denial trends, and ensuring providers receive proper training and education.
Q: Patient is a young but quite debilitated and oxygen-dependent female with a complex history and frequent hospitalizations. She currently presents with exacerbation of bronchiectasis secondary to Swyer-James unilateral emphysema, chronic postinfectious bronchiolitis obliterans syndrome following bronchiolitis obliterans in childhood, and superimposed bacterial pneumonia. Her condition is complicated by morbid obesity with a BMI of 42 and severe obesity hypoventilation syndrome with obstructive sleep apnea. How would this diagnostic note be reported in ICD-10-CM?
Given the variety and complexity of surgical complications, coders should understand the nuances of differentiating between surgical complications and pre-existing conditions, stay up to date with coding guidelines, and familiarize themselves with ICD-10-CM chapters where complications codes are located. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The spectrum of myocardial injury, ischemia, and infarction represents a critical area in cardiology, which Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores in detail, integrating information from current clinical guidelines, diagnostic standards, and management strategies.
Review a study published in a recent edition of Health Affairs that discovered which type of hospitals are not evaluating their AI tools internally for accuracy or potential biases and explored whether models developed in-house or by external developers were supported more by local evaluations.
On November 1, 2024, CMS released its final rule describing calendar year 2025 policies and rates for Medicare’s Outpatient Prospective Payment System and the final rule was published in the Federal Register. This article is a comprehensive overview of all the major highlights, allowing coders to stay informed about key updates and navigate the changes throughout the year.
Medicare or a private payer will ask physicians to put a modifier next to a CPT procedure code listed on their claims when the procedure code isn’t detailed enough to precisely tell what service or procedure was provided. We previously covered three modifiers commonly used by pain management practices. This article reviews three more modifiers commonly used by pain management practices. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
A study published in the Annals of Internal Medicine found that even when patients agreed to be charged for queries sent though a portal, only a tiny fraction of these asynchronous encounters were billed. This article covers why e-visits may be difficult to bill.
CMS recently published diagnosis code update files for discharges and patient encounters beginning on April 1, 2025, and through September 30, 2025. Learn about the revisions featured in the updated files.
Q: A 64-year-old established female patient visits the orthopedic office for ankle pain and swelling. She stepped off the curb yesterday afternoon to get the mail and missed a step, her sandal caught the edge of the curb and she rolled her right ankle. Physical examination shows notable swelling in the right ankle. Full range of motion, although patient complains of discomfort on extension and flexion. Able to weight bear. X-rays negative for fracture. Based on medical decision-making rules, what would this be coded as?
CMS recently published an update to the fiscal year 2025 ICD-10-PCS code set, available for discharges occurring from April 1 through September 30, 2025. Although CMS made no changes to the guidelines, the update includes 50 new codes, 12 deleted codes, and two new tables.
Cheryl Ericson, RN, MS, CCDS, CDIP , explores why CMS will begin collecting data in 2025 to measure performance on the Hospital Harm from Acute Kidney Injury (HH-AKI) electronic clinical quality measures (eCQM), particularly for those who may be less familiar with eCQM.
Although advancements in treatment and early detection improve survival rates, the incidence of cancer diagnoses, including lymphoma, continue to rise. To reflect the growing number of cases and the complexity of neoplasms, new ICD-10-CM codes were introduced for fiscal year 2025. Learn how to capture each diagnosis with greater precision. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Consider a patient who is readmitted for postoperative pain control after a lung transplant two days prior. How would coders report this type of surgical complication in ICD-10-CM? In general, what are the guidelines for coding pain as a surgical complication of transplantations?
For fiscal year 2025, ICD-10-CM Chapter 19 saw an addition of 18 new codes for poisoning by, adverse effect of, and underdosing of immune checkpoint inhibitors and immunostimulant drugs. To properly apply these new codes, Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , breaks down the purposes of these medications and explains how the coding guidelines address the complex range of side effects these drugs can cause.
