CMS may have major changes in store for outpatient hospital reimbursement and compliance, according to the 2025 Outpatient Prospective Payment System proposed rule. The proposed rule, released in July, includes potential changes to payment, coding, and billing for hospital outpatient services.
To comply with a summer court order, the FY 2025 Hospital Inpatient Prospective Payment System was revised to reduce payments for low wage hospitals. Review the updated policy to understand why these adjustments were implemented and what hospitals can expect going forward.
Lymphoma diagnosis codes received a robust overhaul with the release of the 2025 ICD-10-CM codes, reflecting advancements in understanding and classifying lymphoma. Accurate coding is crucial for reporting such nuances, and Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , is here to update coders on the changes.
Q: A 65-year-old female has been on Effexor for major depressive disorder for three months and went to her healthcare provider due to tachycardia and palpitations along with mild muscle cramping. It was found that she had accidentally been taking double her prescribed dose due to misunderstanding the instructions. It is reported that she developed serotonin syndrome resulting from toxicity and was also diagnosed with mild hypertension (138/88) due to the serotonin syndrome. How would this encounter be reported in ICD-10-CM?
Coding professionals face challenges when the clinical meanings of words do not match the ICD-10-CM classification system, particularly for records related to matters of the heart. Follow Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC , as she applies critical thinking, knowledge of disease processes, and an understanding of ICD-10-CM codes to accurately report acute MI cases.
Coagulopathy describes the impairment of the blood’s ability to coagulate, leading to prolonged or excessive bleeding that may occur spontaneously or following an injury. Explore the basics of the condition as well as practical tips for accurate ICD-10 coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
Looking to improve the speed and accuracy of your trigger point injection coding? This article will help you spot the information you need to code the services and find areas where your treating providers need extra help to improve their documentation.
Q: What codes should a coder consider for a patient diagnosed with an eating disorder (e.g., anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder)?
ICD-10-CM contains specific pain codes based on the type of prosthetic device, mesh, or implant. This article reviews best practices for using placeholders and selecting the correct encounter code, as well as other considerations when using diagnosis codes.
Whether the discussion is about reimbursement, quality metrics, patient outcomes, or CC/MCC capture rates, the whispers of risk adjustment have grown to a roar. Jennifer Brettler, DO, FACP, CHCQM-PHYADV , reveals just how much risk adjustment plays a role in documentation and coding integrity, impacting patient care.
Certain diagnosis-related groups (DRG) remain vulnerable to audits and denials, not only for DRG and clinical validation, but for medical necessity as well. Kim Conner, BSN, CCDS, CCDS-O , explores areas coding professionals can support when being proactive against these denials.
Our experts answer questions about serotonin syndrome, the difference between National Correct Coding Initiative edits and medically unlikely edits, and prolonged service codes.
Our experts answer questions on the new ICD-10-CM serotonin syndrome code, key takeaways for documenting and supporting malnutrition diagnoses, and appropriate circumstances for reporting codes from ICD-10-CM subcategory E66.8- (other obesity).
With guidance from Linda Martien, CPC, COC, CPMA, CPC-I, CRC, AAPC approved instructor, AAPC fellow , coding professionals can review arthritis codes to avoid the use of generalized codes in order to reflect a patient’s condition more accurately and ensure compliance with insurance requirements.
When an office/outpatient visit is coded based on time, think beyond face-to-face time to get full credit. This article reviews time-based coding, how to count time, which activities count toward time, and which ones don’t.
Take in the details of the 16 new telemedicine codes for real-time encounters in the CPT 2025 manual while you wait to see whether private payers adopt the services or CMS sways from proposed non-coverage of the codes.
