CMS is planning major reimbursement shifts for outpatient hospital services, according to the 2027 Outpatient Prospective Payment System (OPPS) proposed rule.
Outpatient social care interventions may strengthen outcomes for children and their families, according to a scoping review published in Academic Pediatrics.
Ensure your team is aware of the latest key updates to the Ambulatory Surgical Center (ASC) Payment System that went into effect on October 1, 2026, which includes changes to codes for surgical procedures, skin substitute products, and drugs, biologicals, and radiopharmaceuticals. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The measles outbreak is racing through the United States and quite possibly your own healthcare facility. In 2025, a total of 2,289 measles cases were reported in the United States. As of October 16, 2026, there have been 4,410 cases reported in 2026.
Diagnosis-related group downgrades result from a mix of insufficient or incomplete documentation, coding errors, and diagnoses that lack clinical validation. When higher-acuity diagnoses designated as MCCs or CCs are removed, the case may be reassigned to a lower-paying DRG, resulting in a loss of revenue. Follow Nancy Reading, BS, CPC, CPC-P, CPC-I, as she discusses the challenges of denial reviews conducted by third-party payers and proactive strategies to prevent and manage denials.
At the recent public ICD-10 Coordination and Maintenance Committee Meeting, the Centers for Disease Control and Prevention National Center for Health Statistics discussed 23 proposals involving procedure code topics. Discover some of the updates being considered for implementation on October 1, 2027.
Q: How do the clinical consequences of measles and rubella influence ICD-10-CM code selection, particularly when coding specific complications, congenital rubella syndrome, and infections documented without complications?
Congenital heart defects, the most common type of birth defect, are among the most clinically significant anomalies in neonatal care. Bobbie Vannatter, MHA, RHIA, CCS, CDIP; Andrew Puckett, DNP, RN, NI-BC; and Vitality Shalumov, RN, BSN, CCDS, reviews selected neonatal congenital cardiac conditions and highlights key documentation considerations that influence coding and representation of severity.
Because third-degree burns are a severe injury that destroys the epidermis and dermis and may extend into the underlying subcutaneous tissue, accurate coding depends on clear documentation of burn depth, anatomical site, and total body surface area. Learn how to navigate the fundamentals of ICD-10-CM code selection and sequencing guidelines for third-degree burns, including how to prioritize burn severity and account for multiple injury sites. Note : To access this free article, make sure you first register 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.
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.
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.
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.
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.
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.
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?
