CMS released the 2027 Medicare Physician Fee Schedule (MPFS) final rule, which includes updates related to evaluation and management (E/M) complexity coding, E/M visits during global periods, and remote monitoring.
CMS issued its 2027 Outpatient Prospective Payment System (OPPS) final rule last week. The document includes several provisions, including updates to OPPS and ambulatory surgical center (ASC) payment rates, the method of controlling unnecessary increases in outpatient services volumes, the inpatient only (IPO) list, and prior authorization for botulinum toxin injection codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
For many healthcare organizations, a paid claim feels like a finished claim. The codes were assigned, edits cleared, the claim was submitted successfully, and reimbursement was received. By traditional measures, the process looks successful. But if that claim is audited 18 months later, the question changes from whether it could be billed to whether it can be defended.
A new definition for prescription drug management in the 2027 CPT manual is designed to clear up confusion and set expectations. The 2027 manual adds the definition to the Risk of Complications and/or Morbidity or Mortality of Patient Management (Risk) category for level-based evaluation and management (E/M) codes.
Even though seborrheic keratoses are benign and not contagious, their appearance can sometimes resemble melanoma, a potentially life-threatening form of skin cancer. Shontia Leon-Guerrero, CPC, CEDC, CEMC, CPC-I Educator, explains why understanding the differences between these conditions is important for recognizing when further medical evaluation may be necessary, as well as for proper coding.
Obesity is a complex medical condition characterized by excessive body fat that can negatively affect an individual's overall health and increase the risk of serious medical complications. Providers should clearly establish obesity diagnoses and relevant clinical relationships, while coding professionals should ensure that assigned codes comply with the current guidelines, including applicable instructional notes and code-specific requirements. This article focuses specifically on reporting adult morbid (severe) obesity. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Q: What are some coding and documentation considerations that can impact whether a case triggers a Patient Safety Indicator and presents an opportunity for exclusion?
Mechanical ventilation plays a critical role in supporting patients who are struggling with respiration due to illness, injury, or complications associated with surgical procedures. By maintaining oxygenation and ventilation while the underlying condition is being treated or resolved, this intervention can dramatically increase the survival rates for critically ill patients. Follow Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, as she breaks down medical necessity requirements, mechanical ventilation types, and relevant ICD-10-PCS codes.
At the public ICD-10 Coordination and Maintenance Committee Meeting held September 15–16, 2026, the Centers for Disease Control and Prevention discussed 39 proposals involving diagnosis code topics. Discover some of the requests being considered for implementation on April 1, 2027.
Outpatient social care interventions may strengthen outcomes for children and their families, according to a scoping review published in Academic Pediatrics.
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.
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.
CMS is planning major reimbursement shifts for outpatient hospital services, according to the 2027 Outpatient Prospective Payment System (OPPS) proposed rule.
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.
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?
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.
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.
