After a few years of confusion about how providers should document time for level-based evaluation and management services, the consensus can be summarized as “make it make sense,” according to a review of guidance issued by all seven Medicare administrative contractors.
A recent cross-sectional analysis published in JAMA Psychiatry examined the breakdown of what percentage of mental health outpatients received their care in-person, via telehealth, or a hybrid. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Accurate provider documentation is the foundation of compliant coding, appropriate reimbursement, and defensible claims. Yet, in a rapidly changing healthcare landscape, even highly skilled clinicians can find it difficult to stay current.
CMS released its 2026 Outpatient Prospective Payment System final rule on November 21. The document finalizes many proposed policies, including increasing the payment rate, expanding the agency’s method to control unnecessary increases in the volume of outpatient services, revising the Ambulatory Surgical Center Covered Procedures List criteria, and setting the payment rate for the intensive outpatient program.
CMS finalized changes to the Medicare Diabetes Prevention Program in the 2026 Medicare Physician Fee Schedule final rule, including updating weight collection requirements, extending flexibilities allowed during the COVID-19 public health emergency, and updating the online delivery modality of the program.
In the ever-evolving world of healthcare coding, staying grounded in the fundamentals is not just best practice, it’s a necessity. As regulations shift, payer expectations tighten, and productivity pressures mount, coding professionals must continually revisit the core principles that ensure accuracy, compliance, and integrity in clinical documentation and billing.
MDaudit, a revenue integrity software platform, recently released its annual report that examines trends in coding denials, audits, and technology based on data from the first three quarters of 2025. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Providers will have more opportunities to report +G2211, the complexity of care HCPCS add-on code. Effective January 1, 2026, providers will be able to report the code with evaluation and management encounters in more settings, CMS announced in the final 2026 Medicare Physician Fee Schedule.
On October 31, 2025, CMS released the 2026 Medicare Physician Fee Schedule (MPFS) final rule, which includes implementing two separate conversion factors, updating telehealth services, and changing the payment policy for skin substitutes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders will find a fresh batch of CPT codes that they can begin reporting on January 1, 2026, with 288 new codes coming online. The code update, announced with the release of the 2026 CPT Manual, also includes 46 revised code descriptors and 84 deleted codes.
Beginning January 1, 2026, the AMA will add a number of changes to CPT codes for two related sections: Digitally Stored Data Services/Remote Physiologic Monitoring; and Remote Physiologic Monitoring Treatment Management Services.
A systematic review and meta-analysis published by JAMA Network Open suggests that outpatient follow-up within 30 days of discharge can be associated with reduced risk of readmission, but that association may vary due to risk factors, such as the patient’s age and disease.
A review of 800 studies found that electrocardiogram interpretation assisted by artificial intelligence has the potential to improve diagnostic accuracy and enable earlier detection of cardiac conditions, particularly in resource-limited outpatient settings.
The ICD-10-CM update for 2026 included 213 new codes that incorporated the “flank” as an anatomic area related to injuries. Genetic diseases also continue to make big inroads into the tabular list of diagnoses.
It’s been two weeks since the federal government shutdown began, as well as when Medicare telehealth waivers and flexibilities were set to expire. In a special edition of the MLN Connects newsletter released just as the shutdown began on October 1, 2025, CMS provided some guidance to providers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The 2026 Medicare Physician Fee Schedule proposed rule includes significant potential changes to telehealth billing and coverage, conversion factor calculations, relative value unit weights based on site, skin substitutes, behavioral health, and more.
Q: In the 2026 ICD-10-CM update, in the neoplasm chapter there are some added specific codes for inflammatory neoplasm of the breast. How do those differ from other types of breast cancer?
CMS recently updated its MLN Booklet for evaluation and management services with changes to the sections regarding office or outpatient E/M visits, critical care services, hospital outpatient clinic visits, and telehealth services.
Skin substitutes continue to play a critical role in the treatment of chronic wounds, and there are more products available today than ever before. Although Medicare Administrative Contractors have slowly started to spell out their coverage criteria for skin substitute grafts used to treat certain conditions, progress has been slow.
The American Medical Association recently issued its 2026 CPT code set, which includes 288 new codes, 84 deletions, and 46 revisions. Review the changes to ensure proper procedure coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Chronic conditions are among the most frequently encountered diagnoses in the outpatient setting. Accurate coding of these conditions is critical not only for proper reimbursement but also for compliance, quality reporting, and patient care continuity.
Changes are being made to the ICD-10-CM conventions, general guidelines, and chapter-specific guidelines for fiscal year 2026, which will be effective October 1, 2025. This article summarizes some of the changes coders need to be aware of.
Updated coding guidance can be found in CMS’ Medicare Preventive Services educational tool for several services. Review the changes to ensure proper coding of preventive services.
Medicare coverage of mental health services has expanded in recent years. Along with authorizing payment for additional services and telehealth options, CMS has established several new provider types. Steps have been made to expand access to care, but many healthcare facilities are still working to establish a solid foundation in CPT coding for mental health services.
Q: The 2026 ICD-10-CM code update, effective October 1, 2025, has new codes for flank tenderness (R10.8A-) and flank pain (R10.A-). What's the difference between pain and tenderness?
According to the National Multiple Sclerosis Society, almost one million people in the United States have been diagnosed with multiple sclerosis (MS), a chronic autoimmune neurological disorder. Discover how to code the diagnostic tests for MS, the varieties of the disorder, and treatments for it.
Medicare pays for therapy services when the medical record and the information on the claim form accurately report covered therapy services. That means your documentation must be legible, relevant, and sufficient to justify the services billed. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The implementation of the 21st Century Cures Act has resulted in radiology patients in the outpatient setting being able to view their examination results quicker, according to a study published in JAMA Network Open.
The Outpatient Code Editor provides the answers to the test, but to use it effectively you need to understand the history and the complex configuration of all the parts.
CMS recently updated its July 2025 update to the Ambulatory Surgical Center Payment System to include several new HCPCS codes and revised information about coding for drugs, biologicals, and radiopharmaceuticals. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A study published in Respiratory Care found that integrating respiratory therapists (RT) in a chronic obstructive pulmonary disease (COPD) clinic led to significant improvements in symptoms and exacerbation rates among patients, as well as a reduction in hospitalizations.
CMS recently published the fiscal year (FY) 2026 ICD-10-CM Official Guidelines for Coding and Reporting to accompany the ICM-10-CM update that will be effective October 1, 2025. The guidelines include clarifications and revisions to several areas that coders should note.
Prepare now for 21 code revisions that coders will find in the 2026 CPT manual by reviewing changes in the proposed 2026 Medicare physician fee schedule.
Machine learning (ML) has evolved beyond its status as a technological trend to become an indispensable asset in outpatient surgical risk stratification. Within the domains of medical coding and claims adjudication, coding professionals play a pivotal role in optimizing ML model performance.
The most common ankle tendon repair is for the Achilles tendon, the largest and strongest tendon in the body. Brush up on the CPT codes for repair of this tendon. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The proposed 2026 Medicare physician fee schedule, released July 14, boosts the Part B conversion factor for calendar year 2026, adds billing opportunities for behavioral health services, previews new codes, and updates the agency’s quality reporting programs.
Physical, occupational, and speech therapy are the most common types that people think of when therapy is recommended. However, there is a new type gaining momentum: pelvic floor therapy.
The calendar year 2026 OPPS and ambulatory surgical center (ASC) proposed rule, released on July 15, details payment updates, services covered, outpatient service volume, and quality reporting, among other proposals.
Q: What if a provider sends a summary of their visit with a patient to the patient’s primary care provider. Is this considered a “discussion” of patient management?
To make sure your ICD-10-CM codes are correct and complete, you may need to use an X as a placeholder to expand the code to the proper length. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Medicare considers the shoulder to be “a single anatomic structure,” according to the National Correct Coding Initiative policy manual. In this article, find out what that means from a coding standpoint. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
