Medical coders work with many different code sets including CPT, HCPCS, ICD-10-PCS, and ICD-10-CM. This means coders need to be well-versed in medical terminology. One terminology not often talked about in coding circles is the Systematized Nomenclature of Medicine Clinical Terms—despite the system being around for more than 20 years.
Medicare pays for physical and occupational therapy services when the medical record and the information on the claim form accurately report covered therapy services. This article discusses Medicare’s documentation requirements to justify billed therapy services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A patient was initially treated for extensive burns on his lower back and the posterior side of both thighs. The physician documented that the patient had second- and third-degree burns of the lower back (2% Total Body Surface Area [TBSA] second-degree and 7% TBSA third-degree) and third-degree burns of both thighs (9%). What ICD-10-CM codes would be assigned for this encounter?
Use the documentation “cross-out test,” clinical vignettes, and expert answers to scenarios to educate staff about when they can and cannot unbundle an evaluation and management visit from a same-day procedure.
CMS announced its A/B Medicare administrative contractors have withdrawn the local coverage determinations for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers.
As we approach the end of the year, take a moment to refresh yourself on the ins and outs of the primary code sets an outpatient coder needs to understand and use in their role. This article provides a brief overview of three code sets that will serve as a review for veteran coders or a solid base of information for new coders.
Social determinants of health (SDOH) are critical for the well-being of the patient and are often more important than what occurs in physician’s offices, laboratories, operating rooms, and other clinical settings. Accurately capturing SDOH and providing education on doing so are equally critical for patient care, quality reporting, and reimbursement.
CMS recently published a fact sheet outlining an update coming from all seven Medicare administrative contractors to the local coverage determinations for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers, which will be effective January 1, 2026. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Clinics, specialty groups, and ambulatory care centers are facing systemic strains from the outpatient healthcare infrastructure, according to the Outpatient Pressure Index 2025 published by CERTIFY Health.
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.
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.
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.
Transcatheter aortic valve replacement is a minimally invasive procedure developed to treat patients with severe aortic stenosis who are considered high-risk or unsuitable candidates for traditional open-heart surgery. Learn from Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, as she walks through the procedural coding for both inpatient and outpatient settings.
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.
You’ll have to wait a while longer for National Correct Coding Initiative edits for 2026-effective codes. However, the latest quarterly NCCI update will include new medically unlikely edits for a variety of HCPCS codes that went into effect in July and October 2025.
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.
Artificial intelligence has revolutionized healthcare operations, offering speed and efficiency in certain tasks, but in a field where precision drives reimbursement and compliance, speed without accuracy can turn efficiency into liability. Karen R. Lane, MSN.ed, CCDS, CCDS-O, CDIP, RN, delves deep into one critical risk of using AI: hallucinations in the context of appeals.
Transcatheter aortic valve replacement is a minimally invasive procedure developed to treat patients with severe aortic stenosis who are considered high-risk or unsuitable candidates for traditional open-heart surgery. Learn from Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, as she walks through the procedural coding for both inpatient and outpatient settings.
