Train your staff on the first batch of medically unlikely edits for CPT codes that went into effect January 1, 2026, along with new edits that just went into effect on April 1.
The phrase “don’t reinvent the wheel” applies well to the development of an outpatient CDI program when a mature inpatient CDI foundation already exists. The challenge is not whether the wheel can be reused, but how to navigate the differences.
The human ear is comprised of three parts: the outer, middle, and inner ear. The middle ear is responsible for transmitting sound vibrations to the inner ear. This article will discuss two types of procedures concerning the middle ear: tympanoplasties and tympanostomies.
A greater telemedicine uptake among mental health specialists did not result in improved access to care for patients in communities with specialist shortages, according to a study published in JAMA Open Network.
Net spending on Medicaid outpatient prescription drugs grew substantially in recent years while the number of prescriptions paid by Medicaid only grew slightly, according to a recent issue brief from KFF.
The phrase “don’t reinvent the wheel” applies well to the development of an outpatient CDI program when a mature inpatient CDI foundation already exists. The challenge is not whether the wheel can be reused, but how to navigate the differences.
CMS is signaling a clear shift in how it views risk adjustment, quality performance, and documentation integrity. For coding and CDI professionals, this moment represents not a threat, but a critical inflection point.
Modifier -59 is used to describe a distinct procedural service. It’s appended to codes to identify procedures/services that are not usually payable when reported together. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A patient presents with acute respiratory failure with hypoxia due to an accidental heroin overdose. What is going to be sequenced first: the acute respiratory failure or the poisoning?
Changes to the Medicare provider-based billing requirements for off-campus outpatient departments are coming with the passage of the Consolidated Appropriations Act last month.
Radiation oncology is a specialty utilizing radioelements either externally or internally to treat medical conditions such as cancer. This article serves as a primer for coding radiation oncology services.
Modifiers -50, -RT, and -LT are laterality modifiers that clarify a CPT code by defining which side of the body the service was performed on. But knowing when to use them is not always immediately clear. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The CPT manual includes many types of biopsies: fine needle aspiration (FNA), core needle, and skin (tangential, punch, and incisional). This article focuses mainly on FNA biopsies and its complicated guidelines, while also touching on core needle biopsies.
When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration, as each facet impacts the level of staffing required to conduct the reviews. Coding auditors should pick a few key elements to review, and the items should be of importance to your organization. Ideally, the topics will focus on issues that are frequent or require reassurance. Note : To access this free article, make sure you first register if you do not have a paid subscription.
The February 4 issue of CMS’ MLN Matters outlines the January 2026 update to the hospital OPPS, including COVID-19 CPT code changes; new HCPCS codes for drugs, biologicals, and radiopharmaceuticals; and new unlisted skin substitute product HCPCS codes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
For CPT and ICD-10-CM coding of fracture treatment, coders—particularly those in orthopedic practices—need to identify several vital pieces of information from the physician’s note. This article covers the keys pieces of information and other tips to ensure accurate coding of fracture treatment.
