In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The difference between straightforward and complex cases is now one of the main factors for coding lower endovascular revascularization. Find out how to document and report services with the new code set.
Q: What are some tips for properly documenting evaluation and management as it relates to medical decision-making, including improving communication with providers?
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.
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.
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.
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?
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.
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.
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.
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.
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.
Practitioners work hard, especially when they perform critical care services. Training clinical and coding staff with real-world examples can make sure providers get full credit for their work. Share this case with staff and ask them to decide what services can be reported.
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.
