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.
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.
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?
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.
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.
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.
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.
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 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.
CMS recently released the fiscal year (FY) 2026 ICD-10-CM update, which includes 487 new diagnosis codes effective October 1, 2025. The new codes cover a range of diagnoses, so be sure to review the code update files.
The second quarter edition of Coding Clinic included questions and answers for coding very specific situations not easily found using the Alphabetic Index. Review some of the noteworthy scenarios.
Make sure you incorporate current CMS coding guidance for three preventive services into your workflow and check for denials that might be candidates for an appeal. Review the latest rules for HIV PrEP, hepatitis vaccine, and CRC screens.
We are just entering summertime and meteorologists are already warning about increased heat indexes all over the country. Staying hydrated is important advice because serious maladies can take place when the body becomes dehydrated.
The first quarter edition of Coding Clinic included new and revised guidelines, a change to the Alphabetic Index, and a question and answer section which discusses complicated coding issues. This article highlights noteworthy changes.
Effective October 1, 2024, three new diagnostic codes have been added to the ICD-10-CM classification system. These three new codes are designed to capture early stage type 1 diabetes preceding the onset of symptoms.
Asthma is a common lung disorder in which inflammation causes the bronchi to swell and narrow the airways, leading to airflow obstruction. Discover the coding considerations surrounding this disorder to ensure you’re documenting it correctly. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The Affordable Care Act provides preventive and early diagnosis healthcare services for free to anyone with a health insurance policy. This article provides coding specialists with guidance to ensure they’re documenting these services correctly so that providers are compensated properly.
While the use of artificial intelligence has begun to change how healthcare organizations process data, large language models have not yet reached the level of sophistication to meet the demands of medical coding, according to an op-ed published by Forbes.
Postherpetic neuralgia (PHN) is severe pain caused by damage to the nerves at the area or areas affected by shingles after the rash is resolved. Typically, it is pain that persists four or more months after the initial onset of the rash. For documentation purposes, the physician would need to state which type of PHN the patient has. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
The largest barriers and facilitators to screening, documenting, and addressing adverse social determinants of health across United States’ emergency departments have been identified in a recent study published in JAMA Network Open.
You may have noticed that people are feeling stressed out throughout the United States. Each individual deals with stress in their own way. Most often, ICD-10-CM diagnosis codes reported for these patients may be a bit vague, especially when you are coding for a primary care physician.
With the prevalence of diabetes mellitus among the population expected to grow, an overview of the disease may help you keep track of how to code instances of it. This article will cover the different types of diabetes mellitus and a few tips when coding it.
A recent study published in BMC Public Health, found that patients in Colorado diagnosed with long COVID increasingly sought care from outpatient and specialist visits over hospital and emergency department visits.
CMS recently published diagnosis code update files for discharges and patient encounters beginning on April 1, 2025, and through September 30, 2025. Learn about the revisions featured in the updated files.
Patients diagnosed with a malignant neoplasm, commonly known as cancer, are now living longer due to better treatments. In 2025, there are 47 new ICD-10-CM codes to be used to report lymphoma in remission. This article broadly reviews those new codes.
Assigning proper codes plays a role in the integrity of medical records, supports effective communication between healthcare providers, and safeguards a practice against compliance issues. This article discusses some common dermatological conditions and their respective ICD-10-CM codes/categories.
The concept of social determinants of health (SDOH) has transformed significantly, advancing from increased awareness to data integration and the development of tools and frameworks. This article explores the importance of integrating SDOH into the healthcare framework and the coding process, as well as best practices for leveraging this data to inform health interventions.
Medicare patients who qualify for the new preventive service designed to protect them from HIV will be eligible for up to eight counselling and screening services a year, according to a recently released CMS national coverage determination.
ICD-10-CM contains specific pain codes based on the type of prosthetic device, mesh, or implant. This article reviews best practices for using placeholders and selecting the correct encounter code, as well as other considerations when using diagnosis codes.
Revisions to the E/M guidelines have simplified documentation and eliminated unnecessary documentation. Clinicians may choose levels of E/M services based on time or level of medical decision-making. Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC, CPC emeritus , dives deep into both processes and provides best practices for each.
The American Medical Association recently announced new codes, deletions, and revisions included in the CPT 2025 code set. Explore these notable updates to the code set.
The connection between medical necessity and diagnosis coding should be included with your training on the 2025 update to the ICD-10-CM code set. This article serves as a refresher on medical necessity, possible ICD-10-CM conflicts, and other best practices.
Patients who self-reported housing instability often didn’t have the correct ICD-10-CM codes documented in their record, according to a recent study. Review the results of the study and be more aware of the importance of properly documenting housing insecurity to ensure appropriate housing and medical services are delivered.
A recent draft local coverage determination includes detailed coverage requirements for chronic migraine treatment. This article reviews the terminology that drives migraine coding.
The ICD-10-CM changes for fiscal year 2025 are coming October 1, 2024. Learn about some of the changes to guidelines, notes, wording in current categories, and expansion of code categories.
Q: What ICD-10-CM code should we report for a periprosthetic fracture due to an injury? Do you use the S codes for a traumatic fracture with a secondary code for replacement, or do you select a code from the M97 (Periprosthetic fracture around internal prosthetic joint) category?
Q: What are some of the common documentation pitfalls or missteps related to pediatric malnutrition? And what can CDI specialists do to address them proactively?
CMS finalized many behavioral health requirements related to social determinants of health risk assessments, care management services, and more with the 2024 Medicare Physician Fee Schedule final rule. With all these changes where do providers start?
Q: Is it appropriate to code metabolic encephalopathy related to alcohol withdrawal or alcohol withdrawal delirium? And if so, how do you successfully defend against denials?
Q: A specialty society's fact sheet offers guidance for determining E/M level when an ICD-10-CM social determinant of health code affected the diagnosis or treatment. What is Medicare's policy on this?
Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , delves into ICD-10-CM and CPT coding for urogynecology, a subspeciality that provides necessary crossover care for female patients. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
