Cardiomyopathy refers to a group of conditions in which the heart muscle becomes diseased, making it harder for the body to pump blood effectively to the rest of the body . While accurate ICD-10-CM coding of cardiomyopathy requires precise documentation of the cause (if known) and complications, the type will drive the final code choice. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Coding practices by Medicare Advantage insurers make members seem sicker, which resulted in an extra $33 billion in payments from the federal government in 2021, relative to coding by traditional Medicare providers, according to a study published by the Annals of Internal Medicine .
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?
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.
Many disorders of immunity require ongoing management and often contribute to complications or comorbidities during hospitalization. For inpatient coders, accurately identifying and coding these disorders is crucial, not only to reflect the full clinical picture and support severity of illness and risk of mortality metrics, but also to ensure correct DRG assignment. Note : To access this free article, make sure you first register if you do not have a paid subscription.
CMS recently released an updated MLN fact sheet reminding providers when a transcatheter tricuspid valve replacement for symptomatic tricuspid regurgitation can be covered under the coverage with evidence development policy. Included are the ICD-10-CM/PCS codes that must be reported for inpatient cases.
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.
Beginning October 1, 2025, there will be 116 new ICD-10-CM codes available for chronic non-pressure skin ulcers, added for FY 2026. Nancy Reading, BS, CPC, CPC-P, CPC-I , explores these new codes and how they were added in response to a growing problem identified as xylazine-induced skin ulcers.
A study published by the Journal of the American Heart Association found that ischemic heart disease death rates fell 81% from 1970 to 2022 while deaths from heart attacks decreased 89%. However, deaths from other types of heart disease increased by 81% during the same period.
Dementia is an umbrella term used to describe a group of progressive neurological disorders that affect memory, cognition, behavior, and the ability to perform everyday activities. Coding professionals must utilize diagnosis documentation, ICD-10-CM codes for both dementia and underlying physiological conditions, and coding tips to ensure that dementia-related diagnoses are captured accurately. Note : To access this free article, make sure you first register if you do not have a paid subscription.
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?
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.
Learn how HIM professionals, including coders, can leverage data related to social determinants of health to improve patient care and secure proper reimbursement.
Respiratory failure is a life-threatening condition that occurs when the respiratory system is unable to maintain adequate gas exchange. Accurate coding of this condition ensures that healthcare providers can effectively communicate the severity of the condition, track patient outcomes, and avoid misclassification. Note : To access this free article, make sure you first register if you do not have a paid subscription.
The Agency for Healthcare Research and Quality has released the 2025 Patient Safety Indicators (PSI) updates and revisions. Review the changes in more detail and discover which outdated indicators have been removed and which indicators have been modified.
It is not unusual for a professional medical coder to determine the need for multiple ICD-10-PCS procedure codes to tell the whole story about the care a patient has received during a current admission. Shelley C. Safian, PhD, MAOM/HIM/HI, RHIA, CCS-P, COC, CPC-I , shows how to begin by first referring to sequencing guidelines for principal and secondary ICD-10-CM diagnosis codes.
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.
It is not unusual for a professional medical coder to determine the need for multiple ICD-10-PCS procedure codes to tell the whole story about the care a patient has received during a current admission. Shelley C. Safian, PhD, MAOM/HIM/HI, RHIA, CCS-P, COC, CPC-I , shows how to begin by first referring to sequencing guidelines for principal and secondary ICD-10-CM diagnosis codes.
Our experts answer questions on better coding and CDI collaboration for escalation processes and AI implementation, queries for undocumented diagnoses and cause-and-effect relationships, and codes for hemorrhages as surgical complications.
While many bone fractures are often treated in emergency rooms or orthopedic clinics, certain fractures—especially severe, complex, or high-risk ones—tend to require inpatient admission. Nancy Reading, BS, CPC, CPC-P, CPC-I , shows how recognizing severity of fractures that may warrant hospitalization helps coders capture the full scope of the patient’s condition.
Our experts answer questions about diabetes mellitus in remission, percutaneous versus endoscopic discectomies, and complicated and uncomplicated problems.
Because anemia is not a definitive diagnosis due to the condition having many possible causes and just as many clinical presentations, Nancy Reading, BS, CPC, CPC-P, CPC-I , visits several of the common etiologies for anemia as well as associated coding concerns.
With takeaways from three certified medical professionals, HIM professionals can discover how the complexity of care for major depressive disorder impacts decisions around admissions, treatment intensities, resource allocations, and service quality, beginning with outpatient care.
Cirrhosis of the liver is categorized into distinct types that reflect different patterns of liver injury and disease progression, including hepatic fibrosis and hepatic sclerosis. Proper identification of these forms is critical for clinical accuracy and coding compliance.
CMS recently released an updated MLN fact sheet reminding providers when implantable pulmonary artery pressure sensors for heart failure can be covered under the coverage with evidence development policy. Included are the ICD-10-CM/PCS codes that must be reported for inpatient cases.
As the healthcare landscape evolves with new diseases, technologies, and treatment methodologies, so too must the guidelines that support the ICD-10-CM coding system. Review updates to the ICD-10-CM Official Guidelines for Coding and Reporting for fiscal year 2026 that will become effective October 1. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Joanne Chopak-Foss, PhD , and Alba Kuqi, MD, MSHIM, CDIP, CCS, CCDS, CRCR, CICA, CSMC, RHIA, CCM , look to prove how CDI professionals and coders can fully realize the value of SDOH documentation and coding in maternal and child health and shift the narrative toward equitable care for new and expecting mothers.
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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.
Temperatures in the upper 90s and spikes into the low 100s can bring an increased risk of hospitalization for heat-related illnesses, especially in those areas which do not traditionally experience these outside intensities. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , provides guidance for reporting both diagnosis and procedure codes for sun poisoning and heatstroke admissions.
Differentiating between acute kidney injury and acute tubular necrosis is particularly critical due to their implications on medical complexity and coding classification, so Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores the clinical foundation and diagnostic criteria of AKI and ATN, emphasizing their distinctions and significance for clinical documentation integrity and accurate ICD-10-CM coding.
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 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.
Temperatures in the upper 90s and spikes into the low 100s can bring an increased risk of hospitalization for heat-related illnesses, especially in those areas which do not traditionally experience these outside intensities. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , provides guidance for reporting both diagnosis and procedure codes for sun poisoning and heatstroke admissions.
With the fiscal year (FY) 2026 ICD-10-CM update adding 487 new diagnosis codes, inpatient coders will have the opportunity to report conditions with more specificity in areas such as wound care, ophthalmology, neurology, nephrology, pathology, and chronic disease coding. Note : To access this free article, make sure you first register if you do not have a paid subscription.
While many bone fractures are often treated in emergency rooms or orthopedic clinics, certain fractures—especially severe, complex, or high-risk ones—tend to require inpatient admission. Nancy Reading, BS, CPC, CPC-P, CPC-I , shows how recognizing severity of fractures that may warrant hospitalization helps coders capture the full scope of the patient’s condition.
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.
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.
Excluding skin cancer, breast cancer and prostate cancer are the most frequently diagnosed cancers among women and men, respectively. While both diseases originate in gender-specific organs and can range from slow-growing to aggressive forms, their clinical presentation and diagnostic complexity differ—differences that are reflected in how they are medically coded. Note : To access this free article, make sure you first register if you do not have a paid subscription.
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.
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.
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.
Review the FY 2026 ICD-10-CM tabular addenda for codes that you regularly report so you don’t miss additional information that can augment coding through more guidance or alert you to potential pitfalls.
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.
Differentiating between acute kidney injury and acute tubular necrosis is particularly critical due to their implications on medical complexity and coding classification, so Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores the clinical foundation and diagnostic criteria of AKI and ATN, emphasizing their distinctions and significance for clinical documentation integrity and accurate ICD-10-CM coding.
ICD-10-CM codes for Parkinson’s disease differ based on the primary neurologic diagnosis and any complications or comorbidities involved, as PD can manifest in various forms, each with unique characteristics.
Social issues often get left out of the conversation when providers, caregivers, and patients are busy, stressed, and focused on the immediate problem that occasioned a visit or admission; however, Nicole Nodal-Rodriguez, MSN, RN, CCDS , considers how having SDOH carried through the record can have a trickledown effect on treatment plans, identification of health disparities, and community services.
Accurate coding of hepatitis C scenarios relies heavily on recognizing and interpreting key details within clinical documentation, paying close attention specifically to the type of hepatitis, the acuity of the condition, the current status of the disease, and any associated complications or comorbidities. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Our experts answer questions on the role of prior encounters in queries, coding neoplasms in transplanted organs, and workflows for reporting malnutrition and pathology.
Start training your staff on the diagnosis code changes that will go into effect October 1. CMS will adopt the ICD-10-CM additions, revisions and deletions that it previewed in April. This article highlights some of the changes you should note.
Psychosis often emerges or is managed in outpatient mental health settings, but it can be coded during inpatient hospital stays due to the acute nature of the condition when it reaches a crisis point. To ensure that this mental health diagnosis receives the same diligence as medical and surgical diagnoses, Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , provides coders with guidance on finding the right codes and resolving documentation conundrums.
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.
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.
Review a study based on ICD-10-CM data from the National Vital Statistics System that shows life expectancy for the United States population increased to 78.4 years in 2023 while the mortality rate decreased by 6.0% to 750.5 deaths per 100,000 of the standard population in 2023. Also determined were leading causes of death.
Psychosis often emerges or is managed in outpatient mental health settings, but it can be coded during inpatient hospital stays due to the acute nature of the condition when it reaches a crisis point. To ensure that this mental health diagnosis receives the same diligence as medical and surgical diagnoses, Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , provides coders with guidance on finding the right codes and resolving documentation conundrums.
The ICD-10-CM classifies deep vein thrombosis with a high degree of specificity based on severity, affected extremity, vein location, and laterality, but without detailed clinical documentation or consistent terminology use, coders may need to query providers often for clarification in order to assign the right code.
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.
With hundreds of ICD-10-CM codes available for the various forms and manifestations of osteoarthritis and rheumatoid arthritis, coding these conditions to their highest specificity can be surprisingly complex. Without a thorough understanding of their distinctions, and without clear documentation from providers, navigating this coding landscape can feel overwhelming. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Anemia is a complex condition to manage clinically and document accurately, yet proper diagnosis, documentation, and coding are critical for ensuring appropriate patient care and reimbursement. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores the clinical aspects of anemia, including its definitions, types, causes, and management, while addressing the challenges in clinical documentation and coding.
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.
Our experts answer questions on NICU coding, ICD-10-CM coding for kidney transplants with kidney failure or other complications, and the acceptance of systemwide clinical definitions on queries.
CMS recently proposed hundreds of ICD-10-CM code changes in the 2026 Hospital Inpatient Prospective Payment System proposed rule, including 487 new codes, 38 revised code descriptions, and 28 invalidated codes. The rule also proposes 14 new ICD-10-PCS codes.
Misidentifying seizures and convulsions can easily lead to incorrect code assignment as each seizure subtype carries its own specific ICD-10-CM codes. Coding these conditions can be simplified, however, when coders have a strong grasp of the clinical and coding classifications for seizures. Note : To access this free article, make sure you first register if you do not have a paid subscription.
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.
Review a study based on ICD-10-CM data from the National Vital Statistics System that shows a decline in U.S. drug overdose deaths from 32.6 deaths per 100,000 of the country’s standard population in 2022 to 31.3 deaths per 100,000 in 2023.
Our experts answer questions on overcoming documentation challenges for sepsis, ICD-10-CM coding for infections of devices vs. wound infections as well as class three obesity and/or morbid obesity, and querying physician abbreviations.
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.
Our experts answer questions about assigning modifiers, mental health documentation and assigning evaluation and management service levels based on time.
One of the most frequent causes of hospital-acquired AKI is acute tubular necrosis (ATN). Improving documentation and coding practices for ATN involves not only recognizing the condition but also realizing the impact of coding ATN versus AKI, addressing common misconceptions in the HIM field, and fostering collaboration among CDI specialists, coding professionals, and providers.
Q: A month ago, a patient had undergone an open reduction and internal fixation of a traumatic fracture of the left femur. This afternoon, she was admitted for a severe and deep infection of the left thigh and immediately taken to surgery. An open, wide excisional debridement of the infected skin, subcutaneous tissue, and fascia was carried out, and the internal fixation hardware was removed. Cultures of the fixation pins grew Staphylococcus aureus. Can coders report infections of devices similar to how they would report a wound infection in ICD-10-CM?
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.
One of the most frequent causes of hospital-acquired AKI is acute tubular necrosis (ATN). Improving documentation and coding practices for ATN involves not only recognizing the condition but also realizing the impact of coding ATN versus AKI, addressing common misconceptions in the HIM field, and fostering collaboration among CDI specialists, coding professionals, and providers. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Research of multiple countries on various continents and with varied complexity of healthcare environments reveals significant disparities in health outcomes and access to healthcare, and a staggering percentage of health outcomes are attributed to social determinants of health. Studying these countries shows differences in how socioeconomic issues are captured in documentation and coded using different patient classification systems, guidelines, and regulations.
Review a study based on ICD-10-CM data from the National Vital Statistics System that shows a decline in U.S. maternal mortality rates from 22.3 deaths per 100,000 live births in 2022 to a rate of 18.6 deaths in 2023.
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.
The spectrum of myocardial injury, ischemia, and infarction represents a critical area in cardiology, which Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP , explores in detail, integrating information from current clinical guidelines, diagnostic standards, and management strategies.
Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS , and Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O , review some of the significant changes to the first quarter of AHA’s 2025 Coding Clinic.
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.
Q: Consider a patient who received a hysterectomy two days ago and was later admitted for severe acute abdominal pain around the surgical wound. When the wound was reopened, it was discovered that an instrument had been left in her body. The instrument was removed, and the wound was resutured. How would coders report this situation with ICD-10-CM codes?
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.
