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.
When a woman is pregnant, relational connections between multiple organ systems can affect both mother and fetus and thereby alter, and perhaps complicate, the care they require. In addition, determining whether a condition was pre-existing or due to the pregnancy is important but can be tricky. Shelley C. Safian, PhD, MAOM/HIM/HI, RHIA, CCS-P, COC, CPC-I, provides clarifications for these types of scenarios.
Our experts answer questions on bridging the gap between DSM-5 and ICD-10 for substance-related disorders; differentiating between poisoning, adverse effects, underdosing, and toxic effects; and reporting pancreatic cancer with ICD-10-CM.
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.
A study published in JAMA found that people who experience a traumatic spinal cord injury are at a greater risk of developing long-term chronic conditions such as hypertension, stroke, heart disease, diabetes, and other neurological and psychiatric conditions.
Failure to rescue is a compelling quality metric because it offers a lens through which healthcare organizations can illuminate, analyze, and improve the rescue zone of patient care. Teresa Brown, RN, CCDS, CCDS-O, CDIP, CCS , shows how this metric can guide meaningful improvement in patient safety and outcomes when coding and CDI professionals help use it thoughtfully.
Organizations have become increasingly aware that social determinants of health play a major role in determining health disparities. With this in mind, Kelly Rice, MSHI, BSN, RN, CCDS, CDIP, CCS, CRC, reviews the changes to SDOH for FY 2026 and the response to such changes, explores strategies for continued capture of SDOH, and emphasizes the use of new SDOH ICD-10 codes available.
A study published in the Journal of the American College of Cardiology found that people under age 50 who consume cannabis are 6.2 times more likely to experience a heart attack than individuals who do not. It also found that they are 4.3 times more likely to experience an ischemic stroke and 2 times more likely to experience heart failure.
Asthma and chronic obstructive pulmonary disease, which encompasses emphysema and bronchitis, are two of the most prevalent and debilitating respiratory conditions. Understanding these diseases and their pathophysiology is crucial for accurate diagnosis, treatment, and coding, particularly when the conditions overlap. Note : To access this free article, make sure you first register if you do not have a paid subscription.
When a woman is pregnant, relational connections between multiple organ systems can affect both mother and fetus and thereby alter, and perhaps complicate, the care they require. In addition, determining whether a condition was pre-existing or due to the pregnancy is important but can be tricky. Shelley C. Safian, PhD, MAOM/HIM/HI, RHIA, CCS-P, COC, CPC-I, provides clarifications for these types of scenarios.
Q: Why is it necessary for coders, CDI professionals, and providers to align documentation and coding for substance-related disorders when applying both the DSM-5 and ICD-10? How does this impact risk adjustment and HCC capture?
Our experts answer questions about poisonings vs. adverse effects , coding neoplasm-related conditions, and office and outpatient E/M visit complexity.
Our experts answer questions on new codes introduced to differentiate multiple sclerosis subtypes, the must know concept of Elixhauser comorbidities, and key questions to address prior to coding chest pain.
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.
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.
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 .
