Use the documentation “cross-out test,” clinical vignettes, and expert answers to scenarios to educate staff about when they can and cannot unbundle an evaluation and management visit from a same-day procedure.
CMS announced its A/B Medicare administrative contractors have withdrawn the local coverage determinations for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers.
Medicare pays for physical and occupational therapy services when the medical record and the information on the claim form accurately report covered therapy services. This article discusses Medicare’s documentation requirements to justify billed therapy services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
As we approach the end of the year, take a moment to refresh yourself on the ins and outs of the primary code sets an outpatient coder needs to understand and use in their role. This article provides a brief overview of three code sets that will serve as a review for veteran coders or a solid base of information for new coders.
After a few years of confusion about how providers should document time for level-based evaluation and management services, the consensus can be summarized as “make it make sense,” according to a review of guidance issued by all seven Medicare administrative contractors.
Accurate provider documentation is the foundation of compliant coding, appropriate reimbursement, and defensible claims. Yet, in a rapidly changing healthcare landscape, even highly skilled clinicians can find it difficult to stay current.
Transcatheter aortic valve replacement is a minimally invasive procedure developed to treat patients with severe aortic stenosis who are considered high-risk or unsuitable candidates for traditional open-heart surgery. Learn from Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, as she walks through the procedural coding for both inpatient and outpatient settings.
Transcatheter aortic valve replacement is a minimally invasive procedure developed to treat patients with severe aortic stenosis who are considered high-risk or unsuitable candidates for traditional open-heart surgery. Learn from Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC, as she walks through the procedural coding for both inpatient and outpatient settings.
Beginning January 1, 2026, the AMA will add a number of changes to CPT codes for two related sections: Digitally Stored Data Services/Remote Physiologic Monitoring; and Remote Physiologic Monitoring Treatment Management Services.
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.
Our experts answer questions about emergency transport services, the medical necessity requirements for epidurals to treat chronic pain, and medication noncompliance vs. underdosing.
You’ll have to wait a while longer for National Correct Coding Initiative edits for 2026-effective codes. However, the latest quarterly NCCI update will include new medically unlikely edits for a variety of HCPCS codes that went into effect in July and October 2025.
Providers will have more opportunities to report +G2211, the complexity of care HCPCS add-on code. Effective January 1, 2026, providers will be able to report the code with evaluation and management encounters in more settings, CMS announced in the final 2026 Medicare Physician Fee Schedule.
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.
MDaudit, a revenue integrity software platform, recently released its annual report that examines trends in coding denials, audits, and technology based on data from the first three quarters of 2025. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Coders will find a fresh batch of CPT codes that they can begin reporting on January 1, 2026, with 288 new codes coming online. The code update, announced with the release of the 2026 CPT Manual, also includes 46 revised code descriptors and 84 deleted codes.
Beginning January 1, 2026, the AMA will add a number of changes to CPT codes for two related sections: Digitally Stored Data Services/Remote Physiologic Monitoring; and Remote Physiologic Monitoring Treatment Management Services.
Our experts answer questions about poisonings vs. adverse effects , coding neoplasm-related conditions, and office and outpatient E/M visit complexity.
While CMS declined to consider any codes for revaluation under the agency’s potentially misvalued codes policy for calendar year (CY) 2026, the agency proved responsive to nominators’ requests for certain codes to be valued or revalued.
