There were 371 new codes added to the October update of the 2025 ICD-10-PCS code set, but Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , narrows her investigation into the new codes for one particular body system within the Medical and Surgical section: Lower Arteries.
Review a study funded by the National Institutes of Health that has found adults who were hospitalized for a severe infection, such as respiratory infections or sepsis, were twice as likely to develop heart failure years later.
Artificial intelligence is revolutionizing healthcare administration by enhancing efficiency, accuracy, and decision-making across various processes, with medical coding standing at the forefront of this transformation. Understanding AI-driven programs and the evolution of medical coding is essential for coders to thrive in this rapidly changing landscape. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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?
Leveraging tools like clinical decision support (CDS) systems and physician queries can improve patient care and ensure documentation integrity. Yet medical coders need to ensure they use automated guidance without overstepping into clinical decision-making, maintaining the integrity of both documentation and coding while avoiding potential misinterpretations or misrepresentations of a patient’s condition.
Because discrepancies among payers’ diagnostic standards can lead to documentation issues, coding errors, and denials, revenue integrity professionals are encouraged to increase collaboration between CDI, coding, and clinical staff when addressing varying criteria. Discover further how coders play a key role in analyzing criteria, identifying denial trends, and ensuring providers receive proper training and education.
Given the variety and complexity of surgical complications, coders should understand the nuances of differentiating between surgical complications and pre-existing conditions, stay up to date with coding guidelines, and familiarize themselves with ICD-10-CM chapters where complications codes are located. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: Patient is a young but quite debilitated and oxygen-dependent female with a complex history and frequent hospitalizations. She currently presents with exacerbation of bronchiectasis secondary to Swyer-James unilateral emphysema, chronic postinfectious bronchiolitis obliterans syndrome following bronchiolitis obliterans in childhood, and superimposed bacterial pneumonia. Her condition is complicated by morbid obesity with a BMI of 42 and severe obesity hypoventilation syndrome with obstructive sleep apnea. How would this diagnostic note be reported in ICD-10-CM?
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.
Review a study published in a recent edition of Health Affairs that discovered which type of hospitals are not evaluating their AI tools internally for accuracy or potential biases and explored whether models developed in-house or by external developers were supported more by local evaluations.
Although advancements in treatment and early detection improve survival rates, the incidence of cancer diagnoses, including lymphoma, continue to rise. To reflect the growing number of cases and the complexity of neoplasms, new ICD-10-CM codes were introduced for fiscal year 2025. Learn how to capture each diagnosis with greater precision. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
For fiscal year 2025, ICD-10-CM Chapter 19 saw an addition of 18 new codes for poisoning by, adverse effect of, and underdosing of immune checkpoint inhibitors and immunostimulant drugs. To properly apply these new codes, Nancy Reading, RN, BS, CPC, CPC-P, CPC-I , breaks down the purposes of these medications and explains how the coding guidelines address the complex range of side effects these drugs can cause.
CMS recently published an update to the fiscal year 2025 ICD-10-PCS code set, available for discharges occurring from April 1 through September 30, 2025. Although CMS made no changes to the guidelines, the update includes 50 new codes, 12 deleted codes, and two new tables.
Q: Consider a patient who is readmitted for postoperative pain control after a lung transplant two days prior. How would coders report this type of surgical complication in ICD-10-CM? In general, what are the guidelines for coding pain as a surgical complication of transplantations?
Cheryl Ericson, RN, MS, CCDS, CDIP , explores why CMS will begin collecting data in 2025 to measure performance on the Hospital Harm from Acute Kidney Injury (HH-AKI) electronic clinical quality measures (eCQM), particularly for those who may be less familiar with eCQM.
When denials are not justified, coding compliance auditors participate in the preparation of appeals using the content of the medical record and official reference materials that justify the coding that was submitted. Discover more about the important role coding compliance auditors play in denials management. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: A patient with severe emphysematous bronchitis is hospitalized due to acute RSV bronchitis. He is noted to have a history for cerebrovascular accident with residual oropharyngeal dysphagia occurring in the past year and on day three of the hospitalization, he aspirated some of his breakfast during an episode of severe coughing. The patient’s RSV swab is now showing negative, so viral bronchitis is considered resolved, but patient continues to require treatment for secondary aspiration pneumonia, which is their main concern at this point, as well as acute hypoxic respiratory failure. He will require oxygen continuously. How would this diagnostic note be reported in ICD-10-CM?
After the Medicare Payment Advisory Commission reviewed draft recommendations for 2026 payment updates, which included increases only for hospital inpatient and outpatient services, the commission was urged by the American Hospital Association to revise the recommendations. Learn what AHA is recommending instead before the commission meets again tomorrow morning.
Penny Jefferson, MSN, RN, CCDS, CCDS-O, CDIP, CCS, CRC, CPHQ, CHDA, CRCR, ACPA-C , explores the complexities surrounding the classification of hospital admit types and the challenges caused by inconsistent definitions. By being aware of admit types, coders can ensure accurate reporting, benchmarking, and quality measurement.
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.
