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.
CMS recently announced plans to enhance its auditing efforts for Medicare Advantage plans by increasing the number of audits it conducts and expanding its team of medical coders.
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.
While much of the focus on AI implementation in HIM centers around billing and coding for operational efficiency and error reduction, its value extends far beyond those boundaries. Looking ahead, the stakes involve deeper questions about how automation might ultimately influence clinical decision-making.
AHIMA is currently accepting submissions for research-driven content to be featured in our Poster Sessions at AHIMA25 Conference, October 12-14 in Minneapolis, MN. If your poster is selected, one...
When a physician requests a consult from another physician, how can medical coders tell if the conversation counts toward the data review column in the medical decision-making table? This article provides guidance on when to count those conversations.
Clients who participated in court-ordered assisted outpatient treatments (AOT) displayed significant improvements across several outcome measures, according to a study recently published in Psychiatric Research and Clinical Practice.
With advancements in artificial intelligence (AI) and augmented intelligence enabled healthcare, the American Medical Association provided guidance outlined in Appendix S taxonomy for describing and classifying various AI applications. This article will help coders understand the AI taxonomy.
CMS developed medically unlikely edits (MUE) as a way to limit the number of times a particular service is allowed to be billed by a single provider to a single patient on any given date of service. This article explains how MUEs can be used to stop errors. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The National Institutes of Health recently released a study that found an artificial intelligence screening tool was as effective as healthcare providers in identifying hospitalized adults at risk for opioid use disorder and referring them to inpatient addiction specialists. The tool also has the potential to reduce readmissions.
With its enhanced specificity and comprehensive structure, ICD-11 offers a more detailed and accurate framework for documenting cancer diagnoses. Karla VonEschen, MS, CCDS-O, CPC, CPMA , explores how precise documentation and the coder’s ability to capture all the diagnosis codes to fully describe the condition will be crucial for healthcare organizations.
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.
Make sure your staff know when they can count the independent review of a test toward medical decision-making. This article provides guidance on when to count independent interpretations.
A recent study published in the American Journal of Psychiatry looked into national trends in outpatient mental healthcare and found that the use of psychotherapy increased while the use of psychotropic medication alone decreased.
Modifier -25 is used to report a significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
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.
Jenny Esper, RHIA, CDIP, CCS, CCDS , and Lizabeth Volansky, BSN, RN, CCDS, RHIA, CDIP, CCS , explore the topic of including references or links to definitions within query notes and how such a practice can enhance documentation and coding.
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.
Medicare utilization of CPT critical care code 99291 and add-on code 99292 jumped higher during the pandemic years. That bump has subsided, however, and a review of 10 years of progress in critical care utilization suggests the codes have swiftly adjusted to pre-COVID levels.
There are three ways to bill the services of a non-physician practitioner: incident-to, direct, and shared billing. The type of billing used often depends on the location of service and the degree of physician supervision. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently updated the list of preventive service codes that can be reported with complexity add-on HCPCS code G2211. In a recent change request, CMS deleted codes for services not considered covered preventive services and added codes for services that are considered covered preventive services.
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.
On April 11, CMS released the fiscal year 2026 Inpatient Prospective Payment System proposed rule, which proposes a 2.4% payment increase for hospitals and several adjustments to quality reporting programs, including the Hospital Inpatient Quality Reporting Program.
Coding for joint replacement procedures requires extra attention to detail, particularly for device and qualifier characters and most importantly for partial replacements. Terry Tropin, MSHAI, RHIA, CCS-P , shows how these characters are very specific but give a clear picture of the procedure that was performed for a specific patient.
Revenue integrity professionals have found that working with multiple departments is helpful in addressing denials. Discover how coders—alongside denial, clinical, and CDI professionals—can play a key role in this increased collaboration to manage and prevent denials.
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.
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.
AI is increasingly being integrated into the CDI industry and as these tools evolve, their capabilities will naturally extend into adjacent fields like medical coding. Although AI may not be an entirely welcome change, Sarah Matacale, BSN, RN, CCS, CCDS , highlights practical ways CDI professionals and even coders can adapt to and benefit from these new tools.
Coding for joint replacement procedures requires extra attention to detail, particularly for device and qualifier characters and most importantly for partial replacements. Terry Tropin, MSHAI, RHIA, CCS-P , shows how these characters are very specific but give a clear picture of the procedure that was performed for a specific patient.
Our experts answer questions about the standard of care, reporting reduced services, and problems addressed during evaluation and management office visit.
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.
Accurate medical coding for dermatological procedures is essential for proper payment and compliance. This article provides a detailed overview of coding guidelines for excisions and repairs, ensuring that healthcare professionals correctly report these procedures.
Even though Congress didn’t fully unleash telehealth services, instead extending the long-running telehealth waivers through September, making your telehealth services a permanent offering can improve your practice’s financial health.
The first quarter publication of Coding Clinic added clarifications for some of the new codes from fiscal year 2025 and a question-and-answer section that discussed complicated coding issues. Terry Tropin, MSHAI, RHIA, CCS-P , reviews the advice and guidelines for ICD-10-PCS codes.
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.
Preventing revenue leakage is one of the core goals of a revenue integrity program, but with numerous sources of potential leaks, meeting this goal is often easier said than done. Michele Bear, DBA, MBA, CHRI, CRCR, CHC, CPC , focuses on key elements of successful revenue integrity programs that can prove to be effective and proactive.
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.
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.
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.
Forensic medical coding is a specialized field that combines the precision of medical coding with the complexities of the legal system. Understanding the skills needed and the types of cases in which medical coding is essential becomes crucial to those looking to enter the field. Note : To access this free article, make sure you first register if you do not have a paid subscription.
With 50 new ICD-10-PCS codes implemented on April 1, Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , thoroughly reviews the codes to help inpatient coders accurately apply the updates.
CMS recently issued a bulletin highlighting new Medicare documentation guidelines and providing additional resources for documentation compliance. Deanne Wilk, MPS, BSN, RN, CCDS, CCDS-O, CDIP, CCS , outlines the key takeaways from this latest guidance and emphasizes how health information, CDI, and coding teams play a role in compliant documentation.
The nearly 40,000 new National Correct Coding Initiative edits might seem overwhelming at first, but a divide-and-conquer strategy for the next update can make it more manageable. CMS added dozens of CPT codes to the procedure-to-procedure edits that went into effect January 1, 2025, and medically unlikely edit file that went into effect April 1.
Accurate medical coding for dermatological procedures is essential for proper payment and compliance. This article provides a detailed overview of coding guidelines for excisions and repairs, ensuring that healthcare professionals correctly report these procedures.
CMS recently published its HCPCS Quarterly Update, which brings 148 HCPCS Level II code additions, discontinuations, and revisions. The changes became effective April 1.
In an environment where there is continuous development of new technology for the treatment of medical conditions, the AMA created a third category of CPT codes. Category III codes are a set of temporary codes for reporting emerging technology, services, and procedures. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
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.
With 50 new ICD-10-PCS codes implemented on April 1, Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I , thoroughly reviews the codes to help inpatient coders accurately apply the updates.
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.
Building a team of fully cross-trained coders who are competently able to code all record types is one of a coding manager’s goals. Achieving this goal requires that managers inventory the skills of each coder, identify focused education, and plan for cross-training opportunities.
Reducing hospital readmissions has long been a health policy goal, and CDI programs have started to track and review this metric for improvement. Learn how CDI teams are addressing readmissions, as a familiarity with risk adjustment and the impact of documentation can prove useful to coders who also play a role in risk adjustment through their translations of complete documentation into precise codes.
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.
Selecting a level of medical decision-making (MDM) is confusing and complicated. In this article, Terry Tropin, MSHAI, RHIA, CCS-P, defines key MDM terms and describes a simplified system for selecting a level of MDM.
Our experts answer questions about assigning modifiers, mental health documentation and assigning evaluation and management service levels based on time.
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?
The Centers for Medicare & Medicaid Services has pulled information on health-related social needs (HRSN), a subset of broader social determinants of health factors, for state Medicaid and the Children’s Health Insurance Program, potentially making it harder for services that address HRSNs to be covered by these affected programs.
Although typically associated with outpatient services due to their use of HCPCS codes, chargemasters are also crucial in inpatient settings, as they serve as the foundation for billing services rendered during a patient’s hospital stay. Learn how inpatient coders can help maintain the financial health of their organizations through the proper understanding of chargemasters. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Coders play a crucial role in addressing clinical and coding denials, but they are far from alone in this effort. All HIM professionals are working together to create and implement comprehensive strategies that effectively reduce denials, fostering a unified approach to overcoming these challenges.
Train new coders to follow CMS’ rules when they find CPT guidance that doesn’t match Medicare’s requirements. This article discusses how the CPT manual’s instructions to report modifier -99 (Multiple modifiers) don’t match instructions from CMS and some Medicare administrative contractors.
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.
Selecting a level of medical decision-making (MDM) is confusing and complicated. In this article, Terry Tropin, MSHAI, RHIA, CCS-P, defines key MDM terms and describes a simplified system for selecting a level of MDM.
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.
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.
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.
ICD-10-CM official guidelines once stated that if there is conflicting documentation in the health record, the documentation of the attending physician supersedes that of any other provider. With that rule now gone, Cheryl Ericson, RN, MS, CCDS, CDIP , helps clarify who should be determining diagnoses.
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.
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.
When medical services are rendered, the expectation is that the facility and/or provider will be reimbursed for those services. Sometimes the reality is that a claim will be denied as it “fails to meet medical necessity” by the insurance carrier. It is always in your best interest to appeal all medical necessity denials. Note: To access this free article, make sure you first register here if you do not have a paid subscription.
Radiologists and providers who implant or program implantable medical devices should review the six new magnetic resonance (MR) safety CPT codes that went into effect January 1, 2025. The codes describe the work involved when a medical implant or metallic foreign bodies create additional risks for an MR exam.
A recent report from the Brown University School of Public Health compared the average commercial price for low-complexity, low-intensity medical care in New York hospital outpatient departments to the same care provided in non-hospital settings, such as physician offices and ambulatory surgery centers.
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.
On November 1, 2024, CMS released its final rule describing calendar year 2025 policies and rates for Medicare’s Outpatient Prospective Payment System and the final rule was published in the Federal Register. This article is a comprehensive overview of all the major highlights, allowing coders to stay informed about key updates and navigate the changes throughout the year.
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.
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.
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.
Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.
