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.
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.
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.
Medicare coverage of mental health services has expanded in recent years. Along with authorizing payment for additional services and telehealth options, CMS has established several new provider types. Steps have been made to expand access to care, but many healthcare facilities are still working to establish a solid foundation in CPT coding for mental health services.
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?
Updated coding guidance can be found in CMS’ Medicare Preventive Services educational tool for several services. Review the changes to ensure proper coding of preventive services.
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.
Medicare pays for therapy services when the medical record and the information on the claim form accurately report covered therapy services. That means your documentation must be legible, relevant, and sufficient to justify the services billed. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
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.
The implementation of the 21st Century Cures Act has resulted in radiology patients in the outpatient setting being able to view their examination results quicker, according to a study published in JAMA Network Open.
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.
CDI departments are focusing on pediatric populations through various unique initiatives, particularly with the intent to establish organizational definitions for certain diagnoses and expand clinical knowledge of intensive neonatal care. Such initiatives can support the clinical validation of reported codes and encourage good relationships with providers in case queries are needed.
The Outpatient Code Editor (OCE) provides the answers to the test, but to use it effectively, you need to understand the history and the complex configuration of all the parts.
The pelvis encloses and supports the internal organs, so a pelvic ring fracture—commonly caused by traumatic events such as car crashes—can trigger extensive internal bleeding and other injuries. Learn about some CPT fracture codes for posterior pelvic ring fractures that would be reported in many trauma situations.
Our experts answer questions about diabetes mellitus in remission, percutaneous versus endoscopic discectomies, and complicated and uncomplicated problems.
Machine learning (ML) has evolved beyond its status as a technological trend to become an indispensable asset in outpatient surgical risk stratification. Within the domains of medical coding and claims adjudication, coding professionals play a pivotal role in optimizing ML model performance.
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.
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.
Q: When a diagnosis is clinically evident but not yet documented or there is uncertainty about a cause-and-effect relationship between related conditions, would queries be outlined similarly to other types of queries or include different information?
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.
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.
The Outpatient Code Editor provides the answers to the test, but to use it effectively you need to understand the history and the complex configuration of all the parts.
CMS recently updated its July 2025 update to the Ambulatory Surgical Center Payment System to include several new HCPCS codes and revised information about coding for drugs, biologicals, and radiopharmaceuticals. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A study published in Respiratory Care found that integrating respiratory therapists (RT) in a chronic obstructive pulmonary disease (COPD) clinic led to significant improvements in symptoms and exacerbation rates among patients, as well as a reduction in hospitalizations.
Q: Are there solutions for having better coding and CDI collaboration? How might this help teams with escalation processes and implementation of AI programs?
CMS released the fiscal year 2026 Inpatient Prospective Payment System final rule on July 31, which will provide a 2.6% payment increase for hospitals instead of the original 2.4% considered in the proposed rule. Among other provisions, the rule will continue the mandatory Transforming Episode Accountability Model and modify various quality reporting programs.
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.
Terry Tropin, MSHAI, RHIA, CCS-P , outlines changes to the ICD-10-PCS for fiscal year 2026, which were made primarily in the codes for the cardiovascular system, joints and bones, and nervous system. Some of these changes were in the Medical and Surgical section but others were in the New Technology and Extracorporeal or Systemic Assistance and Performance sections.
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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Prepare now for 21 code revisions that coders will find in the 2026 CPT manual by reviewing changes in the proposed 2026 Medicare physician fee schedule.
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.
Machine learning (ML) has evolved beyond its status as a technological trend to become an indispensable asset in outpatient surgical risk stratification. Within the domains of medical coding and claims adjudication, coding professionals play a pivotal role in optimizing ML model performance.
The most common ankle tendon repair is for the Achilles tendon, the largest and strongest tendon in the body. Brush up on the CPT codes for repair of this tendon. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Using her own CDI team as a case study, Yohan O. Paredes, MD, CCDS , shows how the implementation of structured CDI initiatives in pediatric and OB/GYN settings can optimize coding accuracy, regulatory compliance, and financial performance.
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.
