A number of Medicare telehealth flexibilities extensions in place until January 30, 2026, lapsed during the partial U.S. government shutdown that began January 31, 2026.
The 2026 Outpatient Prospective Payment System final rule isn’t for the faint of heart. CMS finalized many of the major changes from the proposed rule, although the agency did pull back on certain key areas. With big shifts in compliance and reimbursement taking effect, coders have their work cut out for them.
The CPT manual includes many types of biopsies: fine needle aspiration (FNA), core needle, and skin (tangential, punch, and incisional). This article focuses mainly on FNA biopsies and its complicated guidelines, while also touching on core needle biopsies.
Emergency department visits resulting in outpatient treatment increased sharply, while visits leading to inpatient admission did not—particularly among Medicaid patients—according to research recently published in JAMA Health Forum.
Part B providers are facing a radically different reimbursement landscape in 2026. In the 2026 Medicare Physician Fee Schedule final rule, CMS moved ahead with many of the changes it floated in the proposed rule, including fundamental changes to how the conversion factor is calculated, relative value unit valuation, payments for skin substitutes, and more.
A neonatal intensive care unit offers very specialized medical services and treatments to premature and critically ill neonates (i.e., babies 28 days old or younger). Review which ICD-10-CM and CPT codes may be used for providers assisting in this type of care.
CMS released the fiscal year 2026 ICD-10-CM files for use for discharges and patient encounters occurring from April 1 through September 30, 2026. Take time to review the updates. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A study recently published in JAMA Network Open examined trends in outpatient mental health care among Medicare fee-for-service beneficiaries before, during, and after the COVID-19 pandemic.
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.
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.
Q: A patient was initially treated for extensive burns on his lower back and the posterior side of both thighs. The physician documented that the patient had second- and third-degree burns of the lower back (2% Total Body Surface Area [TBSA] second-degree and 7% TBSA third-degree) and third-degree burns of both thighs (9%). What ICD-10-CM codes would be assigned for this encounter?
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.
Medical coders work with many different code sets including CPT, HCPCS, ICD-10-PCS, and ICD-10-CM. This means coders need to be well-versed in medical terminology. One terminology not often talked about in coding circles is the Systematized Nomenclature of Medicine Clinical Terms—despite the system being around for more than 20 years.
Social determinants of health (SDOH) are critical for the well-being of the patient and are often more important than what occurs in physician’s offices, laboratories, operating rooms, and other clinical settings. Accurately capturing SDOH and providing education on doing so are equally critical for patient care, quality reporting, and reimbursement.
CMS recently published a fact sheet outlining an update coming from all seven Medicare administrative contractors to the local coverage determinations for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers, which will be effective January 1, 2026. 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.
Clinics, specialty groups, and ambulatory care centers are facing systemic strains from the outpatient healthcare infrastructure, according to the Outpatient Pressure Index 2025 published by CERTIFY Health.
