Several updates to the Ambulatory Surgical Center payment system recently went into effect, so ensure that your staff knows about these changes, including new HCPCS codes, a deleted code, and revisions.
Medical coding message forums can help coders find the answers to tough coding scenarios and keep claims moving. But remind everyone on your team to make sure their request for help doesn’t create compliance risks or endanger their employment.
The Office of the Inspector General announced it is launching a new audit of evaluation and management services billed on the same day as minor procedures effective March 16, 2026.
The AMA announced several changes coming to maternity care service codes for the 2027 CPT code set in a move aimed to allow care to be reported more specifically across all phases of pregnancy. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: How do coders determine whether to assign an ICD-10-CM P code (for maternal conditions affecting the newborn) or a Z code (for factors influencing health status) for a newborn?
Compared to recent past years, CMS proposed fewer ICD-10-CM code changes in the 2027 Hospital Inpatient Prospective Payment System proposed rule, including 184 new codes, 4 revised code descriptions, and 30 invalidated codes.
Hospitals have had a more complex time attempting to retain fair DRG payment by defending both the documented clinical diagnoses established by the treating provider and the corresponding codes in written appeal. Julie Dagen, RHIA, CCDS, CCS, seeks to address some key aspects of compliant hospital navigation through the rough waters of DRG denials.
From a coding perspective, accurate reporting of artificial openings is essential because it communicates critical information about a patient’s anatomy, clinical status, and the level of care required. Coders must distinguish between a stable, well-functioning artificial opening (status), active management or attention to the opening, and true complications, as each circumstance is classified differently within ICD-10-CM. Note : To access this free article, make sure you first register if you do not have a paid subscription.
ICD-11 elevates SDOH and other contextual factors into a more standardized, digital-first framework that can support the next generation of equity measurement, population health analytics, and financing models. Learn how ICD-11 SDOH coding is not just a classification change–it is an enabler of strategic goals in population health, financial sustainability, and equitable care delivery.
Coding for alcohol- and drug-related disorders requires careful attention to both clinical terminology and the structure of the ICD-10-CM classification system. These conditions fall under the broader category of mental and behavioral disorders due to psychoactive substance use, primarily coded within the F10-F19 range. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Accurate procedure code assignment requires coders to have a good understanding of coding guidelines, anatomy, physiology, and medical terminology, as well as the ability to decipher the operative report. Assigning ICD-10-PCS codes for pacemaker insertions requires all these skills and more in some cases. Teresa Seville, RHIT, CCS , justifies how understanding the types of pacemakers and where they are inserted is paramount for correct coding.
Assigning and sequencing diagnosis codes for COPD in the face of an acute exacerbation of COPD, particularly when the patient’s condition progresses to respiratory failure, has posed challenges to coders for quite a while. Nancy Reading, BS, CPC, CPC-P, CPC-I, demonstrates how to nail down the diagnosis codes based on clinical presentations before determining the correct sequencing for principal diagnosis assignment.
CMS released the fiscal year 2027 Inpatient Prospective Payment System proposed rule on April 14, which proposes a 2.4% payment increase for hospitals that are meaningful users of electronic health records and submit quality measure data. A key addition to the proposed rule is a nationwide expansion of the Comprehensive Care for Joint Replacement model.
Early dose adjustments for individuals undergoing methadone treatment in outpatient settings were associated with improved treatment retention, according to a study published in PLOS Medicine.
When is a procedure coded as a biopsy and when is it coded as something else? The right code depends on the purpose of the procedure. The distinction between a biopsy and another procedure is not always clear.
Wound care claims are incredibly complex, and they often involve extensive medical histories, multiple diagnoses, and procedures that require detailed documentation to support proper code selection. Even a seemingly minor omission or ambiguity in the documentation could make all of the difference.
ICD-10-CM coding guidelines instruct providers to report a code through the entire fracture healing process—changing only the seventh character to signal the stage of healing. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
