Obesity is a complex medical condition characterized by excessive body fat that can negatively affect an individual's overall health and increase the risk of serious medical complications. Providers should clearly establish obesity diagnoses and relevant clinical relationships, while coding professionals should ensure that assigned codes comply with the current guidelines, including applicable instructional notes and code-specific requirements. This article focuses specifically on reporting adult morbid (severe) obesity. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Even though seborrheic keratoses are benign and not contagious, their appearance can sometimes resemble melanoma, a potentially life-threatening form of skin cancer. Shontia Leon-Guerrero, CPC, CEDC, CEMC, CPC-I Educator, explains why understanding the differences between these conditions is important for recognizing when further medical evaluation may be necessary, as well as for proper coding.
Mechanical ventilation plays a critical role in supporting patients who are struggling with respiration due to illness, injury, or complications associated with surgical procedures. By maintaining oxygenation and ventilation while the underlying condition is being treated or resolved, this intervention can dramatically increase the survival rates for critically ill patients. Follow Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, as she breaks down medical necessity requirements, mechanical ventilation types, and relevant ICD-10-PCS codes.
Q: What are some coding and documentation considerations that can impact whether a case triggers a Patient Safety Indicator and presents an opportunity for exclusion?
At the public ICD-10 Coordination and Maintenance Committee Meeting held September 15–16, 2026, the Centers for Disease Control and Prevention discussed 39 proposals involving diagnosis code topics. Discover some of the requests being considered for implementation on April 1, 2027.
Ensure your team is aware of the latest key updates to the Ambulatory Surgical Center (ASC) Payment System that went into effect on October 1, 2026, which includes changes to codes for surgical procedures, skin substitute products, and drugs, biologicals, and radiopharmaceuticals. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Outpatient social care interventions may strengthen outcomes for children and their families, according to a scoping review published in Academic Pediatrics.
The measles outbreak is racing through the United States and quite possibly your own healthcare facility. In 2025, a total of 2,289 measles cases were reported in the United States. As of October 16, 2026, there have been 4,410 cases reported in 2026.
CMS is planning major reimbursement shifts for outpatient hospital services, according to the 2027 Outpatient Prospective Payment System (OPPS) proposed rule.
Q: How do the clinical consequences of measles and rubella influence ICD-10-CM code selection, particularly when coding specific complications, congenital rubella syndrome, and infections documented without complications?
Congenital heart defects, the most common type of birth defect, are among the most clinically significant anomalies in neonatal care. Bobbie Vannatter, MHA, RHIA, CCS, CDIP; Andrew Puckett, DNP, RN, NI-BC; and Vitality Shalumov, RN, BSN, CCDS, reviews selected neonatal congenital cardiac conditions and highlights key documentation considerations that influence coding and representation of severity.
Diagnosis-related group downgrades result from a mix of insufficient or incomplete documentation, coding errors, and diagnoses that lack clinical validation. When higher-acuity diagnoses designated as MCCs or CCs are removed, the case may be reassigned to a lower-paying DRG, resulting in a loss of revenue. Follow Nancy Reading, BS, CPC, CPC-P, CPC-I, as she discusses the challenges of denial reviews conducted by third-party payers and proactive strategies to prevent and manage denials.
Because third-degree burns are a severe injury that destroys the epidermis and dermis and may extend into the underlying subcutaneous tissue, accurate coding depends on clear documentation of burn depth, anatomical site, and total body surface area. Learn how to navigate the fundamentals of ICD-10-CM code selection and sequencing guidelines for third-degree burns, including how to prioritize burn severity and account for multiple injury sites. Note : To access this free article, make sure you first register if you do not have a paid subscription.
At the recent public ICD-10 Coordination and Maintenance Committee Meeting, the Centers for Disease Control and Prevention National Center for Health Statistics discussed 23 proposals involving procedure code topics. Discover some of the updates being considered for implementation on October 1, 2027.
CMS recently released a transmittal regarding the quarterly updates to the OPPS. The transmittal, which was originally published internally, was republished for the public regarding updates that went into effect on October 1. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
New research has found that outpatient follow-up after psychiatric hospitalization among patients with first-admission schizophrenia was associated with a significantly lower risk of readmission, according to a study published in Frontiers in Psychiatry.
Practices that treat conditions such as carpal tunnel syndrome and osteoarthritis of the knee must review a new uniform policy that covers a variety of painful chronic conditions. Start now by training staff and reaching out to patients who are no longer covered.
Laboratory services are often overlooked as potential suspects for fraud because they are typically not considered high-cost services. But the sheer volume of laboratory services billed more than compensates for their low cost. These charges represent hundreds of millions in healthcare spending.
Hepatic encephalopathy is a neurologic complication of severe liver disease in which impaired liver function allows toxic substances that are normally metabolized and eliminated by the liver to accumulate in the bloodstream and reach the brain. For coders, understanding the relationship between hepatic encephalopathy, the underlying liver disease, presence of a coma, and liver transplant complications is essential for accurately capturing the patient’s clinical picture and assigning the most appropriate ICD-10-CM codes. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Three newly released compliance audits highlight significant gaps between high-risk diagnosis codes submitted for Medicare Advantage risk adjustment and the medical records supporting those diagnoses. Across the three organizations, OIG found that 533 of 700 sampled enrollee-years lacked sufficient medical-record support for certain submitted diagnosis codes and estimated approximately $202.2 million in overpayments.
Terry Tropin, MSHAI, RHIA, CCS-P, focuses on the less extensive changes of the fiscal year 2027 ICD-10-CM update for conditions that received only a handful of new codes but are nonetheless important for accurate and specific code assignment. Although these additions may be easy to overlook among the larger expansions to the code set, they provide new opportunities to capture conditions and clinical circumstances with greater precision.
As coding teams collaborate across regions and contribute to shared quality and artificial intelligence evaluation initiatives, a common framework for measuring coding quality becomes essential. Without common evaluation principles, coding decisions may be difficult to compare, benchmark, or use for AI evaluation. Shera Stack, MSN, RN, CRC, and April Russell, MBA, CCDS-O, COC, CPC, CPC-P, CRC, consider how a common approach built around agreement, accuracy, defensibility, and truth provides the foundation for meaningful quality assessment.
Q: How can queries play a role in clarifying malnutrition and cachexia diagnoses while ensuring the patient’s condition is reflected in the medical record accurately for proper coding?
Hypertensive heart disease results from untreated or under-treated hypertension, causing a range of physiologic changes affecting the left atrium, left ventricle, and coronary arteries. Nancy Reading, BS, CPC, CPC-P, CPC-I, delves into the progression of hypertension to heart failure and shows how accurate code assignment and sequencing of the two conditions rely on the reason for admission and the relationships established among the patient’s conditions as documented by providers.
Lysosomal storage disorders are a group of rare, inherited metabolic disorders caused by genetic mutations that affect the normal function of lysosomes, or the structures within cells that contain enzymes responsible for breaking down and recycling various substances, including fats, sugars, proteins, and other cellular materials. Review some of the major categories in which commonly encountered lysosomal storage disorders are classified. Note : To access this free article, make sure you first register if you do not have a paid subscription.
CMS recently published the fiscal year 2027 ICD-10-CM Official Guidelines for Coding and Reporting to accompany the ICM-10-CM update, effective October 1. Coders should note the clarifications and revisions added to several areas of the guidelines, specifically as it relates to sepsis, cancer treatment, hypertension, genetic disorders, and Z codes.
Q: How should a coder handle the documentation and coding of a fragility fracture when the underlying cause, such as osteoporosis, has not been clearly established?
Pediatric coding requires a fundamentally different lens than adult coding, as children represent a uniquely complex population with evolving physiology, age-dependent clinical norms, congenital influences, and a heavy reliance on caregiver-reported history. With this in mind, Renee Beus, MSN, RN, NCSN, outlines why pediatric coding cannot always follow adult frameworks, highlights common documentation pitfalls, and identifies what organizations must prioritize when building reliable pediatric coding and CDI programs.
Practices that perform allergy testing take note: A uniform allergy diagnostic testing policy for Medicare Part B patients will go into effect in 38 states as soon as September 27.
Artificial intelligence (AI) is changing medical coding workflows. AI-assisted technology can help coding professionals work more efficiently. But there is an important distinction between identifying a possible code and determining whether that code should actually be reported.
The AMA recently announced that the 2027 CPT code set includes 299 new codes, 74 revisions, and 80 deletions coming to a variety of services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Society is working hard to eliminate or reduce the stigma associated with the need for psychological healthcare services. Some patients require more intensive treatment and focused care, and the services provided during these inpatient stays are reported using codes from ICD-10-PCS, specifically those found in Section G. Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, provides an in-depth review of this section and the many services that can be reported.
Identifying secondary diagnoses is an important part of accurately reflecting the patient’s overall condition and the care provided during an encounter. While the primary diagnosis represents the main reason for the patient’s visit or admission, secondary diagnoses capture additional conditions that require attention or have an impact on the patient’s care. Note : To access this free article, make sure you first register if you do not have a paid subscription.
A TIA is typically a short-lived transient event that results in no permanent tissue damage or residual neurologic deficits. On the other hand, a stroke results from either a vessel blockage or a hemorrhage, causes some variety of tissue damage, and may leave residual neurologic deficits. Follow Nancy Reading, BS, CPC, CPC-P, CPC-I, as she explores the differences between these two conditions.
Q: What clinical factors distinguish acute skin failure from a pressure injury, and how should the two conditions be approached from an ICD-10-CM coding perspective?
A report issued by the Centers for Disease Control and Prevention found that 15.2% of U.S. pregnant women reported current alcohol consumption during the past 30 days. The report, which examined 2021–2024 data from the Behavioral Risk Factor Surveillance System, also found that 4.9% of pregnant women reported binge drinking and 2.2% reported heavy drinking.
Less than one-half of adults discharged from emergency departments for diabetes-related encounters obtain outpatient follow-up care within 30 days, according to a recent study published in the Journal of General Internal Medicine.
The fiscal year 2027 update to the ICD-10-CM code set includes new, deleted, and revised codes, as well as hundreds of changes to “Excludes” notes and “Code Also” indications. This code set was produced to show greater coding specificity by publishing codes with greater clinical specificity.
Prior to the 1970s, there was not an objective method of evaluation and management documentation, which led to physicians making unscientific decisions about patient treatment. Now, one of the general ways that providers document their services is the SOAP format, which helps them organize their thoughts for a patient encounter. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Next year’s CPT manual will include new surgical implants to address knee pain and heart failure, repair diaphragm hernias, and excise pharyngeal neoplasms.
Q: When coding endoscopic procedures, some CPT codes have multiple procedures bundled in a single code. How do coders report when one of the procedures isn’t done?
Building a strong relationship between coding and CDI begins with the training and education of new professionals. Learn how organizations are using shared education, coding resources, concurrent coding, and ongoing collaboration to close knowledge gaps and help coding and CDI teams resolve DRG mismatches, navigate complex coding questions, and improve documentation and coding accuracy.
Thyroid disorders challenge outpatient hospital coders because the record often contains symptoms, laboratory values, medications, imaging findings, and surgical history before it contains a clear final diagnosis. Those clues can help a coder understand the encounter, but they do not authorize the coder to diagnose the patient.
Beginning in 2027, services for antepartum care, labor management, delivery, and postpartum care will be coded separately. The old global approach to billing obstetric care was intended to simplify billing, but it no longer reflects the variation and complexity of care across the phases of pregnancy.
The ICD-10-PCS updates for fiscal year 2027 were released in June, and its new codes will be effective Oct. 1, 2026. A majority of the modifications involve new qualifier values for generic devices, but in some cases, new values were added to report brand-named devices. Terry Tropin, MSHAI, RHIA, CCS-P, focuses on the changes to the New Technology section.
