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.
Our experts answer questions on distinguishing cachexia from malnutrition for accurate coding, navigating clinical uncertainty and coding for acute skin failure and pressure injuries, and unpacking the fifth universal definition of MI.
The prevalence of healthcare-associated infections in U.S. hospitals declined between 2015 and 2023, according to a Centers for Disease Control and Prevention survey published recently in The New England Journal of Medicine . The findings show continued progress in reducing infections acquired during hospital care, although researchers noted that the overall burden of HAIs persist.
Understanding the clinical findings associated with quadriplegia is an important first step in determining how the condition should be reported. After reviewing the causes and effects of quadriplegia and reportable ICD-10-CM codes for the condition, this article will dive into key physical examination findings and documentation considerations that can help further guide accurate code selection. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Congenital heart defects are commonly encountered chronic conditions in pediatric coding and documentation, yet their presence alone does not ensure they are appropriately reported or fully understood within the clinical context of an encounter. Jenny Esper, RHIA, CCS, CDIP, CCDS, tackles the challenges of determining when a CHD is relevant to the admission and whether the documentation accurately reflects its clinical significance for proper coding.
Q: What are the key characteristics of cachexia versus ASPEN-defined malnutrition, and what ICD-10-CM codes are available for reporting each condition?
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.
CMS intends to introduce multiple new codes next year, according to the proposed 2027 Medicare Physician Fee Schedule. The agency is considering codes for advance care planning services by clinical staff, assessment and treatment of patients who have a reaction to a vaccination, and speech-language services for pediatric patients.
Most veterans receiving Veterans Health Administration outpatient care for major depressive disorder are receiving their recommended treatment, but a growing proportion aren’t, according to a recent study published in JAMA Network Open.
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.
The new ICD-10-CM code for cannabis hyperemesis syndrome improved clinical recognition of the condition, according to a new Centers for Disease Control and Prevention report. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
A diagnosis of systemic lupus erythematosus is only the starting point. Accurate ICD-10-CM coding requires careful attention to the provider's documentation, including whether the lupus is drug-induced, whether specific organ or system involvement is documented, and whether additional codes are required. Note : To access this free article, make sure you first register if you do not have a paid subscription.
A newly released Office of Inspector General report estimates that Medicare Advantage organizations may have received nearly $462 million in improper payments after submitting unsupported acute stroke diagnosis codes to CMS. The findings highlight ongoing concerns about documentation quality and diagnosis validation in risk adjustment reporting.
With insight from Lynette Byerly, BSN, RN, CCDS, CCS, coders can discover how CDI specialists bridge the clinical world to the realm of coding and reporting, especially when pediatric conditions are not always easily reportable.
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 Medical and Surgical, Administration, Extracorporeal or Systemic Assistance and Performance, and Imaging sections.
HCPro invites medical coding professionals to take part in the 2026 Coding Salary Survey. This is your chance to see how your salary, credentials, and role stack up against your peers nationwide. The...
In May 2026, outpatient volumes declined significantly month-over-month and year-over-year in comparison to inpatient admissions, according to a report by Strata Decision Technology. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Hospitals are mandated to separately bill HCPCS Level II codes. This longstanding guidance was recently reiterated by two Medicare Administrative Contractors who have published articles on their websites about this specific instruction.
Expiring eviction moratoriums were associated with an increase in outpatient visits for serious mental illness, according to a study published in JAMA Health Forum.
Q: What are some red flags associated with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) that might trigger payer audits?
Beginning January 1, 2027, services for antepartum care, labor management, delivery and postpartum 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.
Our experts answer questions on identifying cerebral edema and brain compression in the medical record, recognizing when documentation drives diabetes coding, and utilizing photos in queries.
Respiratory syncytial virus and COVID-19 are both types of respiratory viruses, and the symptoms can be very similar and overlap each other. Shontia Leon-Guerrero, CPC, CEDC, CEMC, CPC-I Educator, reviews the signs and symptoms of both conditions in infants and children as well as what coders need to know such as diagnosis codes, procedure codes for vaccine administration, and documentation expectations.
You’ll select a modifier and receive a pay boost, one that’s amplified for eligible accountable care organization participants, if CMS goes through its plan to replace patient trust code G2211 with two modifiers.
The redesign of ICD-11 allows for continuous updates, interoperative compatibility with other electronic systems, improved coordination with related terminologies, and a reduced need for post-production clinical modifications. With these changes in mind, Nancy Reading, BS, CPC, CPC-P, CPC-I, explores how this new framework supports significant enhancements to the classification of diagnoses that is built around stem and extension codes and its ability to cluster post-coordinated codes to describe a single condition.
Accurately telling the patient’s story requires a thorough review of the entire medical record to identify all conditions that were addressed during the encounter, whether directly or indirectly, by the provider.
AI is no longer a distant concept in medical coding and health information management; it is already part of daily work. For many professionals, daily encounters with AI bring a mix of curiosity, caution, and concern.
As if clinically validating sepsis wasn’t complicated enough, adding in the inherent complexity of pediatric health makes reviewing for this diagnosis a challenge. Discover how CDI teams and programs started their pediatric reviews and implemented sepsis education, used query templates and technology, established clinical definitions, and worked with providers and other departments such as coding teams to ensure the diagnosis that is most reflective of the patient’s condition is documented and coded.
CMS published the calendar year 2027 Medicare Physician Fee Schedule (MPFS) proposed rule with policies and code changes affecting physician reporting. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
AI is no longer a distant concept in medical coding and health information management; it is already part of daily work. For many professionals, daily encounters with AI bring a mix of curiosity, caution, and concern.
Train your coding and clinical teams to think like an auditor before you report modifier -25. Improper payments associated with the modifier have triggered more audits and a variety of attempts to detect and recoup improper payments or stop payments from being issued in the first place.
Accurate coding for liver failure requires much more than selecting the correct ICD-10-CM code—it demands an understanding of liver function, disease progression, clinical indicators, and documentation nuances. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Drug overdose deaths in the United States declined for the third consecutive year in 2025, according to preliminary data released by the Centers for Disease Control and Prevention. The decline marks the longest sustained reduction in overdose deaths in decades and brings the national total back to roughly the level seen in 2019, before the COVID-19 pandemic.
The redesign of ICD-11 allows for continuous updates, interoperative compatibility with other electronic systems, improved coordination with related terminologies, and a reduced need for post-production clinical modifications. With these changes in mind, Nancy Reading, BS, CPC, CPC-P, CPC-I, explores how this new framework supports significant enhancements to the classification of diagnoses that is built around stem and extension codes and its ability to cluster post-coordinated codes to describe a single condition.
Q: When reviewing neurologic cases, what documentation clues, imaging findings, and treatments should coders and CDI specialists look for to identify potential cerebral edema or brain compression diagnoses?
Beyond capturing primary and secondary diagnoses, what goes into a record can hugely impact how a patient is cared for both now and in the future, as well as the trajectory of a community’s health at large. See why it’s essential to go beyond surface-level knowledge and gain a true understanding of how and why SDOH data is important to track, especially for pediatric patients.
The 2027 OPPS and ambulatory surgical center proposed rule includes a policy that aims to expand CMS’ method of controlling unnecessary increases in the volume of outpatient services. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Accurately telling the patient’s story requires a thorough review of the entire medical record to identify all conditions that were addressed during the encounter, whether directly or indirectly, by the provider.
Early outpatient follow-up was not associated with differences in hospital-free survival or risk of decline in health-related quality of life among older adults after acute myocardial infarction, according to a retrospective study published in the Journal of Hospital Medicine.
Q: A patient is in the office today being seen for abdominal pain six days post-op of removal of a benign tumor. After ultrasound, cholecystitis is diagnosed and the patient is scheduled for surgery the next day. Is it appropriate to use modifier -24 in this case?
Established in 2000, the inpatient-only list has served as a catalog of procedures that can only be reimbursed by Medicare when performed in the inpatient setting. However, thanks to technological advancements and new surgical techniques, many of these services can now be performed in hospital outpatient departments and ambulatory surgical centers.
Services provided in an inpatient setting are reported using two different coding systems. The facility reports procedures using ICD-10-PCS codes while the individuals providing the care report professional services using CPT codes. Terry Tropin, MSHAI, RHIA, CCS-P, provides a glimpse into how these two coding systems can work together in order to fully report inpatient services.
A newly released Office of Inspector General report concluded that unclear Medicare requirements continue to drive inconsistent interpretations of inpatient rehabilitation facility documentation, coverage, billing, and coding rules, contributing to significant payment errors and compliance challenges.
