Cardiomyopathy refers to a group of conditions in which the heart muscle becomes diseased, making it harder for the body to pump blood effectively to the rest of the body . While accurate ICD-10-CM coding of cardiomyopathy requires precise documentation of the cause (if known) and complications, the type will drive the final code choice. Note : To access this free article, make sure you first register if you do not have a paid subscription.
Coders play a vital role in applying CDI technology standards by guaranteeing that the output of automated tools aligns with compliant coding practices and official coding guidelines. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP, breaks down a framework for selecting, implementing, and maintaining technology solutions that support compliant documentation practices.
A review of 800 studies found that electrocardiogram interpretation assisted by artificial intelligence has the potential to improve diagnostic accuracy and enable earlier detection of cardiac conditions, particularly in resource-limited outpatient settings.
The ICD-10-CM update for 2026 included 213 new codes that incorporated the “flank” as an anatomic area related to injuries. Genetic diseases also continue to make big inroads into the tabular list of diagnoses.
Q: In the 2026 ICD-10-CM update, in the neoplasm chapter there are some added specific codes for inflammatory neoplasm of the breast. How do those differ from other types of breast cancer?
The 2026 Medicare Physician Fee Schedule proposed rule includes significant potential changes to telehealth billing and coverage, conversion factor calculations, relative value unit weights based on site, skin substitutes, behavioral health, and more.
It’s been two weeks since the federal government shutdown began, as well as when Medicare telehealth waivers and flexibilities were set to expire. In a special edition of the MLN Connects newsletter released just as the shutdown began on October 1, 2025, CMS provided some guidance to providers. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Join us on the podium at the 2026 Revenue Integrity Symposium (RIS), to be held September 24-25, 2026, in Savannah, Georgia. We’re now accepting proposals to speak at 2026 RIS. The deadline to apply...
Many disorders of immunity require ongoing management and often contribute to complications or comorbidities during hospitalization. For inpatient coders, accurately identifying and coding these disorders is crucial, not only to reflect the full clinical picture and support severity of illness and risk of mortality metrics, but also to ensure correct DRG assignment. 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, reviews the third quarter publication of Coding Clinic , which added clarifications for complicated coding procedures that may require more than one code when performed together, depending on the objective of each procedure.
Operative reports often contain more precise and detailed information than preoperative notes or consent forms, and correctly interpreting those details is essential to assigning the right inpatient procedure codes. Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP, provides coders with actionable strategies for reviewing surgical documentation and applying codes.
CMS recently released an updated MLN fact sheet reminding providers when a transcatheter tricuspid valve replacement for symptomatic tricuspid regurgitation 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.
As clinical validation becomes an area that payers and regulatory bodies are investigating heavily, the need for steadfast collaboration between coding professionals and CDI specialists has never been greater. TaraJo Vaught, MSN, RN, CCDS, CCDS-O, explores how these two teams can bridge the gaps between them and enhance their clinical validation practices to drive better outcomes across the board.
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.
The American Medical Association recently issued its 2026 CPT code set, which includes 288 new codes, 84 deletions, and 46 revisions. Review the changes to ensure proper procedure coding. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently updated its MLN Booklet for evaluation and management services with changes to the sections regarding office or outpatient E/M visits, critical care services, hospital outpatient clinic visits, and telehealth services.
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.
Chronic conditions are among the most frequently encountered diagnoses in the outpatient setting. Accurate coding of these conditions is critical not only for proper reimbursement but also for compliance, quality reporting, and patient care continuity.
Skin substitutes continue to play a critical role in the treatment of chronic wounds, and there are more products available today than ever before. Although Medicare Administrative Contractors have slowly started to spell out their coverage criteria for skin substitute grafts used to treat certain conditions, progress has been slow.
Payers are further along in the AI process as they use AI to scrub claims against their policies, which many believe is contributing to the recent uptick in denials. As organizations attempt to catch up with technological advancements and defend themselves against payers’ new tactics, departments such as coding, CDI, and revenue cycle should be prepared for increased AI integration and determine the best ways to utilize the technology.
There are 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.
Our experts answer questions on the proper use of the new diabetes code for cases in remission, documentation and coding solutions for denial proofing sepsis claims, and best practices for clinical validation queries.
Like previous federal government shutdowns, the one that ensued when Congress failed to produce a continuing resolution on the budget by October 1 has implications for providers. You should reduce the chances of harm by planning to address them now.
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.
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.
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.
Terry Tropin, MSHAI, RHIA, CCS-P , delves into the 2026 ICD-10-PCS updates that include complicated bypass, restriction, and transfer procedures, which previously could not be specifically coded. Also included are some new devices that require their own code.
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.
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?
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.
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.
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.
Learn how HIM professionals, including coders, can leverage data related to social determinants of health to improve patient care and secure proper reimbursement.
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.
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.
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.
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.
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.
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.
