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.
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.
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.
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.
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.
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.
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.
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.
For the 10 years we have been working with the ICD-10-PCS code set, these codes, used to report procedures provided to an inpatient, have required seven characters. Each character reports a very specific element of the service provided. Here, Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, is going to focus on character 6 for Device.
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.
Six healthcare information management professionals review an initiative at their organization that has provided a structured and sustainable approach to improving the documentation of encephalopathy and offers a replicable framework for addressing documentation challenges of other clinical conditions that are often characterized by diagnostic ambiguity. Such efforts can help ensure appropriate representations of patient acuity, accurate coding practices, sufficient risk-adjustment modeling, and decreased retrospective query burden.
Our experts answer questions on sequencing ICD-10-CM codes for unintentional poisoning with manifestations and for cases of postprocedural sepsis, as well as ensuring post-discharge query compliance.
The human ear is comprised of three parts: the outer, middle, and inner ear. The middle ear is responsible for transmitting sound vibrations to the inner ear. This article will discuss two types of procedures concerning the middle ear: tympanoplasties and tympanostomies.
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.
Practices and revenue cycle management companies that report obstetric services must be ready to report under the new CPT guidelines for maternity care services by September 1.
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.
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.
