With guidance from three certified medical professionals, CDI specialists and coders can learn how to fight against the overwhelming tide of clinical validation denials by promoting strong documentation, capturing clinical pictures with appropriate codes, and justifying treatment plans.
Protect your practice by understanding the code level selection risks that could impact E/M office visit claims. Incorporate the guidance in this article into your compliance plan to make sure they stay on your risk radar.
In January 2024, CMS released guidance for the implementation of the office and outpatient evaluation and management visit complexity HCPCS add-on code G2211. Courtney Crozier provides a breakdown of the code, including documentation requirements and appropriate and inappropriate billing scenarios.
Coding professionals are critical to the compliance initiatives of any healthcare organization, and the application of codes to a claim ignites the compliance ember. Discover how key initiatives not only ensure coders act ethically and responsibly but also enhance the accuracy of coding.
Our experts answer questions on coding COPD, smokers’ cough, and rectal fistulas in ICD-10-CM as well as provide recommendations for addressing malnutrition denials depending on the diagnosis criteria used (GLIM or ASPEN).
Alba Kuqi, MD, MSHIM, RHIA, CCM, CRCR, CICA, CSMC, CSAF, CCS, CCDS, CDIP, explores common reasons for sepsis-related denials, offers strategies for effective documentation and coding, and presents approaches to successfully appeal these denials.
Take in the details of the 16 new telemedicine codes for real-time encounters in the CPT 2025 manual while you wait to see whether private payers adopt the services or CMS sways from proposed non-coverage of the codes.
Coders are more aligned with CDI specialists than they may realize, as a deeper understanding of coding conventions enhances the accuracy and specificity of documentation. Sydni Johnson, BSN, RN, CCDS , and Suzanne Santellanes, BSN, RN, CCDS , shed light on how the tools of coders play a pivotal role in improving compliance strategies and ensuring the integrity of clinical records.
Review a retrospective cohort study published in the Journal of the American Medical Association that found new Alzheimer disease and related dementia diagnoses were more common after falls compared with other forms of traumatic injury.
CMS implemented the FY 2025 IPPS final rule on October 1, which introduced several updates to New Technology Add-on Payment designations, directly affecting how inpatient services are coded and reimbursed. Follow Judith Kares, JD , as she reviews NTAP eligibility criteria and payment strategies, alternative pathways for approval, final new technologies, and application process changes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Denials continue to be a pain point and significant challenge for every hospital across the nation, but Angelica Cage, MBA, BSN, RN, CCDS, CCS, CDIP , provides denial-proofed queries to show how establishing a diagnosis that is strongly supported by the available clinical evidence can reduce or eliminate clinical doubt with respect to the treated condition.
Certain diagnosis-related groups (DRGs) remain vulnerable to audits and denials, not only for DRG and clinical validation, but for medical necessity as well. Kim Conner, BSN, CCDS, CCDS-O , explores areas coding professionals can support when being proactive against these denials.
CMS may have major changes in store for outpatient hospital reimbursement and compliance, according to the 2025 Outpatient Prospective Payment System proposed rule. The proposed rule, released in July, includes potential changes to payment, coding, and billing for hospital outpatient services.
Medicare patients who qualify for the new preventive service designed to protect them from HIV will be eligible for up to eight counselling and screening services a year, according to a recently released CMS national coverage determination.
Protect your practice by understanding the code level selection risks that could impact E/M office visit claims. Incorporate the guidance in this article into your compliance plan to make sure they stay on your risk radar. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently announced updates to the January 2025 Integrated Outpatient Code Editor, including new HCPCS codes and changes to a handful of status indicators.
Q: A 65-year-old female has been on Effexor for major depressive disorder for three months and went to her healthcare provider due to tachycardia and palpitations along with mild muscle cramping. It was found that she had accidentally been taking double her prescribed dose due to misunderstanding the instructions. It is reported that she developed serotonin syndrome resulting from toxicity and was also diagnosed with mild hypertension (138/88) due to the serotonin syndrome. How would this encounter be reported in ICD-10-CM?
