Pressure ulcers are one of the best-known quality-of-care conditions among medical staff, clinical documentation integrity (CDI), and coding professionals. Yet while hospitals often track any skin integrity issues, CDI professionals…
Every coder eventually faces the gap: the clinical picture in the record clearly suggests something the documentation never quite says. The bridge across that gap is the physician query —…
The National Correct Coding Initiative is the invisible referee on nearly every multi-code claim — and the source of some of the most persistent confusion in professional-fee billing. Understanding how…
For years, hierarchical condition category (HCC) coding lived in a specialist corner — the domain of Medicare Advantage risk-adjustment teams. That era is over. With value-based contracts spreading across payers…
Few two-digit strings generate as much payer attention as modifier 25 — the flag for a significant, separately identifiable E/M service performed by the same practitioner on the same day…
Since the office-visit overhaul, evaluation and management levels rest on two alternative pillars: medical decision-making or total time on the date of the encounter. Coders may use whichever supports the…
Every October 1, the diagnosis code set changes — and every October, some organizations sail through while others spend the fourth quarter working denials they created themselves. The difference is…
On July 14, 2026, CMS released the calendar year 2027 Physician Fee Schedule proposed rule (CMS-1848-P), with comments due September 14, 2026. Proposed rules aren't final — policies routinely change…
The FY 2027 ICD-10-CM code set is out, and the clock is running: the new codes take effect October 1, 2026, for encounters and discharges through September 30, 2027. This…
Telehealth billing in 2026 is more settled than the emergency-rules era — but it's settled into something genuinely awkward: a dual-track system where Medicare and commercial payers want the same…
Every practice has a denial rate. The difference between healthy and struggling revenue cycles isn't whether denials happen — it's what happens next. Too many organizations treat denials as write-off…
Ask five coders which certification to pursue and you'll get five confident, contradictory answers. That's because the real answer depends on where you want to work. The two most recognized…
Oncology coding rewards precision like no other specialty — staging, laterality, histology, and treatment intent all flow through the codes into registries, risk models, and reimbursement. The FY 2026 ICD-10-CM…
For years, artificial intelligence lived at the edges of the CPT code set — a handful of Category III codes tracking emerging technology. CPT 2026 marks a turning point: AI-driven…
Social determinants of health (SDoH) coding used to feel optional — a nice-to-have for population health teams. That era is ending. Payers, quality programs, and risk-adjustment models increasingly expect SDoH…
If there's one section of CPT 2026 that justified its own training session, it's peripheral vascular intervention. Effective January 1, 2026, the AMA deleted the lower extremity revascularization (LER) codes…