When to Use Modifier 59 Without Audit Risk
Know when to use modifier 59, when CMS expects an X modifier, and how documentation can prevent NCCI denials and audit exposure in outpatient billing.
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October 23, 2026
Modifier 25 Documentation Requirements That Hold Up
Modifier 25 documentation requirements explained: build defensible notes, reduce denials, and prepare your practice for payer and audit review today.
October 22, 2026
How to Level E/M Visits Without Audit Risk
Learn how to level E/M visits using MDM or time, align documentation with CPT rules, and reduce denials, downcoding, and audit exposure across settings.
October 21, 2026
CPT AI Services Coding Guidelines for 2026
CPT AI services coding guidelines help teams match codes to documented clinical work, confirm payer coverage, and reduce denials, audit risk, and leakage.
October 20, 2026
Pressure Injuries Are Becoming a Data Problem, Not Just a Nursing Problem
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…
October 5, 2026
The Art of the Compliant Physician Query
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 —…
September 2, 2026
NCCI Edits Demystified: PTP Pairs, MUEs, and the Right Way to Use 59
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…
August 31, 2026
Risk Adjustment Coding: Why HCCs Are Every Coder’s Business Now
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…
August 28, 2026
Modifier 25 Under the Microscope: Using It Right in an Audit-Heavy Era
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…
August 26, 2026
E/M Leveling in Practice: Choosing Between MDM and Time
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…
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August 24, 2026
Your October 1 Readiness Checklist: Six Weeks to the New Code Set
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…
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August 21, 2026
The CY 2027 Medicare Proposed Rule: What Coders Should Watch
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…
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August 19, 2026
FY 2027 ICD-10-CM: What’s Coming October 1 and How to Prepare
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…
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August 17, 2026
Telehealth Coding in 2026: Audio-Only Codes and the 98000-Series
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…
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August 14, 2026
Denial Management 101: Turning Rejections into Revenue
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…
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August 12, 2026
Career Corner: CPC vs. CCS — Which Certification Fits Your Goals?
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…
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August 10, 2026
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