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 —…
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…
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…
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…
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…
Exclusion notes are among the most misunderstood conventions in ICD-10-CM — and the April 1, 2026 update quietly changed several of them in ways that affect everyday code assignment. If…
Remote physiologic monitoring has been one of the fastest-growing service lines in outpatient medicine — and one of the most frustrating to bill. Until this year, the CPT structure assumed…
If you've been thinking about a career in medical coding — or leveling up the one you have — there's one credential that comes up in job posting after job…
Ever found yourself Googling "how do I actually start a career in medical billing and coding" and feeling like every answer just leaves you more confused? If so, you're far…
We all lost an hour of sleep when we “sprang forward” this past weekend. This week is National Sleep Awareness Week for 2026. In its 28th year and instituted by the…
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through eligibility, documentation, the social determinants…
Let me start with the two big news items. First, Nina Youngstrom, the editor of the Report on Medicare Compliance, actually got a response from the Centers for Medicare &…
Once again, a well-known consulting organization has mischaracterized the “incident-to” requirements. A few months ago, I wrote about an article that asserted you can’t bill “incident to” when the patient…
Lots of things happening last week for me to talk about. First, still no sign of the 2026 Outpatient Prospective Payment System (OPPS) Final Rule. Many of us expected a…
The 2026 Medicare Physician Schedule Final Rule includes several distinct policy changes in which the Centers for Medicare & Medicaid Services (CMS) modifies how it uses or pays for services…
The global AI in medical coding market is projected to reach USD 8.4 billion by 2033, rising from USD 2.4 billion in 2023. A CAGR of 13.6% is anticipated during…