The American Medical Association (AMA) introduced 17 new telemedicine evaluation and management (E&M) codes this year. Here’s the breakdown of these new codes: CPT® code range 98000-98007 are reported for…
In the current climate of cost containment, commercial payers are increasingly downgrading MS-DRGs after claims are submitted, not disputing the need for inpatient care, but questioning the clinical support for…
I think it is important to challenge one portion of an article that was widely distributed two weeks ago. The article included a statement that, while accurately characterizing the way…
As the healthcare industry continues to evolve in 2025, the demand for skilled medical billers and coders has reached unprecedented levels. This growth is fueled by ongoing changes in healthcare…
Like many of you, I am deathly allergic to clinical documentation integrity (CDI), but do not worry; I premedicated with prednisone and an antihistamine prior to writing this article. I…
Clinical documentation integrity (CDI) has matured beyond its initial focus on coding accuracy and Diagnosis-Related Group (DRG) optimization. In 2025, it is central to payer compliance, audit defense, risk adjustment,…
As the healthcare industry changes, there needs to be a shift from a growth perspective to an efficiency perspective. Most hospitals had their highest case mix index (CMI) during COVID,…
Continuing with our look at areas of coding confusion, let’s today examine pain. According to Medline Plus Magazine from the National Institutes of Health (NIH), pain is the most common…
As with many other physicians of a certain age, I have had the opportunity to practice patient care in both the worlds of paper and electronic charting. Granted, as a…
Dawson Ballard, a coding auditor and educator for Chicago-based Rush University Medical Center who has more than 20 years experience in the profession, sees artificial intelligence coding platforms as beneficial. …
While underdosing is no longer a new concept in coding it remains a common area of confusion. Underdosing is when a patient takes less of a medication than is prescribed. …
Few topics crop up in our articles more often than the Two-Midnight Rule. While it is frequently discussed and debated, I would posit that few regulations are easier to explain.…
If you’ll recall, a couple of weeks ago, I reported on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for the social determinants of health (SDoH) in the…
Interoperability has been a longstanding goal for healthcare: The promise of being able to exchange data seamlessly between health information networks has been a goal the industry has been working…
The clinical documentation integrity (CDI) profession began its heyday in 2008, with the advent of the Medicare Severity Diagnosis-Related Group (MS-DRG) system that built and expanded upon the simpler system…
A new study from Mount Sinai suggests that using generative artificial intelligence to help with coding automation has some significant limitations. WHY IT MATTERS For the research, Mount Sinai's Icahn School…