In my travels to hospitals across the country and time spent in emergency rooms shadowing the critical work of social workers, I’ve seen firsthand the
Does code 38228 rely on the start and stop time documented in the medical record?
When is the new 2026 code 37262 reported?
If a nuclear medicine planar scan is performed of the knees for a possible infection, would this be coded as 78300 or 78800? Does it matter which radiopharmaceutical was used? Nuclear medicine technologists are saying it should be coded as an infection scan using 78800. Their point is that an infection radiopharmaceutical is being used, so it should be coded as 78800. However, when I read the heading of the section for 78800, it states “(for specific organ, see appropriate heading),” which would be the musculoskeletal system. Since a limited planar scan is present in that section, I believe 78300 should be used.
Why was 87812 established in 2026?
When do we report code 94640 for continuous inhalation treatment?
What details should the operative report include when billing code 31624? What requirements exist for bronchial alveolar lavage to be coded?
Under what conditions do we report new 2026 code 87494?
On the hospital side, during an MAA mapping study, the doctors are using a device called a TriNav catheter to temporarily occlude the vessel. To be clear, they are not performing an embolization at this point. Historically, we have billed for catheterization and imaging, but with the release of the C9797 code, we are now being instructed to bill C9797 during the MAA mapping, even when no true embolization is performed. The patient returns a few weeks later for the Y90 treatment, which also involves the use of the TriNav catheter. At that time, I billed the procedure with C9797. What is the correct way to bill for the MAA mapping session on the hospital side?
When a PTCA is done for in-stent stenosis (T82855A), what is the correct root operation: dilatation or revision?
Is the cost for incurring the expense specific to the portable pump included in the reimbursement rate for 96416?
Monitor Mondays listeners know that I end each segment with a song. Normally the topic drives the song, but to start the new year, the
Medicare regulations are complex and even seasoned professionals struggle to apply them consistently. Due to overwhelming demand, Dr. Hirsch returns for Part 2 of Ask Dr. Hirsch: Clarifying Medicare’s Most Misunderstood Rules to answer even more of Medicare’s most misunderstood questions, covering inpatient status, observation, SNF access, Medicare Advantage denials, and more. Join Dr. Hirsch as he provides clear, referenced answers to real-world questions submitted by your peers, helping you navigate Medicare compliance with confidence and clarity.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Artificial intelligence is rapidly transforming healthcare revenue cycle operations, from coding and auditing to compliance and denials. Join industry leaders Pam Warren (MaineHealth) and Raemarie Jimenez (AAPC) for a live fireside chat exploring how AI is changing workflows, workforce roles, payer-provider dynamics, and compliance risk—and what organizations should be doing now to prepare.
Prepare for FY 2027 IPPS changes with a comprehensive 3-part masterclass covering ICD-10-CM/PCS updates, MS-DRG shifts, NTAPs, compliance risks, and reimbursement strategies.
Stay ahead of FY 2027 reimbursement changes with expert analysis of MS-DRG shifts, NTAP updates, Medicare Code Edits, and emerging technologies impacting inpatient payment accuracy.
Stay ahead of FY 2027 ICD-10-PCS changes with expert analysis of new procedure codes, revised guidelines, and high-impact updates affecting reimbursement, compliance, and inpatient coding accuracy.
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