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Laboratory Question for the Week of October 1, 2018

MedLearn Publishing October 1, 2018

Please advise how hospital laboratories can be paid for outpatient susceptibility studies (CPT® 87181–87190) for positive cultures. This is an issue due to medical necessity; however, the provider doesn’t have a diagnosis at the time of the order. This is not paid if the organism is not identified. Most laboratories automatically perform this test as part of routine culture work-ups.

Radiology Question for the Week of October 1, 2018

MedLearn Publishing October 1, 2018

What is the CPT® code for lung shunt fraction liver mapping? Here is part of the documentation below. There is more detail in the report but these lung shunt fraction studies for hepatic masses seem to be common.

Patient received 5.2 MCI Technetium 99M MAA. Multiple static views of the lungs and abdomen were obtained. The geometric mean of the lungs and liver were obtained. The lung shunt fraction was obtained.

Respiratory Question for the Week of October 1, 2018

MedLearn Publishing October 1, 2018

Does Medicare have rules about use of code 94750–pulmonary compliance study (e.g., plethysmography, volume and pressure measurements)?

Pharmacy Question for the Week of October 1, 2018

MedLearn Publishing October 1, 2018

When do the new level II codes Q5108 and Q5110 take effect?

Medicare Payment Perspective: Is Healthcare Really a Business?

Duane C. Abbey, PhD, CFP September 26, 2018

CMS is encouraging the integration of healthcare providers so that their size is increased to have averaged payments represent a break-even or better. CMS (the

Hospice Transfer Seen as a Reduction in Hospital DRG Payment

Marvin D. Mitchell, RN, BSN, MBA September 26, 2018

Providers should consider how to optimize the patient’s health status prior to discharge to hospice. In his RACmonitor article of Aug. 8 regarding the recent

Changes in Readmission Adjustment Factors

Timothy Powell, CPA, CHCP September 26, 2018

In FY 2019, hospital performance in the HRRP will be assessed relative to hospitals within the same peer groups. Since 2013, Medicare has penalized hospitals

Admission Order Regulation Change Brings Relief – And Uncertainty: Part 2

Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI September 26, 2018

2019 IPPS removes requirement for authentication of admission orders prior to discharge. EDITOR’S NOTE: This is the second and final installment of a two-part series.

The Value of a Certified Coder and CDI in our Practices

Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC September 25, 2018

With good collaboration and the right team members, continual improvements are attainable. Recently I have been engaged in a project of continual improvement in our

Human Trafficking: New ICD-10 Codes Empower Efforts to Identify and Aid Victims

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP September 24, 2018

New ICD-10 codes that address human trafficking become effective Oct. 1. This year has seen the launch of the ICD-10 Z codes, and now we

Are There ICD-10-CM or CPT® Coding Implications to Clarify Fourth Universal Definition of AMI?

Terry A. Fletcher BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, ACS-CA, SCP-CA, QMGC, QMCRC, QMPM September 24, 2018

The new definition includes clinical concepts that were not an option before when choosing an MI diagnosis. Since 2012, changes and updates have continued to

Moving in the Right Direction in Getting to the Root Cause of Clinical Documentation Improvement

Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FC September 24, 2018

The clinical query process is a small yet important part of any CDI initiative. By now I am confident that most in the clinical documentation

Compliance for the Inpatient Psychiatric Facility (IPF-PPS): Minimizing Federal Audit Findings by Strengthening Best Practices

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.

April 9, 2026

Mastering MDM for Accurate Professional Fee Coding

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.

March 31, 2026

The PEPPER Returns – Risk and Opportunity at Your Fingertips

Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.

March 19, 2026

Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue

Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.

January 29, 2026

Featured Webcasts

Mastering OB GYN Coding Accuracy: Precision Coding for Compliance and Reimbursement

Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Stacey Shillito, CDIP, CPMA, CCS, CCS‑P, CPEDC, COPC. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.

May 14, 2026

2026 ICD-10-CM/PCS Coding Clinic Update Webcast Series

Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.

April 13, 2026

2026 ICD-10-CM/PCS Coding Clinic Update: Fourth Quarter

Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.

December 14, 2026

2026 ICD-10-CM/PCS Coding Clinic Update: Third Quarter

Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.

October 12, 2026

Laboratory Question for the Week of October 1, 2018

Radiology Question for the Week of October 1, 2018

Respiratory Question for the Week of October 1, 2018

Pharmacy Question for the Week of October 1, 2018

Medicare Payment Perspective: Is Healthcare Really a Business?

Changes in Readmission Adjustment Factors

Admission Order Regulation Change Brings Relief – And Uncertainty: Part 2

The Value of a Certified Coder and CDI in our Practices

Human Trafficking: New ICD-10 Codes Empower Efforts to Identify and Aid Victims

Are There ICD-10-CM or CPT® Coding Implications to Clarify Fourth Universal Definition of AMI?

Moving in the Right Direction in Getting to the Root Cause of Clinical Documentation Improvement

Featured Webcasts

Compliance for the Inpatient Psychiatric Facility (IPF-PPS): Minimizing Federal Audit Findings by Strengthening Best Practices

Mastering MDM for Accurate Professional Fee Coding

The PEPPER Returns – Risk and Opportunity at Your Fingertips

Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue

Trending News

Using AI to Study Clinician Behavior – and the Compliance Risk Hidden Inside It

Why AI Tools Used in the Revenue Cycle Require Human Oversight

Pulling Back the Curtain: How Payers Decide Which Claims Receive Review: Part II of a Five-Part Series

The Vital Importance of National Colorectal Cancer Awareness Month

Featured Webcasts

Mastering OB GYN Coding Accuracy: Precision Coding for Compliance and Reimbursement

2026 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2026 ICD-10-CM/PCS Coding Clinic Update: Fourth Quarter

2026 ICD-10-CM/PCS Coding Clinic Update: Third Quarter

Trending News

Coding Update: An Index Change for Parkinson’s Disease

Cutting Through the Fog of Guidance for Incident-to Billing

Important HIPAA Changes You Should Know About

One New Form in, Two to Go – And the Delicacy of Handling a Switch from Inpatient to Observation Billing

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