Here’s a quick quiz. Imagine that a National Coverage Determination (NCD) lists six conditions for which a treatment is covered. During a review you find
After more than 18 months of planning by the Centers for Medicare & Medicaid Services (CMS) and a mad scramble by hospitals in response to
In 2009, the headlines read that rural children’s mental health was being overlooked and disregarded.” Fast forward nearly 10 years, and the headlines still remain
There is good news and bad tucked away in the details of the 2018 proposed Inpatient Prospective Payment System (IPPS) Final Rule released last week
We performed a Y-90 mapping case in interventional radiology (IR). At the end of the procedure, we injected the Technetium MAA dose for the follow-up scan. Is there a specific code that should be added to account for the injection?
In the cardiology question of 4-17-17, the provider asked what codes would be assigned for explanting the dual-system permanent pacemaker and implanting and attaching two new leads to the existing pacemaker on the other side of the chest. You stated that codes 33222, 33235 and 33217 would be assigned, but these only cover the relocation of a skin pocket and the electrodes. Based on the question, is the whole pacemaker being removed, relocated, and then re-implanted with two new leads? If so wouldn’t you code 33233, 33235, and 33208?
One of our commercial insurers has denied our claims based on a “lack of clinical indicators.” We are assigning diagnostic codes based on the physician’s diagnostic statements. Should we be doing something else?
When is it appropriate to report CPT code 94640?
According to the American Medical Association (AMA), the following code took effect on January 1, 2017: 90682—influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use. However, our MAC has denied claims for this code. Does Medicare not accept this new code?
Does CMS allow modifier 91 with the NCCI PTP edits?
As we reflect on the transformation into spring, with large parts of the country still confronted by temperatures in the mid-30s at night and days
EDITOR’S NOTE: The following is a physician’s perspective on the Sandy Brewton article, “LHC vs Coronary Angiography: Take Heart When Coding.” I was one of
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.
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.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. 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.
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.
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.
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