EDITOR’S NOTE:
This series is based on the “Developing Facility-Specific Coding Guidelines” which is an AHIMA Practice Brief. This practice brief was updated in December 2023. It also contains an Excel tool to assist you in the development of your coding guidelines.
April begins the third quarter of the federal fiscal year. CPT®, HCPCS, and ICD-10-CM/PCS codes can be updated effective from April 1st. It is also a time when you should be reviewing and updating your facility-specific coding guidelines. Over the next couple of weeks, I will walk you through developing or updating your coding guidelines.
First question – do you have a written version of your coding guidelines? Or do you have notes or a folder of items to remember while you are coding? Written guidelines are useful tools for new coders as well as contracted coding staff. These guidelines promote data consistency which is important because the claims data is utilized to determine reimbursement penalties such as readmission and quality concerns. If you do not have written guidelines, you can start today!
Next question – do you know what inpatient and outpatient procedures you need to code from a reimbursement, chargemaster, or data requirements perspective? The inpatient procedures that are DRG Operating Room procedures are a basic requirement. With regards to the chargemaster, typically specific revenue codes require a CPT/HCPCS code to be sent from the abstract or Health Information Management (HIM) coders. From a data perspective, some departments require coded data such as dialysis, blood transfusions, trauma diagnoses for the Trauma Registry, and cancer diagnoses for the Cancer Registry.
Your assignment this week is to talk with the chargemaster coordinator and identify which revenue codes require HIM to assign codes. Also, talk with department managers regarding their data needs. Talk with other coders about what questions they have about procedures that they are coding and if they have any questions about what to code. Investigate any repetitive issues such as forgetting to code a specific procedure or diagnosis and it is returned based on the claims scrubber.
Another concern is if your state has a data reporting requirement. Review those requirements. I live in Pennsylvania which has the Pennsylvania Healthcare Cost Containment Council (PHC4) which requires quarterly data submission. One data requirement is that all traumatic injuries are reported with an external cause code for how the injury occurred and where it occurred. The data requirement is different than the Official Coding and Reporting Guidelines where you only report the initial occurrence.
Resources:
We’ve spent the better part of the last decade talking about what artificial intelligence (AI) can do for patients – predicting sepsis, flagging deterioration, and
The articles describe a significant 2026 dispute over the misuse of health information exchanged by asserting a treatment purpose through Carequality. (Raths) The core allegation
Please log in to your account to comment on this article.
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.
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.
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.
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.
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.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
