Category: Medical Coding

Z-Codes in Documenting SDOH

The Pervasive Underutilization of Z-Codes: A Crisis in Healthcare

In the complex world of modern healthcare, a patient’s journey is shaped by more than just their medical diagnosis. Factors like housing stability, access to nutritious food, reliable transportation, and social support networks—collectively known as Social Determinants of Health (SDOH)—are increasingly recognized as powerful drivers of health outcomes. While healthcare systems have the tools to […]
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Outpatient CDI Program

Why Outpatient CDI Programs Are Essential for Accurate HCC Coding and Risk Adjustment

Healthcare is an ever-evolving landscape. In this era of value-based care, accurate documentation and coding are important for financial stability and quality patient care. Hierarchical Condition Categories (HCCs) are crucial for risk adjustment and reimbursement, especially in the outpatient setting. This is where Outpatient CDI programs come into play. They are not just beneficial but […]
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ICD code updates

ICD-10-CM Code Updates: New, Revised & Deleted Codes You Need to Know

For the 2026 ICD-10-CM code updates, you’ll find 16 new “R” codes that offer greater detail for reporting pain and tenderness in the pelvic, perineal, subpubic, abdominal, and flank regions. The existing code R10.2- (Pelvic and perineal pain) will become a parent code. A notable addition is R11.16 (Cannabis hyperemesis syndrome (CHS)), specifically for nausea […]
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CPT 95165

CPT Code 95165: Reimbursement Updates for Allergen Immunotherapy

Allergen immunotherapy remains a cornerstone of treatment for many patients suffering from allergic conditions, offering long-term relief and potentially altering the course of disease. For allergy and immunology practices, CPT code 95165, which covers the professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, is a vital component of their […]
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Medical coding strategies

Top Medical Coding Strategies to Maximize Reimbursements

The difference between a thriving medical facility and one struggling with cash flow often lies in the precision and strategic application of its coding processes. Maximizing reimbursements and strengthening financial health hinges on a proactive approach to medical coding – one that goes beyond simply assigning codes and delves into optimizing every facet of the […]
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proper medical coding practices

Why Proper Medical Coding is Critical for Your Physician Practice

For physicians, understanding and implementing proper medical coding practices isn’t just about administrative efficiency; it’s the lifeblood of your practice, directly impacting reimbursement, compliance, and ultimately, your financial health. Ignoring or mismanaging medical coding can lead to a cascade of problems: denied claims, delayed payments, audits, and even legal repercussions. On the other hand, mastering […]
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HCPCS Level I vs Level II

HCPCS Level I vs. Level II Codes: Key Differences for Accurate Medical Billing

In the intricate world of healthcare billing and coding, accuracy is paramount. Healthcare providers rely on standardized coding systems to communicate diagnoses, procedures, and services to payers. Among these crucial systems are the Healthcare Common Procedure Coding System (HCPCS) codes, which are essential for proper reimbursement. However, the HCPCS system isn’t a monolithic entity; it’s […]
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Therapeutics ICD-10-PCS

Mastering Therapeutics Coding with ICD-10-PCS: Guide

As healthcare documentation continues to evolve, the ability to accurately capture procedures performed in inpatient settings is vital for patient safety, proper reimbursement, and compliance. One of the most sophisticated tools used in this context is the ICD-10-PCS (International Classification of Diseases, 10th Revision, Procedure Coding System). Designed for inpatient procedure coding in the U.S., […]
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Outpatient Medical Billing Process

8 Steps to Clean Up Your Outpatient Medical Billing Process

Is your outpatient medical billing process feeling more like a tangled web than a well-oiled machine? You’re not alone. In the fast-paced world of healthcare, billing errors and inefficiencies can easily creep in, leading to delayed payments, increased denials, and a significant drain on your practice’s resources. The good news? You don’t have to overhaul […]
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