Posts by Brian.m
Two reasons why the 2027 OPPS proposed rule hurts your hospital
By Brian Murphy The 2027 OPPS (outpatient) proposed rule landed just prior to the July 4 holiday weekend. CMS’ timing is conspicuous, presumably to dodge the tomatoes hurled at it from the likes of the American Hospital Association. Not a whole lot of great news in here for healthcare orgs; here are two and…
Read MoreYou should be billing G2211 in heavy volume, per CMS
Who remembers G2211? Starting in 2024 this CPT code took the mid-revenue cycle by storm. Despite paying very little ($16.04) it was intended to be used in quantity. It has been. A new study by the Journal of the AMA found that its first year of full use, calendar year 2024, G2211 was billed 26…
Read MoreDo hospital ratings matter? Here’s what your peers say
By Brian Murphy Hospital ratings: Does anyone care? Healthgrades earlier this year announced its top 50, top 100, and top 250 hospitals awards. Links below; do you see your home state or hospital represented? Some heavy hitters made the Top 50 Hospitals list (though none from my home state of MA, which is traditionally…
Read MoreNew 2027 ICD-10 codes are out (effective Oct. 1)—what you need to know
By Brian Murphy The 2027 ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) codes are out. You can view them on the CMS website at the link below. They take effect Oct. 1, 2026. So what do we have? At a high level: ICD-10-CM: 190 new codes, 30 deletions, 4 code revisions ICD-10-PCS: 101 new codes, 38 deletions,…
Read MoreCoding in the Gray: Why Human Judgment Still Matters (part 1 of a 2-part series)
Download the report here. There is a LOT of talk these days about automation. Autonomous coding solutions that can code with near-perfect accuracy—and no human intervention. Providers picking a code from a drop-down menu, enabled by a computer-generated prompt, and voila: Maximized billing and denial-proof revenue. We’re not buying it. We’ve been hearing talk of autonomous coding since at least 2007-08, and it never seems to happen the way the predictions say. Denials persist. Errors continue. And more myths are perpetuated. What makes full…
Read MoreSharpies and stage lights: MUSC’s Tracy Ferro on outpatient CDI origins
Listen to the episode here (Spotify). At ACDIS 2026 I delivered an unofficial episode of Off the Record with my guest today: Tracy Ferro, Executive Director, System CDI for Medical University of South Carolina Health (MUSC). The “podcast” was delivered on stage, at the outpatient symposium. MUSC’s OP CDI program is new and being built in flight, and Tracy and I presented on it together, running the session a bit like an…
Read MoreMedicare Annual Wellness Visits (AWVs) a fantastic risk adjustment tool–but don’t sleep on FFS
If you work in outpatient CDI you might have already reached the conclusion that the Medicare Annual Wellness Visit (AMW) is your friend. You’d be right. The AWV is first and foremost a tool for preventive screening and health. But it’s also a powerful tool in the arsenal of mid-revenue cycle work. For Medicare Advantage…
Read MoreThe Great Sepsis War rages on; will we see a truce, or a winner?
By Brian Murphy The Great Sepsis War rages on. The infection itself, which kills hundreds of thousands every year, but also in the hallowed halls of coding classification. Where in the A41.9 will we end up with this deadly but controversial infection? (aside: sepsis isn’t funny, but the rage elicited over conflicting definitions and…
Read MoreDifferent Minds, Extraordinary Strengths: The UC Davis Coding Internship Story
Listen to the podcast. This country does a decent job in our primary schools working with children and young adults with special needs. Certainly many improvements have been made in the last 40-50 years. But once neurodivergent kids become adults, that support seems to vanish. Tami Gomez stepped into this large breach by launching the UC Davis Neurodiversity Coding Internship Program. This new program creates professional pathways for neurodivergent individuals by offering hands-on training, mentorship,…
Read MoreDownload The State of Physician Queries
Download the report. The old-timers—and perhaps a few relatively recent-timers—will recall a recent past when a query was pretty straightforward. Discrete to the encounter. Fee-for-service. Reimbursement driven. Ask the question, get a response. Dusted and done. Those days are long gone. A query isn’t just a query, anymore. And that’s a good thing. This new…
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