Coding
Fifth Universal Definition of Myocardial Infarction (MI) published: What it says for your CDI, coding, and clinical teams
The Fifth Universal Definition of Myocardial Infarction (MI) has been published in the Journal of the American College of Cardiology. What is the new definition? The fifth definition removes the fourth definition’s numerical classification (i.e., MI types 1, 2, 3, 4a, 4b, 4c, 5) and replaces them with three categories: Primary MI, Secondary MI, and…
Read MoreWho Owns Sepsis? The Battle to Define a Deadly Condition
By Brian Murphy, host, Off the Record podcast Listen to the episode here. CDI, coding, and clinical medicine are involved in a tug-of-war over a complex, life-threatening medical emergency that seems resistant to all forms of consensus. I’m talking about sepsis of course, and on today’s show I got to talk about sepsis with someone…
Read MoreDownload Coding in the Gray: Why Human Judgment Still Matters (part 2 of a 2-part series)
Download the report on our resources page. 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…
Read MoreHow Norwood changed an organization’s CMI trajectory–to the tune of $2.56M
A drop in case mix index (CMI) isn’t necessarily indicative of a problem. A high-performing surgeon leaves your hospital, observation cases tick up seasonally, and you get a short-term drop. But flagging CMI over time warrants a closer look. Last year Norwood was asked to partner with an organization to focus on assessing and improving CDI performance. The CFO asked for an initial focus on CMI lift after long-term financial concerns. Norwood placed a three-person team to help…
Read MoreCC/MCC changes in 2027 IPPS final rule: We summarize them for you
The 2027 IPPS final rule includes several CC/MCC reimbursement changes to diagnoses you should be aware of. Watch for these in the documentation and report them and/or query if clinical indicators present. An audit now to confirm their presence or absence is a good strategy. They take effect Oct. 1. For example, hypoglycemia (i.e., low…
Read MoreInpatient Audit Storm Clouds
Download the report on our resource page. The Office of Inspector General (OIG) never rests. After taking on Medicare Advantage organizations and aggressive risk adjustment coding practices from 2023-2025, the sights of the nation’s regulatory watchdog have shifted. The new target? Acute care hospitals and inpatient admissions. Plus some other outpatient odds and ends. This…
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…
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