Understanding MCC and How It's Used In medical coding, MCC stands for Major Complication or Comorbidity. It is a classification used in the ICD-10-CM and MS-DRG (Medicare Severity Diagnosis-Related Group) systems. MCCs represent conditions that are severe and...
Read the Case Carefully Skim the entire scenario once to understand the big picture (inpatient, outpatient, ED, surgical, etc.). Underline or highlight key clinical details: Primary diagnosis Secondary diagnoses/comorbidities Procedures performed Patient status (new...
Pro fee coding, short for professional fee coding, refers to the process of assigning medical codes to professional services provided by physicians and other qualified healthcare professionals. Pro fee coding focuses on capturing and billing for the provider’s...
What Is Medical Necessity in Medical Coding & Billing? Medical necessity is a cornerstone of accurate medical coding and billing. It determines whether a service, procedure, or supply is reasonable, necessary, and appropriate based on a patient’s medical...
What Is an Encoder in Medical Coding? An encoder is a specialized software tool used by medical coders to streamline the coding process by helping identify the correct diagnosis (ICD-10-CM), procedure (CPT/HCPCS), and modifier codes. Encoders often integrate official...
Medical Coding Audits: Guidelines & Tips for Compliance and Accuracy Medical coding audits are essential for maintaining compliance, ensuring accurate reimbursement, and reducing the risk of denials or legal penalties. Whether you're a coding professional,...
Medical Coding Compliance Guidelines & Tips for Medical Coding & Billing Maintaining billing and medical coding compliance is critical for preventing audits, avoiding penalties, and ensuring timely reimbursement. Healthcare organizations, providers, and coders...
Here’s a detailed overview of the finalized CMS Top Changes for 2026, including policy and payment changes affecting Medicare Advantage (MA), Part D, traditional Medicare, and ACA Marketplace plans: Medicare Advantage (Part C) In the final CY 2026 Rate Announcement,...
Who Hires New CPC-A and CPC Coders? Breaking into the medical coding field as a newly certified CPC-A (Certified Professional Coder Apprentice) or CPC (Certified Professional Coder) can feel overwhelming. Many healthcare organizations prefer experienced coders, but...
Medical Coding and Billing Guidelines for Sleep Apnea Sleep apnea is a common and serious sleep disorder that affects millions of Americans. Accurate billing and medical coding for sleep apnea are critical for ensuring proper reimbursement and compliance when...