In this episode, Denise Herman, Inpatient DRG Validator & Coding Analyst at BESLER, provides us with a glimpse into BESLER’s upcoming webinar, Coding Clinic Q1 2025: Key Updates and Guidance, hosted live on Wednesday, July 9, at 1 PM ET.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- Why the AHA Coding Clinic is considered an essential resource for medical coders
- How coders should integrate Coding Clinic guidance into their workflows
- What the risks are of not using Coding Clinic as a resource
- How coders can stay current with Coding Clinic updates
- What ways the Coding Clinic support collaboration and quality improvement among coding professionals
- What types of coding scenarios were addressed in the Q1 2025 Coding Clinic Q&A section
- What the risks are of not using Coding Clinic as a resource
- How coders can stay current with Coding Clinic updates
- New codes released in the Q1 2025 Coding Clinic
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Denise Herman, Inpatient DRG Validator and Coding Analyst at BESLER. In this episode, Denise will provide us with a glimpse into BESLER’s upcoming webinar, Coding Clinic Q1 2025: Key Updates and Guidance that we’re hosting live on Wednesday, July 9, at 1 PM Eastern Time. Welcome, and thank you for joining us, Denise.
Denise Herman: Thanks for having me, Kelly. I’m really excited to be here.
Kelly: We’re excited to have you. Well, let’s go ahead and jump in.
Denise: Sounds good.
Kelly: Yeah. So, this webinar titled 2025 is the first quarter Coding Clinic. So earlier this year and last year, we hosted similar webinars on Coding Clinic. So, this topic is likely familiar to some of our listeners. So why is the AHA Coding Clinic considered an essential resource for medical coders?
Denise: Oh, this is a great question, Kelly. So, the AHA Coding Clinic…it provides official guidance on ICD-10 CM and ICD-10 PCS coding, answering real-world coding questions, clarifying sequencing, and ensuring coders adhere to the most current coding standards. Its recommendations are recognized by CMS and many payers, making it a critical reference for compliance and accurate coding practices. In addition, there’s a few key reasons for its importance. The first is authoritative guidance. The Coding Clinic is published by the AHA, the American Hospital Association, and is considered the official source for coding advice in the United States. Its recommendations are highly recognized by auditors, payers, and regulatory agencies. But let me stress, the Coding Clinic advice clarifies vagueness. Coding Clinic addresses real-world questions in gray areas that coders encounter, offering clear solutions for situations not explicitly described in the ICD-10 PCS Codebooks.
So Coding Clinic advice provides compliance and audit protection. By adhering to Coding Clinic guidance, it helps organizations avoid coding errors that could result in claim denials, compliance violations, or even financial penalties. Lastly, Coding Clinic offers sequencing and reporting advice. The publication provides detailed instructions on the correct order of codes and how to report complex medical scenarios, which is vital for accurate and consistent billing and data reporting.
Kelly: Wow. It does seem like it is an essential resource for sure. So how should coders integrate Coding Clinic guidance into their workflow?
Denise: This is a great question as well. Coders should really make sure that they regularly consult the Coding Clinic when they’re encountering ambiguous or complex documentation from providers. From a facility level, software should be updated with the latest guidance. The best practice is to annotate, print, or electronic codebooks with new clarifications and ensure that all coding decisions are supported by the most recent Coding Clinic advice.
Kelly: Wow. Thank you for that explanation. So, what are the risks of not using Coding Clinic as a resource?
Denise: This is a really important topic to discuss. So, failure to use Coding Clinic guidance can result in incorrect code assignments, compliance violations, claim denials, and even job performance issues. Coders are responsible for maintaining access to all necessary professional resources, including the Coding Clinic, to ensure accurate coding and avoid costly errors.
Kelly: Well, those risks sound significant. So how can coders stay current with Coding Clinic updates?
Denise: Coders should subscribe to Coding Clinic newsletters, participate in continuing education, and use coding lookup tools that integrate the latest Coding Clinic content. Many organizations provide access to Coding Clinic as part of their coding software, but coders must ensure they have up-to-date access independently if it’s not provided by their employer. Another way to stay current is to attend your local chapter meetings for the organization that issues a coder’s credentials.
Kelly: That makes a lot of sense. Thank you. In what ways does Coding Clinic support collaboration and quality improvement among coding professionals?
Denise: Collaboration and quality improvement should always be occurring. No one coder or auditor can possibly know everything. There are too many gray areas, specific patient scenarios, and documentation variances that anyone could be expected to know them all. Coding Clinic serves as a reference point for coders, auditors, and CDI specialists to resolve coding questions and ensure consistent, high-quality coding. It supports regular audits, feedback, and peer discussions, helping teams align on best practices and improve documentation and reimbursement outcomes. It helps to keep coding consistent across HIM, coding and auditing professionals.
Kelly: It sounds like it certainly does. So, what types of coding scenarios were addressed in the Q1 2025 Coding Clinic Q&A section?
Denise: In the 2025 first quarter, there were several exciting updates, and these included 28 question-and-answer scenarios covering a wide range of topics, such as updates to coding for COVID-19, obesity classification, and various medical and surgical procedures. I would say that the major update is that code assignment for COVID-19 can no longer be based solely on a positive test result. Instead, it must be based on provider documentation of a COVID-19 diagnosis. It is important to note for asymptomatic patients who test positive but have no documented diagnosis, coders are now required to query the provider since false positives can occur. Obesity was a topic covered in Quarter 4 of 2024’s Coding Clinic. However, they did clarify this past quarter by stating if both Class III obesity and morbid obesity are documented, only the code for Class III obesity should be reported, as it is a more specific term. Class III obesity may also be categorized as severe obesity, and this clarification helps coders avoid duplicate coding for the same condition.
Alzheimer’s disease coding was another topic covered in Q1’s Coding Clinic. We are instructed when a patient is diagnosed with Alzheimer’s disease, coders must distinguish between Alzheimer’s alone and Alzheimer’s with dementia based on the provider’s documentation and using the appropriate ICD-10 CM codes to reflect the full clinical picture. And the first quarter also highlighted several updates and procedures for new technologies, including clarification of body part characters and a new testing capability for sepsis. It’s important to also mention…there were no changes in the ICD-10 PCS coding guidelines for this quarter.
Kelly: Wow. Thank you for sharing a lot of those scenarios with us. So how about ICD-10 CM codes? Were there any new codes released in the Q1 2025 Coding Clinic?
Denise: No, there weren’t any new ICD-10 CM diagnosis codes introduced in the Q1 2025 release. However, despite there being no changes to ICD-10 PCS guidelines, there were 50 new ICD-10 PCS procedure codes along with two revised and 12 deleted ICD-10 PCS procedure codes. I know we are just about out of time, so I’ll wrap it up with a few key takeaways. In summary, I would recommend keeping in mind the following points. First, the Coding Clinic is the official source for interpretation and clarification when the classification and guidelines do not fully address a coding scenario. Coding Clinic advice can clarify, refine, or even alter the interpretation of official guidelines in real-world coding scenarios. Third, coders must stay current with Coding Clinic publications to ensure compliance and avoid misinterpretation of guidelines. The last point I would like to make is ignoring Coding Clinic guidance can result in coding errors and compliance issues. I strongly suggest to all of our listeners: Please join me for our upcoming webinar on Quarter 1, 2025 Coding Clinic, where I will go into more detail on the topics teased in this podcast. The webinar will be presented on Wednesday, July 9, at 1 PM Eastern.
Kelly: Well, thank you so much for joining us, Denise, and for sharing this sneak peek into the upcoming webinar, Coding Clinic Q1 2025: Key Updates and Guidance that we’re presenting live on Wednesday, July 9, at 1 PM Eastern Time. And as a bonus, you can earn CEU. Thanks again, Denise.
Denise: Thank you for having me, Kelly.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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