In this episode, Kristen Eglintine, BESLER’s Senior Manager of Revenue Integrity Services of Coding and Projects provides us with a glimpse into BESLER’s next free Webinar, Coding Clinic Q3 & Q4 2025: The Latest Coding Updates & Tips hosted live on Wednesday, December 3rd 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:
- What a Coding Clinic is and why it matters for coding professionals
- Why guidance is so important to coders
- Key highlights from the third quarter
- How the new guidelines will affect coders going forward
- What coders can expect from quarter 4
- The most significant new or revised ICD-10-CM, PCS codes from Q4 2025
- Coding Clinic procedure guidance
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Kristen Eglintine, BESLER’s Senior Manager of Revenue Integrity Services of Coding and Projects. In this episode, Kristen will provide us with a glimpse into BESLER’s next free Webinar, Coding Clinic Q3 & Q4 2025: The Latest Coding Updates & Tips that we’re hosting live on Wednesday, December 3rd at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristen.
Kristen Eglintine: Hi, Kelly. It’s an honor to be back here. So, thank you for having me. I’m looking forward to this conversation.
Kelly: Me too. Well, let’s go ahead and jump in. So, we’re talking about BESLER’s upcoming webinar that’s covering Coding Clinic updates from Q3 and Q4 from this year. Since BESLER’s already presented two other Coding Clinic webinars this year, many of us are familiar with its importance. However, some of our new listeners might not quite understand. So can you share some insight into what Coding Clinic is and why it matters for coding professionals?
Kristen: Absolutely, Kelly. I just want to welcome everyone who’s joining us. Thank you for listening. Coding Clinic is the official U.S. publication for medical coding advice, primarily focusing on accurate use of diagnosis and procedure codes. And those include ICD-10-CM, ICD-10-PCS codes, and HCPCS codes. It’s published quarterly. And like you said, BESLER has already hosted a few webinars this year on Q1 and 2. So this upcoming webinar will be focusing on Q3 and 4. So who produces this Coding Clinic? It’s published by the AHA, which is the American Hospital Association’s Central Office, which is considered the designated U.S. clearinghouse for Medical Coding Standards. The AHA Central Office works in cooperation with other national organizations that include CMS or Centers for Medicare and Medicaid Services and AHIMA that we all know so well, which is the American Health Information Management Association. As far as what Coding Clinic’s purpose is, it provides official coding advice, rules, decisions, clarifications regarding the ICD-10-CM and PCS and HCPCS codes for hospitals or clinics and coders throughout the US. As I just mentioned, it is published quarterly. These newsletters address FAQs. It addresses sequencing issues and gives us practical examples for reporting medical information from provider records. Guidance from Coding Clinic is authoritative. Coders and billing professionals, as well as auditors, consultants, and insurers all are expected to adhere to advice from Coding Clinic for compliant, accurate coding practice.
It does serve as references for regulatory reporting and code assignments, diagnostic and procedural sequencing, data edits, and documentation requirements. So, it’s amazing, and there is a lot of good that comes out of it.
Kelly: Thank you for sharing all that with us. I know it’s pretty important for coders. Why is their guidance so important to coders?
Kristen: So, there’s a couple of key reasons that we’ll go over. It is essential. As I mentioned, it does serve as the official authority for medical coding guidance. So, it’s published by AHA and it is recognized by auditors, payers, and regulatory agencies across the U.S. as the definitive resource for coding standards and advice. It’s an educational resource, which is super important to coders. It resolves ambiguous real-world scenarios. So, it answers questions and it addresses those gray areas that coders face in practice, provides case studies, Q&As, and examples that help coders understand complex coding situations and applies rules correctly in practice for situations that may not be fully covered by our code sets. Additionally, it keeps coders current. Coding standards and code sets change frequently. So, these quarterly published updates help reflect the new codes and revised guidelines and any emerging clinical scenarios. And then following Coding Clinic’s advice just helps ensure compliance and provides protection during audits.
Kelly: Well, that is very important. We know that. The upcoming webinar will review questions submitted to Coding Clinic from their third and fourth quarter releases. To start with, what are some of the key highlights from the third quarter?
Kristen: Yeah, so, great question. Each release is packed with great information. So, here’s just a few of the major highlights from Q3. There are multiple topics on diabetes covered, the first being diabetes with complications. So new guidance classifies hyperlipidemia, for example, as a diabetic complication, linking these appropriately to diabetes codes. This is a topic that our upcoming webinar will go over in detail. The second for diabetes would be hypoglycemia in diabetes, and Coding Clinic has clarified coding for the severity. And then the third topic on diabetes would be pre-symptomatic type 1 diabetes. Specific codes are introduced to distinguish early-stage type 1 diabetes from other types. In addition to diabetes, Coding Clinic has emphasized correct code selection for BMI coding based on the patient’s age group. So, there’s different codes for pediatric versus adult BMI. We have guidance that was issued for coding specificity in regards to pulmonary embolisms. Pancytopenia is another topic. So, coding sequencing was clarified for pancytopenia due to medications or chemotherapy, identifying the cause as principal or secondary as indicated. And this is a topic we are going over in our webinar as well. There are updated codes and sequencing for dementia with mood, anxiety, or psychotic symptoms. Vaping, big topic. New and revised coding scenarios for vaping associated disorders. This topic again is included in our webinar. Such a relevant topic in today’s environment.
Vaping has become a major health issue, especially among teens and young adults, leading to conditions such as e-cigarette or vaping associated lung injuries, chronic respiratory disorders. Hospitals are seeing more and more admissions for these type of conditions. So, coders need to know how to accurately capture these encounters. And then the last one I’ll mention is updates to reporting for chemotherapy or radiation adverse effects. These updates include sequencing and code selection for cancer therapy complications.
Kelly: Wow, what a great overview. Thank you. Is there a particular topic from the Coding Clinic updates that you can discuss in detail explaining how these new guidelines will affect coders going forward?
Kristen: Yes, absolutely. I mentioned pancytopenia due to medications is a topic we’ll highlight in our upcoming webinar. The updated guidance from Coding Clinic’s Q3 clarifies that when pancytopenia is caused by drugs or chemotherapy, the sequencing of codes now depends on the primary reason for the encounter and the clinical scenario. And I always appreciate when Coding Clinic gives PDX selection guidance as choosing the PDX. It can be tricky. Incorrect PDX sequencing can lead to a DRG misassignment and that does impact hospital revenue. So, our guidance from Coding Clinic is that if the main reason for the admission is to manage the pancytopenia itself, such as treating the symptoms, giving a transfusion, addressing the complications, then the pancytopenia should be sequenced as the principal diagnosis. If the main focus is managing the drug toxicity or the adverse effect, then the appropriate T-code representing that drug toxicity or the adverse effect would be sequenced as your principal diagnosis. So, the key takeaway would be that sequencing now is more flexible and must be based on the clinical reason for admission and advising coders to review the medical record carefully to determine whether the care was primarily for the pancytopenia or for the toxic/adverse effect and code accordingly to that.
Kelly: It sounds very complex. Thank you for that, Kristen. What about quarter four? What can coders expect from this quarter?
Kristen: The fourth quarter covers an extensive range of topics that are all tied to the October 1st annual update. That includes new and revised codes. It includes guideline changes along with some coding Q&As. The main topics covered are all of the new and revised codes. And a few major highlights from the new codes covered will be demodex blepharitis. So new codes were introduced. We can now separately report this from just a general blepharitis for improved ophthalmology documentation. Malignant inflammatory neoplasm of breast. So, there’s new coding for this rare subtype, and we’re advised to follow site-specific and behavior guidance for proper classification. Additional documentation is required for new code assignments for leukocyte adhesion deficiencies, which will clarify one’s genetic basis. Diabetes is covered again in Q4, but this type is for type 2 diabetes in remission. So, there’s a specific code for diabetes in remission, clarifying the sequencing and the use for follow-up encounters. And this topic, again, will be covered in our upcoming webinar. Lipodystrophy is another topic that’s highlighted. We’re going to report that under a new code, distinguishing it from related lipid disorders, new separate codes for relapsing, remitting MS if the variant is documented correctly. We have expanded codes for laterality for abdominal or pelvic pain.
Cannabis, okay, so another hot topic. There’s a cannabis hyperemesis syndrome. So, we have new codes and guidance for this clinical condition. Antibiotic and drug poisoning, new codes here for adverse effects and underdosing with instructions for poisoning versus adverse effect sequencing. There’s expanded adverse food reaction coding and blast injuries. So new external cause codes, plus coding tips for military or trauma reporting. And then in addition to those new codes, Coding Clinic does address updated coding guidelines, focusing on the meaning of commas in the alphabetic index. They address coding for multiple sites. HIV code sequencing had a major rehaul, and this is a topic in our upcoming webinar that we’ll go over. And then back to diabetes. Coding Clinic does talk about the type 2 diabetes and remission guidelines as well as the codes.
Kelly: Wow, there’s a lot of updates there in Q4, a lot you’re going to cover too. So, what do you think are the most significant new or revised ICD-10-CM, PCS codes from Q4 2025? And how might these affect provider reporting and reimbursement?
Kristen: So, great question. I’ll go over two. So, the first being the coding Q&A on expanded diagnosis codes for rare diseases and conditions. So here we have the lipodystrophy, malignant inflammatory neoplasm of breast, the leukocyte adhesion deficiency. These are rare genetic syndromes. The impact would be that providers can now more precisely document and report these conditions. It facilitates targeted treatment, better research, and better risk adjustment for reimbursement. The second most significant change that’s addressed in Q4 would be diabetes and remission coding. So, addition of codes for diabetes and remission and updates in the metabolic syndrome coding is super important. The impact would be improved tracking of the diabetes population and the outcomes. This is going to give us better treatment. We’ll also support payers and quality improvement initiatives.
Kelly: Thank you. I know you’ve mentioned a lot of diagnosis topics, but what about procedures? Does Coding Clinic offer procedure guidance?
Kristen: Both Q3 and Q4 feature substantial ICD-10-PCS procedure changes. So, there’s a lot of topics covered and they range from novel surgical techniques to devices to the new technology codes introduced. Specifically, in Q3, we’ll see under surgical technique clarifications, guidance on coding for sternal plating. We’ll see guidance on spinal fusion devices, new techniques in wound management, and hybrid surgical approaches. The Q3s as far as procedure coding does go over device coding and documentation requirements, along with some QAs on sequencing. So, there’s some scenario-based clarification for coding multiple procedures performed together, as well as device removals and reinsertions, or when a biopsy, for example, is performed with a more extensive procedure. For Q4, the procedure coding updates include 150 new ICD-10-PCS codes that coincide with the October 1st new code update. A couple of examples would be the dilation of the carotid artery with embolic protection. We have new procedure codes for endocardiac pacing systems, wireless capsule GI inspections, pelvic fusion devices, and gene therapy procedures. Also, expanded use of the new technology section is reviewed in Q4.
So, while Coding Clinic may often seem to focus primarily on diagnosis coding, it also provides valuable guidance for procedure coding that shouldn’t be overlooked. And although I typically don’t cover HCPCS in our webinars, it’s important to mention that Coding Clinic publishes quarterly updates covering HCPCS as well, ensuring coders stay informed about changes across all code sets. Quarterly HCPC updates have a big impact with payment changes directly impacting reimbursement rates, code eligibility, and billing compliance for drugs, devices, and procedures. Thanks for tuning in to our Coding Clinic discussion. If you found today’s episode helpful, register now for our upcoming webinar on Coding Clinics Q3 and 4, where I’ll go over all of this and more in detail. The webinar is scheduled for Wednesday, December 3rd, at 1 PM Eastern Time, and I look forward to seeing you then. Thank you for having me today, Kelly.
Kelly: Thank you so much for joining us, Kristen, for giving us the sneak peek into BESLER’s Upcoming Webinar, we’re covering Coding Clinic from Q3 and Q4 of this year. And as you mentioned, you’re presenting that live on Wednesday, December 3, at 1 PM Eastern Time. And as a bonus, you can earn CEU. Thanks again, Kristen.
Kristen: Thank you.
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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