Coding Clarified

10/10/2026

EMPLOYERS: What if you could receive funding for up to 50% of an apprentice’s wages while building your medical coding workforce?

Our U.S. Department of Labor Registered Medical Coding Apprenticeship Program offers healthcare employers an opportunity to develop skilled, certified medical coders while potentially reducing hiring and training costs!

Employer Benefits Include:

* Up to 50% wage reimbursement through eligible workforce funding programs, subject to availability and approval.
* Retention incentives for apprentices who successfully complete the required employment period.
* Pretrained medical coding candidates ready to gain real-world experience.
* Structured apprenticeship training with 2,000 hours of on-the-job training and 144 hours of related technical instruction.
* Recruitment and training support to help employers build a qualified coding workforce.
* Reverse referral opportunities that allow employers to enroll candidates they already want to hire.
* Reduced recruitment and training costs while developing long-term employees.

Wage reimbursement and incentive eligibility depend on applicable program requirements and available funding.

Healthcare employers, hospitals, physician practices, and revenue cycle organizations: This is an opportunity to invest in tomorrow’s medical coding professionals while benefiting your organization today!

Learn more about our apprenticeship program and employer benefits:

https://codingclarified.com/coding-clarified-medical-coding-apprenticeship-employer-faqs/

Apprentices learn while they work, gain valuable experience, and move toward becoming fully employable medical coders.

10/09/2026

When a patient has HIV disease, does B20 always become the principal diagnosis? No. The reason for the admission matters.

If a patient with HIV disease is admitted for an unrelated condition, such as a traumatic injury:

• Code the unrelated condition as the principal diagnosis.
• Report B20, Human immunodeficiency virus [HIV] disease, as a secondary diagnosis.
• Report codes for other documented c onditions as additional secondary diagnoses when appropriate.

The key is determining what occasioned the admission. If HIV disease is not the reason for admission, don’t automatically sequence B20 first.

This is a great sequencing rule for CPC students to know and another reminder to always check the chapter-specific ICD-10-CM guidelines.

10/09/2026

Critical care coding is all about the details. A patient’s location alone does not support critical care—you need the patient’s condition, qualifying critical care services, time, and documentation to support the codes reported.

Our 2026 Critical Care Coding guide breaks down CPT 99291 and 99292, including qualifying time, documentation requirements, separately reportable procedures, bundled services, Medicare considerations, and payer-specific rules.

A few important reminders:

99291 covers the initial 30–74 minutes of qualifying critical care.
99292 is an add-on code for additional qualifying time—always verify payer-specific rules.
Critical care time does not have to be continuous.
Time spent on separately reportable procedures cannot also count toward critical care time.
Simply being in the ICU does not automatically support critical care coding.
99221–99223 are hospital inpatient/observation E/M codes, not critical care codes.
For CPC students, remember: critical patient + critical management + qualifying time = evaluate whether critical care coding is supported.

10/09/2026

Coding Clarified Medical Terminology Word of the Day!

Suffix
-emia

Pronunciation: EE-mee-uh
Meaning: blood condition; presence of a substance in the blood
Example: Hyperglycemia — abnormally high glucose in the blood
Usage: Extremely common in laboratory, endocrine, hematologic, and diagnosis terminology.

10/09/2026

What is Proscar?
Proscar prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH).
Proscar is used to treat symptoms of benign prostatic hyperplasia (BPH) in men with enlarged prostate. Finasteride is for use in men only and should never be taken by a woman or a child.
Proscar may also be used to reduce the risk of a sudden inability to pass urine and the need for surgery related to BPH in men with an enlarged prostate.
Proscar may be used alone or prescribed along with another medicine, an alpha-blocker called doxazosin, to help you better manage your BPH symptoms.

The HCPCS Level II code for oral Finasteride 5 mg (the generic equivalent of Proscar) is HCPCS Code S0138, which describes Finasteride, 5 mg.

Medical Coding Details for Proscar (Finasteride)
HCPCS Code: S0138 (Finasteride, 5 mg, non-Medicare drug code).
Common ICD-10-CM Diagnosis Code: N40.1 (Benign prostatic hyperplasia with lower urinary tract symptoms) or legacy code 600.0 for benign enlargement of the prostate.
Drug Classification: 5-alpha-reductase inhibitor used primarily to treat Benign Prostatic Hyperplasia (BPH).
Billing Note: S codes are temporary national codes used by private insurers and state/non-Medicare programs; Medicare typically does not use S codes for outpatient prescription drugs covered under Part D, which are handled through pharmacy benefit plans rather than standard HCPCS medical billing.

10/09/2026

Critical Care Medical Coding and Billing Guidelines 2026: CPT 99291, 99292, Time & Documentation

Critical Care Medical Coding and Billing Guidelines 2026 | CPT 99291, 99292, Time & Documentation

Are you confident when coding critical care services? Understanding CPT 99291 and 99292, time requirements, documentation, and Medicare billing rules is essential for accurate medical coding and reimbursement.

In this video, we break down the 2026 Critical Care Medical Coding and Billing Guidelines to help medical coders, billers, and CPC students understand when critical care codes apply and how to avoid common coding mistakes.

What You'll Learn:

CPT 99291: Initial 30–74 minutes of critical care

CPT 99292: Additional critical care time and payer-specific rules

What qualifies as critical care

Critical care time calculations and documentation requirements

Medicare billing guidelines and bundled services

Separately reportable procedures

Critical care vs. regular E/M services

Common coding mistakes to avoid

Practical CPC exam preparation tips

Important Reminder: A patient being in the ICU does not automatically qualify for critical care coding. The patient's condition, services provided, and documented qualifying time must support the codes reported.

Whether you're preparing for the CPC exam or working as a medical coder, understanding these guidelines can help improve coding accuracy, support compliance, and prevent claim denials.

Read our complete 2026 Critical Care Coding Guide:

https://codingclarified.com/critical-care/

Explore more medical coding education, billing guidelines, case studies, and CPC exam preparation resources at https://codingclarified.com/

10/09/2026

Do you know the difference between simply having a CPT/HCPCS code and having a service that Medicare will actually cover?

That’s where National Coverage Determinations (NCDs) come in.

An NCD is a nationwide Medicare coverage policy established by the Centers for Medicare & Medicaid Services (CMS). It helps determine whether a specific item or service is covered by Medicare and under what circumstances.

For medical coders and billers, NCDs may include important information about:

• Coverage criteria
• Indications and limitations
• Medical necessity
• Documentation requirements
• Covered services, items, and technologies
• Related Medicare coding and billing guidance

Remember: Correct coding alone does not guarantee Medicare payment. The documentation and circumstances of the service must also support applicable Medicare coverage requirements.

Before submitting a Medicare claim, know when an NCD applies—and always verify the current policy.

10/09/2026

The marshmallows were supposed to get toasted—not the trick-or-treaters!

We’re having some Halloween fun with real ICD-10-CM external cause codes. X03.0XXA identifies exposure to flames from a controlled fire outside of a building or structure, with A indicating the initial encounter.

Another reminder that ICD-10-CM has a code for just about everything—even when Halloween festivities go up in flames!

10/09/2026

Good Morning!

What are you coding today?

10/08/2026

HIV coding requires careful attention to sequencing, especially when the patient is admitted for an HIV-related condition.

When the reason for admission is an HIV-related condition:

• Assign B20, Human immunodeficiency virus [HIV] disease, as the principal diagnosis.
• Then assign additional diagnosis codes for all reported HIV-related conditions.

But there is an important exception to remember.

If the patient is admitted for hemolytic-uremic syndrome associated with HIV disease, sequence:

1. D59.31 — Infection-associated hemolytic-uremic syndrome
2. B20 — Human immunodeficiency virus [HIV] disease

CPC students: sequencing exceptions like this are exactly why reading the chapter-specific ICD-10-CM guidelines matters. Don’t assume B20 is always sequenced first just because HIV disease is present.