Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
If you're a Find-A-Code subscriber, there's no need to worry. Find-A-Code's fee calculators are ready for the change. You can count on Find-A-Code for the most complete and accurate information you need as a medical coder/biller.
Reader Question: Assign Fracture Dx to Relevant Surgical Code, Only
Question: We have a patient who underwent an open reduction and internal fixation (ORIF) for a left, displaced lateral malleolus fracture in addition to an ORIF for left proximal fibular fracture. Should I include both diagnosis codes on both procedures?
Minnesota Subscriber
Answer: In your example, you should not designate both diagnosis codes to both procedures, despite the fact that the fractures are within close proximity to one another. Just as you would if the provider performs the procedures on entirely separate anatomic sites (i.e. left leg, right leg), you will only apply the diagnosis relevant to each...
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