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Coding Clarified

Medical Coding Online School
Get certified in as little as 16 weeks
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Online Medical Coding Course, get certified in as little as 16 weeks at a fraction of the average cost. We use AAPC’s approved curriculum to help qualify you for your medical coding certification. We offer a medical coding personal mentor along with our own coding group for all students that you have access to every question ever asked. We have a 98% success rate, we won't let you fail. Accepting

students daily throughout the United States. Become a certified medical coder today. Make a new career change. We offer payment plans and financing. We are excited that you are ready to start your journey as a medical coding specialist. "Let us Clarify Coding for You"
Coding Clarified provides a self-paced course to prepare you to become a certified professional medical coder. In just a few months, you’ll benefit from a stable and rewarding career that’s in high demand. Through our comprehensive medical coding program, you’ll learn exactly what’s needed to pass the medical coding exams to achieve your certification. With medical coding credentials, you’ll take control of your future to benefit from a rapidly expanding career. Apply for a scholarship today.

03/19/2026

Congrats on 2 years at Coding Clarified, Lori!

03/18/2026

The CMS-HCC Model Version 28 (V28) introduces significant changes to disease interactions and their associated Risk Adjustment Factor (RAF) scores, with a focus on narrowing the coefficients for complex comorbidities. The final V28 model, used for 2024–2026, includes 115 payment HCCs and updated interaction terms that often yield lower RAF scores than the previous V24 model.

Top Resources for HCC V28 Interaction RAF Scores
CMS Revised V28 Relative Factor Tables: The most accurate source for V28 coefficients is the CMS website. The "Revised CMS-HCC Model Relative Factor Tables" PDF provides the specific numerical values for interaction pairs, such as CHF+Diabetes and Renal+CHF.
AAPC Knowledge Center V28 Overview: The AAPC blog provides a detailed summary of the V28 model changes and interactions, explaining how interaction terms still contribute to RAF scores even if one condition is "trumped" by a higher-level HCC.
DoctusTech V28 Summary: This guide outlines the key changes in HCC V28, including the reduction in RAF scores due to the new constraints in the model.
RAAPID V28 Model Information: This blog provides an in-depth look into the changes, including a list of the 2,294 ICD-10 codes that no longer map to a payment HCC in V28.

Key V28 Disease Interactions & Estimated RAF Impact
Disease interactions in V28 act as "multipliers" when specific pairs of conditions coexist. The following are among the recognized combinations:

Immune Disorders & Cancer: (HCC47_gCancer)
Congestive Heart Failure (CHF) & Diabetes: (HCC85_gDiabetesMellit)
CHF & Chronic Obstructive Pulmonary Disease (COPD): (HCC85_gCopdCF)
CHF & Renal Disease
Cardiorespiratory Failure & COPD
CHF & Specified Heart Arrhythmias
Sepsis & Pressure Ulcer
Important V28 Note: Many interaction coefficients were reduced in V28 compared to V24. For example, the Diabetes + CHF interaction was approximately 0.121 in V24, but reduced to 0.112 in V28.

Changes in V28 Coding
Constraining: Related HCCs (e.g., uncomplicated diabetes vs. complex diabetes) are given the same, often lower, coefficients to decrease overpayment.
Removal of Codes: 2,294 diagnosis codes (including some forms of malnutrition and depression) no longer map to a payment HCC.
Hierarchy Remains: Interactions are additive and apply independently of HCC hierarchy.

PDF https://www.cms.gov/files/document/revised-cms-hcc-model-relative-factor-tablespdf

03/18/2026

HCPCS Modifier MB indicates that an ordering professional is exempt from consulting a Clinical Decision Support Mechanism (CDSM) for advanced diagnostic imaging due to a significant hardship exception regarding insufficient internet access. It is used for Medicare claims, specifically for advanced imaging like CT, MRI, or nuclear medicine.

Key Aspects of Modifier MB
Purpose: Identifies a hardship exemption from Appropriate Use Criteria (AUC) consultation requirements.
Context: Applies to advanced diagnostic imaging services (e.g., CT, PET, MRI, nuclear medicine).
Reason: The ordering professional lacks necessary internet access (a "significant hardship").
Usage: Used on claims to indicate why a CDSM was not consulted, under the Medicare AUC program for imaging.
Effective Date: Effective for services provided on or after January 1, 2020.

03/18/2026

Coding Clarified Medical Terminology Word of the Day!

Prefix
gen- / geno-

Pronunciation: jen / jen-oh
Meaning: origin, producing, forming
Example: Pathogenesis — origin of disease
Usage: Used in pathology and genetics

03/18/2026

Medical Coding: Risk Adjustment Model V28 Explained

If you work in HCC coding, auditing, CDI, or value-based care, understanding Risk Adjustment Model V28 is essential. This latest CMS update significantly changes how diagnoses translate into RAF (Risk Adjustment Factor) scores and ultimately impacts reimbursement.

In this blog, we break down what V28 is, why it was implemented, and how it differs from previous versions. You’ll learn how changes to HCC categories, ICD-10-CM mapping, and condition weighting affect coding accuracy and financial outcomes.

V28 introduces major structural changes, including expanded HCC categories, removal of thousands of diagnosis codes from risk adjustment mapping, and updated weighting logic designed to better reflect patient severity and reduce overpayments.

For coders, this means documentation accuracy and specificity are more important than ever. Many conditions that previously impacted RAF scores no longer do, and overall risk scores are expected to decrease under the new model.

Whether you're new to risk adjustment or already working in HCC coding, this guide will help you understand how to adapt your coding practices for V28.

Read the full blog here:
https://codingclarified.com/medical-coding-risk-adjustment-model-v28/

03/18/2026

What is golimumab?
Golimumab is used to treat rheumatoid arthritis and ankylosing spondylitis in adults.

Golimumab is also used alone or in combination with other medicines to treat psoriatic arthritis and polyarticular juvenile idiopathic arthritis in adults and children at least 2 years old.

Golimumab is also used alone or in combination with other medicines to treat ulcerative colitis in adults when other medicines have not worked or could not be tolerated.

The HCPCS code for Golimumab (specifically Simponi Aria) for intravenous (IV) use is J1602 (Injection, golimumab, 1 mg). It is billed in 1 mg units, meaning a 50 mg vial requires 50 units. It is used to treat autoimmune conditions like rheumatoid arthritis, often billed with ICD-10 codes M05.9 or similar.
Key Coding Details for Simponi Aria (J1602):
HCPCS Code: J1602 (Injection, golimumab, 1 mg, for intravenous use).
Billing Units: 1 mg = 1 unit. Typically, 50 units are billed per 50 mg vial.
Administration Codes: Commonly 96413 (chemotherapy administration) or 96365 (IV infusion).
Indication: Intravenous infusion for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
Note: This code (J1602) is for the intravenous formulation (Simponi Aria). Subcutaneous (Simponi) is typically billed under pharmacy benefits.
Required Documentation:
Diagnosis (e.g., M05.9 for Rheumatoid Arthritis).
Medical necessity for IV treatment.
Dosage administered (1 mg per unit)

03/18/2026

Wednesday Wisdom!

Medical coding for grafts depends primarily on the type of graft, the anatomical site, and the surface area covered. Skin grafts are generally categorized into autografts (split-thickness or full-thickness) and skin substitute grafts. For autografts, codes are based on the type and size, while skin substitute grafts (15271–15278) are strictly classified by body area and wound surface area.
Key Coding Categories
Split-Thickness Autografts (STSG): Involves harvesting a thin layer of epidermis and dermis.
Trunk, arms, legs: 15100 (first 100 sq cm).
Face, scalp, hands, feet, etc.: 15120 (first 100 sq cm).
Full-Thickness Autografts: Involves the entire epidermis and dermis.
Codes like 15200 (trunk, arms, legs) and 15220 (face, scalp, etc.) are commonly used for smaller areas.
Skin Substitute Grafts (15271–15278):
These are used for products requiring fixation (sutures, staples, or adhesives).
Trunk, Arms, Legs: 15271 (up to 100 sq cm), 15273 (100 sq cm or more).
Face, Scalp, Hands, Feet, etc.: 15275 (up to 100 sq cm), 15277 (100 sq cm or more).
Additional area is typically reported using add-on codes (e.g.+15272+15274+15276+15278).
Other Tissue Grafts:
Autologous soft tissue grafts (e.g., fat, dermis) are reported using specific codes such as 15769 or 15771/15773 for fat grafting.
Bone grafts (e.g., 21210, 21215) include harvesting; use modifier -52 if the graft is not harvested by the surgeon.
Important Billing Tips:
Documentation: Always specify the graft type, precise anatomical location, and total surface area (in sq cm).
Exclusions: Skin substitute codes cannot be used for non-graft dressings (e.g., ointments, foams) or injected substitutes.
Add-on Codes: Ensure "each additional" codes are used correctly based on the primary procedure code performed.

03/18/2026

Good Morning!

What are you coding today?

03/17/2026

The apprenticeship program exists because employers typically do not accept the CPC-A designation. That decision is made by employers—not by Coding Clarified.

What we’re doing is bridging that gap.

Many new coders earn their CPC but struggle to get hired because employers want experience and will not accept the apprentice status. Our apprenticeship pathway is designed specifically to solve that problem by creating a structured transition from certification to employment.

Here’s how the pathway works:

• Step 1: Earn your CPC certification
• Step 2: Complete Practicode and hands-on coding experience
• Step 3: Enter the Coding Clarified apprenticeship pathway
• Step 4: Work with employer partners who hire apprentices and provide paid on-the-job training

The goal is simple: turn CPC-A coders into employed medical coders.

We don’t control employer hiring rules, but we can build a bridge that helps new coders gain the experience employers require. That’s exactly what the apprenticeship program is designed to do.

If someone has their CPC-A and wants to move into a paid coding role, this pathway is built for that purpose.

CPC or CCS Opportunity – USA ONLY

If you hold a CPC or CCS credential and are interested in potential employment opportunities through the Coding Clarified Apprenticeship Program, we’d love to connect with you.

Please send your resume to [email protected]
and include the following information in your email:

• Full Name
• State you reside in -USA candidates only!
• County of Residence
• Credential (CPC or CCS) NO CPC-A

If you are a CPC-A
You can remove your A status by completing AAPC Practicode first, then applying.

Qualified candidates will be added to our potential candidate list for consideration as employers partner with us to hire through the apprenticeship program.

Stay tuned for information coming soon.

03/17/2026

Coding Clarified Medical Coding Apprenticeship – Employer FAQs

Thinking about hiring a medical coding apprentice or participating in a registered apprenticeship program?

In this video, we break down the most important Employer FAQs for the Coding Clarified Medical Coding Apprenticeship Program, including how the program works, employer expectations, funding opportunities, and how businesses can build a strong coding workforce pipeline.

This program is designed to help employers train and retain skilled medical coders while creating real workforce expansion opportunities through structured on-the-job training and education.

If you’re an employer looking to grow your team with trained, CPC-aligned coders, this is a must-watch.

Read the full blog here:
https://codingclarified.com/coding-clarified-medical-coding-apprenticeship-employer-faqs/

03/17/2026

Coding Clarified Medical Terminology Word of the Day!

Prefix
gastro-

Pronunciation: gas-troh
Meaning: stomach
Example: Gastritis — inflammation of the stomach
Usage: Very common in digestive system terminology

03/17/2026

What is glycopyrrolate?
Glycopyrrolate helps to control conditions such as peptic ulcers that involve excessive stomach acid production.

Glycopyrrolate is also used to reduce drooling in children ages 3 to 16 who have certain medical conditions, such as cerebral palsy.

Glycopyrrolate injection is also used during surgery to reduce secretions in your stomach or airway, and to help protect your heart and nervous system while you are under general anesthesia.

HCPCS codes for Glycopyrrolate depend on the administration method: J1596 or J1597 for injection (0.1 mg), and J7643 for compounded inhalation solution (unit dose, per mg). J7642 is used for concentrated inhalation solution, per mg. These codes are used for Drugs Administered Other than Oral Method.
Key Glycopyrrolate HCPCS Codes (2026):
J1596: Injection, glycopyrrolate, 0.1 mg
J1597: Injection, glycopyrrolate (Glyrx-pf), 0.1 mg
J7643: Glycopyrrolate, inhalation solution, compounded product, administered through DME, unit dose form, per mg
J7642: Glycopyrrolate, inhalation solution, compounded product, administered through DME, concentrated form, per mg
Important Considerations:
J1596/J1597: Generally used for IV/IM injections.
J7642/J7643: Specifically for inhalation solutions administered via Durable Medical Equipment (DME).
Common Place of Service (Inhalation): Office (11) or Ambulatory Surgical Center (24).
Note on NDC: Always verify the National Drug Code (NDC) for precise billing.

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