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Auditor Insights | Arthritis Coding: Start With the Type Before You Choose the Code

by Mary Bort | Aug 27, 2026 | Auditor Insights

“Arthritis” may be common in documentation, but coding it correctly requires more than just identifying the affected joint.  Not All Osteoarthritis Is the Same  Osteoarthritis (OA) is one of the most common types of arthritis in medical records, but several distinct...

Auditing Insight | OIG Audit Flags Major Medicare Compliance Risk for SI Joint Injections

by Kate Hutchison | Aug 18, 2026 | Auditor Insights

A new Department of Health and Human Services (HHS) Office of Inspector General (OIG) audit puts sacroiliac (SI) joint injections squarely in the Medicare compliance spotlight. Issued on August 3, 2026, the full OIG audit details documentation, billing, and workflow...

Auditor Insights | Colorado Health First Behavioral Health: Modifier U9 Requirement Takes Effect

by Tamara Jones | Aug 11, 2026 | Auditor Insights

A new billing requirement is now in effect for behavioral health services provided by pre-licensed and unlicensed clinicians under Health First Colorado.  What Changed July 1?  Effective July 1, 2026, pre-licensed and unlicensed clinicians may not...

Auditor Insights | Split/Shared Services: Can Your Documentation Support the Billing Provider?

by Leah Culley | Jun 12, 2026 | Auditor Insights

Split/shared visits continue to be a frequent source of audit findings—not because the services weren’t appropriately provided, but because the documentation doesn’t clearly identify who performed the substantive portion of the visit. The Documentation...

Auditor Insights | Assistants at Surgery in a Teaching Hospital: Know When an Exception Applies

by Susan Bonham | Jun 1, 2026 | Auditor Insights

Coding assistant-at-surgery services in a teaching hospital can be challenging, particularly when determining whether Medicare will reimburse the assistant. One of the most common misconceptions is assuming that an assistant surgeon is automatically paid whenever they...

Auditor Insights | Point-of-Care Testing: Does It Count Toward MDM Data?

by Leah Culley | Jun 1, 2026 | Auditor Insights

Point-of-care (POC) testing is common in today’s clinical setting, but it’s also one of the most frequently misunderstood components of E/M coding. A common misconception is that every POC test performed automatically counts toward the Amount and/or...
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