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Dr Santosh Guptha

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Neurology Coding

FIMC® Neurology Coding by PMBAUSA – Mastering High-Risk Surgical Coding

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Neurosurgery stands at the intersection of clinical complexity, high financial risk, and intense regulatory scrutiny. It is consistently identified by CMS, commercial payers, and the Office of Inspector General OIG as one of the highest-risk medical specialities due to high reimbursement values, technically complex procedures, and frequent documentation gaps. For medical coders, this makes neurosurgery not just another speciality—but a true test of advanced coding expertise.

The FIMC®-Neurosurgery Coding Course is purpose-built to prepare medical coders for this challenge.

This advanced, fellowship-level program goes far beyond basic CPT and ICD-10 knowledge. It trains coders to think like auditors, interpret operative reports like surgeons, and apply payer rules with precision. Participants gain a deep understanding of diagnosis-driven coding, global surgery rules, modifier discipline, and bundling compliance, all of which are critical to surviving and succeeding in neurosurgery billing environments.

In an era where OIG audits focus heavily on medical necessity, improper unbundling, and diagnosis–procedure mismatches, organizations are actively seeking coders who can protect revenue while maintaining strict compliance. The FIMC – Neurosurgery Coding Course equips you with the skills, judgment, and confidence to code high-risk neurosurgical cases accurately—without triggering denials, audits, or recoupments.

This course is ideal for coders who want to:

Move into high-paying, high-responsibility roles

Specialize in inpatient, surgical, or hospital-based coding

Become audit-ready experts in one of the most scrutinized specialities

Future-proof their careers in an environment where accuracy equals survival

If you are ready to move beyond routine coding and master a speciality where every code choice matters, the FIMC – Neurosurgery Coding Course is your gateway to elite-level neurosurgery coding expertise.

This is not basic training. This is speciality mastery. Visit www.pmbausa.com

FIMC® – Neurology & Neurosurgery Coding Course Modules
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Module 1: Introduction to Neurology & Neurosurgery Coding
• Scope and significance of neurology vs neurosurgery coding
• Outpatient, inpatient, and surgical environments
• Why neurology and neurosurgery are high-risk specialties
• CMS, commercial payer, and OIG scrutiny overview
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Module 2: Neuro Anatomy & Physiology for Coders
• Central Nervous System CNS
• Peripheral Nervous System PNS
• Autonomic Nervous System
• Brain lobes, brainstem, cerebellum
• Spinal cord, vertebral levels, nerve roots
• Cranial nerves and functional correlation
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Module 3: ICD-10-CM Coding for Neurology & Neurosurgery
• Chapter 6 G00–G99 guidelines
• Injury and trauma coding for neuro cases
• Neoplasm coding for brain and spinal tumors
• Acute vs chronic vs sequela coding
• Laterality, site, and etiology specificity
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Module 4: Cerebrovascular Disorders & Stroke Coding
• Ischemic vs hemorrhagic stroke
• TIA vs CVA vs stroke sequela
• NIH Stroke Scale documentation impact
• Inpatient admission and follow-up coding
• Common audit errors in stroke cases
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Module 5: Seizure Disorders & Epilepsy Coding
• Seizure vs epilepsy distinction
• Intractable vs non-intractable epilepsy
• Status epilepticus coding
• Medication-resistant epilepsy documentation
• Neurology and neurosurgery overlap cases
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Module 6: Headache, Migraine & Pain Syndromes
• Migraine with and without aura
• Intractable headache documentation
• Cluster and tension headache coding
• When symptom coding is allowed
• Medical necessity support
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Module 7: Neuropathy, Radiculopathy & Spine Disorders
• Peripheral neuropathy types
• Radiculopathy by spinal region
• Disc disorders and nerve compression
• Laterality and level specificity
• Neurology vs neurosurgery decision points
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Module 8: Movement Disorders & Neurodegenerative Diseases
• Parkinson’s disease and tremors
• Multiple sclerosis and demyelinating disorders
• ALS and motor neuron disease
• Progressive vs stable neurological conditions
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Module 9: CPT Coding for Neurology Evaluation & Management
• Office and hospital E M coding
• MDM vs time-based selection
• New vs established patient rules
• Prolonged services
• Teaching physician and split shared rules
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Module 10: Diagnostic Neurology CPT Coding
• EEG coding and documentation
• EMG and nerve conduction studies
• Bundling and NCCI edits
• Professional vs technical components
• Medical necessity rules
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Module 11: Neurosurgery CPT Coding – Cranial Procedures
• Craniotomy and craniectomy codes
• Brain tumor excision and biopsy
• CSF shunt placement and revision
• Stereotactic navigation and microscope rules
• Global surgery implications
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Module 12: Neurosurgery CPT Coding – Spine Procedures
• Laminectomy, discectomy, decompression
• Spinal fusion coding principles
• Corpectomy coding requirements
• Diagnosis-driven spine coding
• Level counting and approach documentation
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Module 13: Neurointerventional Procedures
• Mechanical thrombectomy CPT 61645
• Intra-arterial infusion CPT 61650 and 61651
• Bundled angiography rules
• Vessel specificity and documentation
• Common audit triggers
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Module 14: Modifiers in Neurology & Neurosurgery
• Modifiers 25, 26, TC, 59
• Surgical modifiers 22, 51, 58, 62, 78, 80, 82
• Correct vs incorrect modifier usage
• Payer-specific modifier rules
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Module 15: Medical Necessity & Prior Authorization
• Documentation requirements for approval
• Conservative management expectations
• Elective vs emergent neuro procedures
• Peer-to-peer and appeal support
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Module 16: Common Coding Errors & Denials
• ICD-10 and CPT mismatches
• Bundling and unbundling errors
• Missing or incorrect modifiers
• Documentation gaps
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Module 17: OIG Audit Risk & Compliance
• High-risk neurology and neurosurgery CPT codes
• OIG focus areas
• CMS bundling rules
• Audit defense strategies
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Module 18: Inpatient Neurology & Neurosurgery DRG Impact
• Neuro-related MS DRGs
• CC and MCC identification
• POA indicators
• Clinical validation vs coding rules
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Module 19: Real-World Neurology & Neurosurgery Case Studies
• Outpatient neurology cases
• Inpatient stroke and ICU cases
• Neurosurgical operative note analysis
• Documentation improvement exercises
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Module 20: AI & Technology in Neuro Coding
• AI-assisted neurology and neurosurgery coding
• NLP challenges in operative reports
• Human validation vs automation
• Future trends in neuro coding
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Module 21: Quality Assurance & Internal Auditing
• QA checklists for neuro claims
• Peer review processes
• Error trend analysis
• Continuous improvement
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Module 22: Final Assessment & Fellowship Certification
• Advanced neurology and neurosurgery scenarios
• Coding and audit-based evaluation
• Minimum passing criteria
• Award of FIMC® – Neurology & Neurosurgery Coding Fellowship
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Course Outcome
Graduates of this fellowship will be able to:
• Confidently code complex neurology and neurosurgery cases
• Prevent denials and withstand audits
• Interpret operative reports with precision
• Transition into high-demand neuro specialty coding roles

SNF Coding

Skilled Nursing Facility SNF Coding Course by PMBAUSA LLC

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Skilled Nursing Facility SNF coding is one of the most important and high demand areas in US healthcare medical coding today. With the aging population and increasing need for post acute care, SNFs play a critical role in patient recovery and continuity of care after hospital discharge.

In medical coding, SNF stands for Skilled Nursing Facility. It is a licensed healthcare setting that provides short term skilled nursing care and rehabilitation services to patients recovering from hospitalization, illness, injury, or surgery. These services are typically provided under Medicare Part A and require strict documentation and accurate coding to ensure compliance and proper reimbursement.

What is a Skilled Nursing Facility

A Skilled Nursing Facility is a facility or part of a facility that provides skilled nursing care and related services. Patients admitted to an SNF require ongoing medical or nursing care or rehabilitation services that cannot be safely provided at home.

SNF patients commonly include individuals who are injured, disabled, sick, or recovering from major surgeries. These facilities also act as special care centers for patients who need temporary rehabilitation services such as physical therapy occupational therapy or speech therapy following a hospital stay.

Role of Medical Coding in SNF

SNF medical coding is complex and highly specialized. Coders working in SNF settings must understand both clinical documentation and reimbursement methodologies. Accurate coding is essential because SNF claims are closely audited and directly impact facility revenue.

SNF coders primarily work with ICD 10 CM diagnosis codes to capture patient conditions and comorbidities. They also use CPT and HCPCS codes to report therapy services and other procedures when applicable. In addition to coding systems, SNF coders must understand Medicare guidelines coverage rules and documentation requirements.

Understanding PDPM in SNF Coding

One of the most critical aspects of SNF coding today is the Patient Driven Payment Model PDPM. PDPM replaced the older RUG system and shifted the focus from therapy minutes to patient clinical characteristics.

Under PDPM reimbursement is driven by multiple case mix components including nursing physical therapy occupational therapy speech language pathology non therapy ancillary services and the presence of comorbidities. Accurate diagnosis coding directly impacts PDPM classification and payment rates.

This makes SNF coding highly documentation driven. Coders must identify all relevant conditions support medical necessity and ensure diagnoses are clearly supported in the medical record.

Why SNF Coders Are in Huge Demand

There is a significant and growing demand for skilled SNF coders across the US healthcare industry. The reasons include

Increased utilization of post acute care services
Aging Medicare population
Complex PDPM based reimbursement
High audit risk requiring trained specialists
Shortage of coders with SNF and PDPM expertise

Healthcare organizations are actively seeking coders who understand SNF workflows Medicare Part A billing PDPM logic and compliance requirements.

Career Opportunities in SNF Coding

SNF coding offers excellent career growth opportunities for medical coders. Roles include SNF coder PDPM specialist coding auditor quality analyst and compliance reviewer. Experienced SNF coders often earn higher salaries due to the complexity and responsibility of the role.

SNF coding is especially suitable for coders who want to work in inpatient post acute or facility based environments rather than physician office coding.

PMBAUSA LLC Fellowship in SNF Coding

To address the growing industry demand PMBAUSA LLC offers FIMC SNF Fellowship in Skilled Nursing Facility Coding. This advanced fellowship program is designed to train medical coders in real world SNF coding scenarios with a strong focus on PDPM Medicare guidelines documentation review and audit readiness.

The FIMC SNF Fellowship equips coders with practical skills required to work confidently in SNF environments and prepares them for high demand roles in the healthcare industry.

Visit www.pmbausa.com for SNF Coding

SNF coding is a critical and fast growing specialty in medical coding. It combines clinical knowledge regulatory compliance and complex reimbursement logic. With PDPM driving Medicare payments accurate SNF coding has never been more important.

For medical coders looking to future proof their careers SNF coding offers stability growth and strong demand. Specialized training such as the FIMC SNF Fellowship by PMBAUSA LLC provides the right pathway to enter and excel in this rewarding specialty.

Basics of Neurosurgery Coding – ICD-10-CM

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Neurosurgery diagnoses are mainly coded from:
o Chapter 6 (G00–G99): Diseases of the Nervous System
o Chapter 13 (M00–M99): Musculoskeletal system (spine-related conditions)
o Chapter 19 (S00–T88): Injuries & trauma (head injury, spinal trauma)
• Always identify whether the condition involves:
o Brain
o Spinal cord
o Peripheral nerves
• Laterality (right, left, bilateral) is critical, especially for:
o Brain lesions
o Spinal nerve involvement
• Differentiate acute vs chronic neurosurgical conditions
• Common neurosurgery-related diagnoses:
o Brain tumors (benign vs malignant, primary vs secondary)
o Intracranial hemorrhage
o Hydrocephalus
o Herniated intervertebral discs
o Spinal stenosis
o Traumatic brain injury (TBI)
• Use sequela codes for late effects of brain or spinal injuries
• Identify underlying cause vs manifestation (e.g., tumor causing hydrocephalus)
• In inpatient cases, capture CC/MCC conditions impacting MS-DRGs
• Assign Z codes when applicable (history of brain surgery, devices)
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Basics of Neurosurgery Coding – CPT
• Neurosurgery CPT codes are primarily found in CPT Surgery Section (61000–64999)
• Coding is procedure-driven, based heavily on the operative report
• Key neurosurgical procedure categories:
o Craniotomy / craniectomy
o Brain tumor excision or biopsy
o Burr hole procedures
o Ventricular shunts
o Spine surgeries (laminectomy, discectomy, fusion)
o Peripheral nerve decompression
• Understand approach, intent, and extent of surgery:
o Diagnostic vs therapeutic
o Partial vs total excision
• Global surgical package rules apply (pre-op, intra-op, post-op)
• Common modifiers in neurosurgery:
o -51 Multiple procedures
o -59 / -XS Distinct procedural service
o -62 Co-surgeon
o -80 / -82 Assistant surgeon
o -22 Increased procedural services
• Spine coding requires attention to:
o Number of vertebral levels
o Cervical vs thoracic vs lumbar
o Anterior vs posterior approach
• Many neurosurgery codes are bundled—review NCCI edits carefully
• Imaging guidance, microscopy, and navigation may be separately reportable if documented
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Inpatient Neurosurgery & DRG Considerations
• Neurosurgical procedures often group to high-weight MS-DRGs
• Accurate capture of:
o Principal diagnosis
o Procedure codes
o CC/MCC conditions
• POA indicators are mandatory for inpatient claims
• Clinical documentation integrity (CDI) is critical in neurosurgery cases
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Common Neurosurgery Coding Pitfalls
• Missing documentation of levels operated
• Incorrect laterality assignment
• Unbundling procedures incorrectly
• Not applying correct global period rules
• Ignoring NCCI bundling edits
•

Reimbursement in 2026

2026 Medical Billing Updates: What Medical Coders, Billers, and Providers Need to Prepare For Now

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Payers Tighten Reimbursement Policies: What You Need to Know for 2026 and Beyond

As the healthcare industry moves deeper into value-based care and cost-containment strategies, major insurers are updating reimbursement policies that significantly impact coding, billing, documentation, and care delivery. From remote monitoring restrictions to inpatient reimbursement changes, staying informed is essential for providers, coders, and revenue cycle teams.

Here’s a breakdown of key payer updates that will affect practices nationwide in the coming months.

BCBS North Carolina: Inpatient Status Changes for Elective Procedures

Starting February 2026, Blue Cross Blue Shield of North Carolina will no longer approve inpatient status in advance for elective procedures under its Medicare Advantage and D-SNP plans. Instead, the level of care will be determined retrospectively, based on the patient’s clinical condition post-procedure.

What It Means: Providers and coders must ensure accurate clinical documentation post-procedure to justify inpatient status. Pre-authorization protocols will shift dramatically.

Cigna’s Downcoding Policy: Targeting High-Level E/M Codes

Launched on October 1, Cigna’s downcoding policy allows automatic adjustment of higher-level E/M codes (99204-99205, 99214-99215, and 99244-99245) if documentation does not meet complexity standards.

  • Temporarily paused in California HMO plans pending regulatory review

  • Cigna states that 97% of providers won’t be affected

  • Affected providers can request a manual review of adjustments

What It Means: Coding accuracy is more critical than ever. Providers must document medical necessity and complexity clearly to prevent revenue loss.

UnitedHealthcare: Remote Monitoring Coverage Cuts

Effective 2026, UnitedHealthcare will restrict coverage for remote physiologic monitoring (RPM) for conditions like Type 2 diabetes and most hypertension cases.

  • RPM will remain covered for heart failure and hypertensive disorders of pregnancy

  • Applies to Medicare Advantage, commercial, exchange, and Medicaid members

What It Means: Providers using RPM technology must review new policy limits to avoid claim denials and reassess patient monitoring protocols.

BCBS Massachusetts: Overcoding Audit Expansion

As of November 3, BCBSMA has expanded its claims review process targeting providers who frequently bill Level 4 and 5 visits.

  • Focuses on a small subset: ~1–2% of PCPs and 3–4% of specialists

  • Providers can submit documentation to support coding and appeal reductions

What It Means: Expect more pre- and post-payment audits. Ensure E/M coding aligns with current documentation guidelines and risk-based stratification.

Elevance Health: 10% Penalty for Out-of-Network Providers

Starting in 2026, Elevance Health will impose a 10% penalty on claims involving out-of-network providers at in-network facilities under Anthem BCBS commercial plans in 11 states.

  • Emergency services and prior-approved cases are exempt

What It Means: Facility billing teams must verify provider network status to avoid penalties. This adds another layer of billing compliance and financial risk.

Aetna: New Claims Review and Inpatient Payment Policy

Aetna introduced a claims and code review program (effective Sept. 1), triggering medical record requests for certain claims:

  • High-dollar, implants, anesthesia, and bundled claims may be reviewed

Additionally, a new “Level of Severity” Inpatient Payment Policy launches in 2026, modifying how short inpatient stays (1–5 midnights) are reimbursed:

  • These will be paid at a lower rate, similar to observation services

  • Full inpatient reimbursement requires meeting supplemental admission criteria

What It Means: Expect reduced reimbursement for short stays and increased documentation demands. Revenue cycle teams must track and appeal when appropriate.

  • Medical necessity and documentation are under increasing scrutiny

  • Automation and AI are being used to flag high-level codes for downcoding

  • Short inpatient stays will face payment reduction without solid clinical justification

  • RPM and telehealth policies are tightening—know what’s covered

  • Audit readiness must be a standing priority in all billing departments

Final Thoughts

Reimbursement policies are becoming more nuanced and data-driven, and providers must evolve in real-time. Staying ahead requires a proactive approach—combining compliance training, strong documentation, and deep understanding of payer policies.

At Medesun Healthcare Solutions, we train medical coders and billing professionals to navigate these challenges with confidence. Our programs—including Certified AI Medical Coder (CAIMC) and Certified Professional Medical Biller (CPMB)—prepare you for today’s policies and tomorrow’s innovations.

Follow this newsletter for regular updates on reimbursement trends, coding audits, payer policies, and more.

Connect with me for insights, resources, and Medical Coding Training options for your RCM or coding team.

#medicalcoding #healthcareRCM #reimbursement #payerpolicy #CAIMC #Medesun #telehealth #inpatientcoding #downcoding #EandM #remoteMonitoring #healthcarebilling #LinkedInNewsletter

Dr. Santosh Kumar Guptha Trainer/Author

CCS-P, CCS , CPC, COC, CIC, CPC-P, CRC, CCC, CPCO, CANPC, CPB, CPMA, CEMC, CEDC, CIMC, CFPC, CUC, COBGC, CPCD, COSC, CPRC, CPEDC, CHONC, CENTC, CRHC, CGIC, CASCC, CGSC, CSFAC, CCVTC, RMC, RMA, CMBS, CMRS, CSCS, CSBB, FCR, FNR, FOR, CHA, CHL7, AHIMA Approved ICD-10 Trainer

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