CCO.us Podcast | Medical Coding, Billing, Auditing & Risk Adjustment

66 Episodes

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Mammography Coding Explained BI-RADS, Breast Density & R92.3 Codes

2026-10-2830:54

BI-RADS & Breast Density Coding: Are You Choosing the Right ICD-10-CM Code? A BI-RADS letter is NOT your diagnosis code! In this episode, Alicia Scott explains how to interpret breast density statements, navigate R92.3 codes, apply laterality, and avoid common mammography billing mistakes. You'll also learn about: FDA reporting vs. CMS billingBillable vs. nonbillable codesMedicare's 11-month screening ruleDense breast tissue and supplemental imaging coverage This episode is from the CCO Club Q&A #1741 webinar. Watch the full video here: https://youtu.be/R9Th7noOTMA

Basal Ganglia and Beyond: Finding Anatomy in ICD-10-CM & CPT Manuals

2026-10-1832:09

What happens when the physician documents a precise anatomical structure, but you can't find that term in your coding manual? In this episode, Alicia Scott uses the basal ganglia to demonstrate how anatomy is organized differently across ICD-10-CM, CPT, and Medicare coverage policies. You'll learn: Why searching anatomical terms alone can lead to confusing resultsHow I61, I63, S06.3, and G23 organize diagnoses differentlyHow to distinguish subcortical and cortical hemorrhageWhen to consider I61.0, I61.1, I61.2, and I63.81Why mechanism and vessel matter in cerebral infarction codingHow to navigate the CPT Index for brain proceduresWhy coverage policies and procedure codes serve different purposesHow documentation queries can help improve specificity Discover a practical research technique that applies well beyond neurology. This episode is from the CCO Community #1762 webinar. Watch the full video here: https://youtu.be/Fu6tmeQHw7I

When Does Medication Qualify as High Risk? High-Risk Drug Management

2026-10-1527:05

Does a dangerous medication automatically make an E/M encounter high risk? In this episode, Alicia Scott explains the two independent drug-related high-risk examples in the E/M risk column, the requirements for intensive toxicity monitoring, decisions involving parenteral controlled substances, and why IV administration alone doesn't establish high risk. You'll learn: ✔ Moderate vs. high-risk drug management ✔ Intensive monitoring for toxicity ✔ The four-gate monitoring framework ✔ Monitoring for harm vs. therapeutic effect ✔ Parenteral controlled substance decisions ✔ Insulin, diuretic, and antineoplastic examples ✔ Why high risk doesn't automatically mean high MDM This episode is from the CCO Community Q&A #1762 webinar. Watch the full video here: https://youtu.be/yvh9ZVQsO7A

Retrospective Coding Gone Wrong Documentation, HCCs & False Claims Act

2026-10-0837:21

A diagnosis can be accurate—and still fail to support a claim if the documentation underneath it doesn't meet applicable requirements. In this episode, Alicia Scott examines retrospective HCC coding through the lens of a major settlement involving allegations about medical-record amendments and risk adjustment data. The discussion focuses on documentation provenance, amendment requirements, provider involvement, add-only reviews, audit trails, HCC models, and workflow design. You'll learn: The Identify–Attribute–Preserve testEHR amendment and audit-trail considerationsWhy provider sign-off isn't the whole analysisRisks of add-only retrospective reviewsHCC model/date-of-service considerationsAudit extrapolation conceptsFive project-design questionsWhat to do when you identify a concern This episode is from the CCO Podcast #1751 webinar. Watch the full video here: https://youtu.be/OQPXZ6miyw0

Breaking Into Revenue Cycle: Essentials for Medical Coders & Billers

2026-10-0531:26

Trying to break into healthcare revenue cycle but don't know where to start? In this episode, Alicia Scott explains the five stages of revenue cycle, professional vs. institutional claims, common transaction numbers, rejected vs. denied claims, important KPIs, entry-level job opportunities, and credentials that can help you build your career. You'll learn: The five stages of revenue cycleWhere beginners can enter the fieldCMS-1500 vs. UB-04837P vs. 837ICommon transaction numbersRejections vs. denialsRevenue cycle KPIsEntry-level job titlesRevenue cycle credentials This episode is from the CCO Podcast #1751 webinar. Watch the full video here: https://youtu.be/2--io3qRajw

#box-pro-ellipsis-179328735360030{-webkit-line-clamp:2;}CCO.us Podcast | Medical Coding, Billing, Auditing & Risk Adjustment

CCO.us Podcast | Medical Coding, Billing, Auditing & Risk Adjustment