Wright Medical Billing, LLC

03/16/2026

🚨 New Medicare ABN Form Released - 3/13/2026

CMS has issued an updated Advance Beneficiary Notice of Noncoverage (ABN) for Medicare Fee-for-Service.

If your practice or billing company uses ABNs, now is the time to download the updated form and review the instructions to make sure you’re using the correct version. Using the wrong form or completing it incorrectly can put providers at risk of losing the ability to bill the patient when Medicare denies a service.

📌 Special Note from CMS (March 13, 2026):
The Office of Management and Budget (OMB) has approved the control number for the updated Advance Beneficiary Notice of Non-coverage (ABN) (CMS-R-131). CMS has notified the industry through its website and the Medicare Learning Network.

‼️The updated ABN is effective now and expires March 31, 2029.
Providers may continue using the expired version until May 12, 2026, but must transition to the approved form by that date. ‼️

🔎 ABN overview page (CMS):
https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn

📄 ABN instructions:
https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-form-instructions.pdf

⬇️ Download the updated ABN forms (English, Spanish, and large print):
https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-forms-english-and-spanish-incl-large-print.zip

ABNs may seem straightforward, but errors in how they’re issued or completed can lead to compliance problems and lost revenue. If you work in medical billing, coding, or compliance, it’s worth reviewing the updated form now so your team is ready before the transition deadline.

03/13/2026

Happy Friday the 13th!

Stay safe out there!

03/08/2026

Friday Fundamentals!

Medical coding for pneumonia involves assigning the correct ICD-10-CM codes based on the causative organism (etiology), the clinical manifestation, and any associated conditions.
Common ICD-10 Pneumonia Codes
The following codes are frequently used when the specific organism is either known or not yet identified:
J18.9 – Pneumonia, Unspecified Organism: The most common fallback code when the documentation lacks a specific cause or is waiting on lab results.
J15.9 – Bacterial Pneumonia, Unspecified: Used when the provider documents "bacterial" but does not identify the specific strain.
J12.9 – Viral Pneumonia, Unspecified: Applied for suspected viral pneumonia without a confirmed virus.
J12.82 – Pneumonia Due to COVID-19: Specifically for pneumonia confirmed to be caused by SARS-CoV-2.
J69.0 – Aspiration Pneumonia: For pneumonia caused by the inhalation of food, vomit, or liquids.
J18.1 – Lobar Pneumonia, Unspecified Organism: Used only when the provider explicitly documents "lobar pneumonia" without a causal organism.
Key Coding Guidelines
Etiology First: If the pneumonia is caused by an underlying condition like Q fever (A78) or Rheumatic fever (I00), code the primary disease first.
Document Specificity: Avoid vague language. Documentation should specify if the pneumonia is bacterial, viral, or fungal to ensure more accurate coding.
Associated Conditions: Code additional manifestations like a lung abscess (J85.1) or pleural effusion if present and documented.
Billing Levels: Inpatient management for simple pneumonia often qualifies for Level 2 (CPT 99232) medical decision-making due to the presence of an acute illness with systemic symptoms.
Inpatient Reimbursement (MS-DRGs)
Admissions for simple pneumonia typically fall under these Medicare Severity Diagnostic Related Groups:
DRG 193: Simple pneumonia with Major Complications or Comorbidities (MCC).
DRG 194: Simple pneumonia with Complications or Comorbidities (CC).
DRG 195: Simple pneumonia without CC/MCC.
Admissions for simple pneumonia typically fall under these Medicare Severity

02/20/2026

Here's what medical coders need to know. There are no code additions, deletions, or revisions to ICD-10-CM in the April update for fiscal year 2026. That CMS releases ICD-10-CM April 2026 update.

02/04/2026

Monday Morsels!

01/25/2026

01/26/2026 - our office will be closed.

01/24/2026

👉 Excludes1 means the two conditions cannot be coded together because they represent the same clinical concept or mutually exclusive conditions.

So when you are stuck asking which one do I code, the answer comes from the documentation and the reason for the encounter.

How to decide step by step:
1.Identify what is actually being treated or evaluated.

Look at the provider assessment, not just the symptom list. What condition is driving the visit, treatment, or plan.

2.Choose the most specific and accurate diagnosis.

If one code represents a confirmed condition and the other is a symptom or related condition, you code the confirmed condition.

3.Do not code both.

Excludes1 is not optional. Even if both are documented, only 1 code can be reported.

4.Ask yourself this test question.

If this condition did not exist, would the other code still make sense?

If the answer is no, they are Excludes1 and only the true underlying condition is coded.

Quick example logic without specific codes:
•A definitive diagnosis vs a symptom of that diagnosis
•A congenital condition vs an acquired version
•Acute vs chronic versions when guidelines prohibit both

Exam tip for CPC and real life coding:

If you see Excludes1, stop immediately. Do not look for a way around it. The correct answer is always to determine which diagnosis best reflects the provider intent and code only that one.

01/23/2026

Telehealth & Remote Monitoring – Revised
Learn what’s changed:

CMS added a resource link for the latest telehealth information
We added information on how to suppress a practitioner’s home address in PECOS
They removed Telehealth frequency limitations for subsequent inpatient and nursing facility, and critical care consultations
We’ll permanently allow teaching and supervising physicians to supervise through virtual presence
They will continue to pay Rural Health Clinics and Federally Qualified Health Centers for medical Telehealth services through December 31, 2026
Starting in CY 2026, they will only add services to the Medicare Telehealth services list on a permanent basis
We added 5 new CPT and HCPCS codes to the Medicare Telehealth services list
For CY 2026, we updated the:
Medicare Economic Index
Originating site fee

https://www.cms.gov/files/document/mln901705-telehealth-remote-monitoring.pdf

01/18/2026

01/01/2026

Have a Happy New Year, Coders!

2026!!!

Don't over celebrate like Santa & the Elves 🤣 Stay safe!

12/26/2025

A Very Chaotic Christmas: An ICD-10 Adventure

On the Twelfth day of Christmas.

Reindeer Riot

ICD-10 code F43.8: Emotional stress.

Santa is having some emotional distress when the reindeer get loose right before takeoff.