Reimbursement Readiness

Episode 04 – Specific Diagnosis Coding Instructions

In Episode 4 of Reimbursement Readiness, Donna Cartwright dives deep into ICD-10-CM diagnosis coding for diabetic ulcers. She walks listeners through using the Alphabetic and Tabular Indexes, explains how to apply combination coding with ulcer severity, and highlights important coding notes such as “code first” and “use additional code.” You'll also learn the distinctions between Excludes 1 and Excludes 2 notes, and how causal relationships are presumed using terms like “with” and “and.” This episode equips wound care professionals to code diabetic ulcers accurately and compliantly—ensuring documentation supports medical necessity and meets audit expectations.

ICD-10-CM Guidelines (FY25 October 1, 2024)
https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf

NEWS FLASH: Major Medicare Proposed Rule Changes Affecting CTPs

7/23/2025 – CMS recently released proposed 2026 changes to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (HOPPS)—including a major shift in reimbursement for cellular and/or tissue-based products (CTPs).

In this Reimbursement Readiness News Flash, expert Kathleen Schaum breaks down what providers need to know now and how to prepare for potential reimbursement changes for CTPs used in wound care.
Let your voice be heard and submit a public comment on the proposed rule changes: 

Medicare Physician Fee Schedule (Submissions due 9/12/2025)
https://www.federalregister.gov/documents/2025/07/16/2025-13271/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other#open-comment
Hospital Outpatient Prospective Payment System (Submissions due 9/15/2025)
https://www.federalregister.gov/documents/2025/07/17/2025-13360/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical#:~:text=Thank%20you%20for%20taking%20the,%2D2025%2D0306%2D0002

Episode 03 – Report Diagnosis Correctly at Every Encounter

In Episode 3, coding expert Donna Cartwright joins Kathleen Schaum to begin an essential series on ICD-10-CM diagnosis coding. Listeners will gain a foundational understanding of how the ICD-10-CM system was developed, why it was adopted in the U.S., and how the codes are structured across the Alphabetical and Tabular Indexes. Donna explains how diagnosis codes provide specificity, support medical necessity, and impact reimbursement outcomes. Whether you're new to coding or need a refresher, this episode equips you to use ICD-10-CM codes more effectively in your wound/ulcer management practice.

2025 ICD-10-CM Coding Guidelines
https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf
2025 ICD-10-CM Code File
https://www.cms.gov/medicare/coding-billing/icd-10-codes

In this foundational episode of Reimbursement Readiness, Kathleen Schaum walks listeners through the structure and importance of Medicare’s Local Coverage Determinations (LCDs) and Local Coding and Billing Articles (LCAs). Learn how to identify and use these key documents to support your wound/ulcer management practice, avoid costly audit errors, and build a solid reimbursement strategy. Get ready to challenge common myths, refine your documentation, and prepare for future episodes with expert guidance.

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LCDs and LCAs

Reimbursement Readiness: Introductory Episode – Part 2

In Part 2 of the introductory episode, Kathleen Schaum introduces the foundation for all upcoming reimbursement discussions: Medicare’s Local Coverage Determinations (LCDs) and Local Coding and Billing Articles (LCAs). These essential documents serve as your roadmap to Medicare coverage. Learn how to identify the LCDs and LCAs relevant to your wound/ulcer management services and why reviewing them is a critical first step toward successful reimbursement.

Prepare now so you’re ready to follow along in the first full episode!

Welcome to the launch of Reimbursement Readiness: Business Tips for Wound Practice, presented by Kathleen Schaum and friends.

In Part 1 of this special introductory episode, Kathleen shares the vision behind this new educational series and introduces the expert-led approach to closing reimbursement knowledge gaps in wound/ulcer management. Learn what to expect from future episodes, how to participate, and why this podcast will become an essential tool for professionals across all wound care settings.

Subscribe now and start your journey toward reimbursement excellence.