Pinellas Park, Fla. – April 24, 2026 

Brundage Group announced that its Chief Medical Officer, Dr. Brett Hoggard, earned recognition from Becker’s Hospital Review as one of the “Great Leaders in Healthcare 2026.” Becker’s Hospital Review is a leading source for healthcare industry news and analysis.

Dr. Hoggard, Chief Medical Officer and Director of Quality at Brundage Group, guides the clinical team and oversees the development of clinical service lines. He shapes clinical strategy, sets rigorous standards, and advises executives and clinical leaders nationwide.

A diplomate of the American Board of Internal Medicine, Dr. Hoggard brings a unique combination of clinical expertise and operational insight. His leadership helps healthcare organizations implement strategies that balance high-quality patient care with compliance and financial performance.

Dr. Hoggard plays a key role in product innovation, working with product, technology, and operations teams to keep solutions clinically relevant, easy to use, and part of provider workflows. His involvement helps Brundage Group’s offerings support clinicians effectively.

In addition to his executive leadership, Dr. Hoggard is a recognized authority in physician documentation. He co-authored the Association of Clinical Documentation Integrity Specialists course, Clinical Documentation Essentials for the Hospital Provider, which equips clinicians across the country with practical tools to improve documentation accuracy, compliance, and the representation of patient complexity.

“Dr. Hoggard’s recognition by Becker’s Hospital Review shows the impact of his leadership at Brundage Group and in healthcare overall,” said Dr. Tim Brundage, Founder and CEO of Brundage Group. “His ability to combine clinical excellence with new ways of working brings real results for our clients and their patients.”

The full list of honorees can be viewed here.

About Brundage Group
Brundage Group is the trusted choice of hospital systems for revenue cycle management solutions. We support hospitals nationwide with customized solutions, including a full suite of physician advisory services, proprietary level of care analytics, and physician-led education to relay quality care. Our programs help hospital organizations break down departmental silos by unifying all departments in the mid-revenue cycle. Learn more at brundagegroup.com.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Dr. Hoggard Named 2026 Great Leader in Healthcare appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

By Robin Sewell, CDIP, CCS, CIC, CPC, CCDS

How did the phrase “Clinical Validation” get coined when it comes to queries? As Clinical Documentation Integrity (CDI) professionals, we use that term essentially to “invalidate”, not “validate”, a clinical condition when there are insufficient clinical indicators to support it. …But do providers know CDI speak? Do they understand why they are receiving the query? Have we “mis-named” the query type, creating a misnomer? 

How often have you submitted a clinical validation query to rule out a diagnosis only to have the provider “confirm” or “validate” the diagnosis? 

To test out my theory, I “crowd-sourced” several Physician Advisors using a query that was the subject of a denial. The denial was for acute postoperative respiratory insufficiency.  The payer stated that the patient had normal postoperative weaning status post CABG, and as such, acute postoperative respiratory insufficiency was invalid.  

When I read the query, it was obvious to me that the query writer did not think the documented postop respiratory insufficiency was clinically valid, and it appeared their intent was to have it removed, aka “invalidated.”  

The Query In Question

Documentation includes the diagnosis of respiratory insufficiency on the pulmonary consult date xx/xx/25. 

Clinical Indicators: 

xx/10/25 Op note: Operation performed-CABG x2: LIMA to LAD, saphenous vein graft to diagonal, endoscopic harvest of left long saphenous vein… 

Post-Op diagnosis: Multi-vessel CAD 

XX/10/25 Pulmonary Consult: “… Acute respiratory insufficiency, postoperative-on vent postop, tolerating weaning per protocol…” 

XX/11/25 Pulmonary Consult: “… successfully extubated XX/10/25…” 

XX/11/25 Hospitalist Consult: “…Acute respiratory insufficiency, postoperative. Symptoms have resolved. Patient is currently on 3 L nasal cannula. He will be weaned off…” 

Based on the above, please further specify the patient’s respiratory status:

The intention of the query seemed clear to me: The patient was extubated on the same day as the procedure and was tolerating normal weaning.  I agreed with the payer that this was invalid; however, it was not so obvious to the physician.  

The Query Hypothesis

To test my hypothesis that physicians often misunderstand “clinical validation” (and to campaign for reforming the query process), I submitted the query to several physicians to get their opinion. It was an informal poll with these options, while encouraging feedback on their thought process:

1. The query writer wants me to select respiratory insufficiency (regardless of whether it is postop/pulmonary, etc.). 
2. Since the diagnosis is already documented, the query writer does not understand/read the clinical indicators very well.
3. The query writer suspects the diagnosis of acute pulmonary insufficiency is not clinically valid.
4. The query writer wants you to rule out acute or postop pulmonary insufficiency.  
5. Other

Providers who were not involved in CDI functions and who did not participate in clinical validation denials and appeals confirmed the hypothesis. Here were some of the comments by the physicians involved in the experiment:

• “Why would they think it’s not clinically valid? At the minimum the sedation is not allowing the patient to breath on their own.” 
• “I tried to take my knowledge out of the picture, and yes, if you sent this to a physician with minimal insight into coding and CDI, they absolutely would not know what the question is about.”  
• “I think I was asked so often in clinical life about these sorts of issues that maybe I never gave it much thought and just answered the best I could, assuming there was a good reason to be asked.” 
• “I would pick option 2 since the note on xx/10 states that dx. Also, it states that the patient had adequate oxygenation, with no mention of respiratory distress or hypoxia. Instead, it leans towards a quick wean off oxygen.” 
• “…for this case I think it’s straightforward. I don’t think you’d need an MD to validate it.”

These comments were very insightful. They revealed that many physicians do not understand clinical validation, and, as we already know, many do not understand coding guidelines. 

Where To Go From Here

So, what can be done to rectify this knowledge/communication gap? As we patiently await more guidance from AHIMA and ACDIS from an updated Query Practice Brief, can we at least call a spade a spade? What is it we really need from the provider? I vote we label these queries very plainly as “Rule Out Diagnosis.” Then, within the query itself, we clearly explain why.  

Dear Doctor: 

The documentation includes the diagnosis of respiratory insufficiency on the pulmonary consult date xx/xx/25, which has limited clinical evidence supporting it as a valid diagnosis.

Clinical Indicators: 

xx/10/25 Op note: Operation performed-CABG x2: LIMA to LAD, saphenous vein graft to diagonal, endoscopic harvest of left long saphenous vein… 

Post-Op diagnosis: Multi-vessel CAD 

XX/10/25 Pulmonary Consult: “… Acute respiratory insufficiency, postoperative-on vent postop, tolerating weaning per protocol…” 

XX/11/25 Pulmonary Consult: “… successfully extubated XX/10/25…” 

XX/11/25 Hospitalist Consult: “…Acute respiratory insufficiency, postoperative. Symptoms have resolved. Patient is currently on 3 L nasal cannula. He will be weaned off…” 

Based on the above, was the respiratory status normal postoperative weaning from vent, and thus acute respiratory postoperative insufficiency was ruled out: 

_ Yes- Normal postoperative weaning from vent (ruled out) 

_ No- Abnormal postop weaning from vent: Acute respiratory insufficiency, postoperative is clinically valid.

The Takeaway

This isn’t about changing compliance standards. It’s about improving communication clarity.

Because if the provider doesn’t understand the question, we shouldn’t be surprised when we get the wrong answer. 

Maybe it’s time to rethink the term “clinical validation query.” 

Because right now? 

It might be doing the exact opposite of what we intend. 

The post Query IQ: Clinical Validation Queries appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Unifying CDI, Coding, and Physician Advisors

The landscape of hospital revenue integrity is rapidly evolving, and the once-separate worlds of Utilization Review (UR), Clinical Documentation Integrity (CDI), coding, and Physician Advisors are now converging into a unified strategy. Cheryl Ericson, RN, MS, CCDS, CDIP’s career journey exemplifies this transformation. With experience in public health, nursing, insurance, and hospital administration, Cheryl witnessed firsthand how siloed functions led to inefficiencies and missed opportunities. Coders, nurses, and physicians often operate independently, unaware of how their work impacts the broader clinical revenue cycle. Claims data (also referred to as administrative data) both directly and indirectly impact hospital revenue as a function of reimbursement and value-based care.

The Power of Collaboration

Today, effective revenue integrity depends on structured collaboration. Cheryl emphasized the importance of regular meetings, case reviews, and open dialogue among UR, CDI, coding, and Physician Advisors. This collaborative approach breaks down barriers, fosters mutual respect, and ensures that each group’s expertise is leveraged toward shared organizational goals. It all begins with physician documentation; without physician support, we can’t achieve optimization. Having physicians actively involved is invaluable; sometimes, when you’re coding or working through cases, their direct input can clarify ambiguities and ensure that the documentation reflects the true clinical picture. Physician Advisors, once seen as peripheral, are now central to bridging clinical and administrative priorities. Their involvement ensures that physician intent is accurately captured; coding reflects true patient acuity, and documentation supports both reimbursement and quality metrics. Cheryl noted, “Physician Advisors have gained a lot more confidence and a lot more knowledge. I think before they used to be very dependent on CDIs and coders, and so they didn’t necessarily express their own opinions as much.” This evolution highlights how Physician Advisors now play a more assertive and informed role, contributing their own perspectives alongside the expertise of other revenue cycle teams.

Adapting to a Changing Environment

Hospitals today face pressures like shrinking margins and staffing shortages. Cheryl emphasizes that achieving sustainable revenue integrity requires integrating UR, CDI, coding, and Physician Advisors into a cohesive reporting framework. At many hospitals, UR, CDI, and coding report to different departments, creating silos and communication barriers. Cheryl notes, “Often departments are so focused on their own silo and trying to meet those metrics instead of considering how their metrics relate to organizational goals.” By integrating these functions into a single clinical revenue cycle structure, organizations can improve coordination, oversight, and accountability. This alignment ensures that committees, such as those focused on sepsis, readmissions, or mortality, make decisions that consider clinical functions and downstream impacts associated with patient status and coding, while supporting organizational goals such as the case mix index, denial prevention, and quality. Cheryl recommends practical steps, including unified leadership, transparent technology, and a shared culture of learning, to help teams work toward common objectives and strengthen both financial and clinical outcomes.

Looking Ahead

As outpatient volumes rise and inpatient cases become more complex, the need for integrated expertise will only grow. The migration of procedures from the inpatient to the hospital outpatient setting will be hastened by the elimination of the inpatient only list, likely resulting in an eventual shift to independent ambulatory surgical centers leading to significant loss of revenue for most hospitals. For example, the National Patient and Procedure Volume Tracker by StrataSphere® for 12/31/24 shows that inpatient primary knee replacement is down 21.2% in 2024 compared to 2023. Inpatient primary hip replacement is down 3.8% when comparing 2024 rates to 2023. The healthcare industry is changing more rapidly than at any other time, as payers fight to maintain profits by challenging hospital billing practices. In contrast, hospitals contend with new regulations designed to reduce fraud and waste. Cheryl’s insights and ongoing thought leadership reinforce a clear message: revenue integrity is a team sport, and success depends on breaking down silos in favor of unified, strategic, measurable action. The future of hospital financial health lies in the seamless integration of UR, CDI, coding, and Physician Advisors, ensuring hospitals remain viable, compliant, and focused on delivering high-quality patient care.

The post Spotlight: Cheryl Ericson – From Silos to Synergy appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – April 8, 2026 

Brundage Group, a leading provider of physician-led, tech-enabled clinical compliance and revenue integrity solutions for U.S. hospitals and health systems, announced today that it has partnered with strategic health care investor, Water Street Healthcare Partners. The partnership comes as hospitals and health systems are facing mounting financial pressures, increasing medical necessity denials, and escalating regulatory and payer demands for patient care.

Through their partnership, Water Street and Brundage Group will enhance the company’s solutions, helping hospitals and health systems ensure patient care is thoroughly documented, clinically justified, and able to withstand payer and regulatory scrutiny. Brundage Group provides a full suite of clinical status integrity and denials management services, real-time analytics, and utilization management education delivered by top-tier physician advisors through a tech-enabled platform. Founded in 2007 by Timothy Brundage, M.D., Brundage Group has attracted a growing base of health systems and hospitals across the country.

“Our mission is to help hospitals and health systems remain viable to the communities they serve by ensuring clinical accuracy that supports fair reimbursement for patient care. Water Street shares our mission and brings deep industry expertise and resources to help us advance it. Together, we will invest in expanding our elite team of physicians and developing cutting-edge technology to empower more hospitals and health systems in delivering exceptional care to their patients and communities,” said Dr. Brundage, founder and CEO, Brundage Group.

About Water Street
Water Street Healthcare Partners is a strategic investor dedicated to building market-leading businesses in three critical health care sectors: medical products and diagnostics, pharmaceutical and life sciences, and health care services. The firm has completed more than 165 investments and acquisitions to build 48+ companies contributing to improved patient care, innovation, and a more efficient health care system. Working closely with leadership teams, Water Street contributes its industry experience and network of resources to support businesses’ growth objectives. Based in Chicago, Water Street’s team is a distinctive blend of health care executives, investment professionals, and functional specialists with decades of experience investing in and operating global health care businesses. For more information, visit waterstreet.com.

About Brundage Group
Brundage Group is a leading provider of physician-led, tech-enabled clinical and revenue integrity solutions for U.S. hospitals and health systems. Its team of top-tier Physician Advisors, proprietary analytics, and educational programs empower health care providers with ensuring inpatient care is thoroughly documented, clinically justified, and compliant with regulatory standards. Founded in 2007, Brundage Group is dedicated to enhancing clinical accuracy, regulatory compliance, and financial health for hospitals and health care systems nationwide, so they can focus on providing exceptional care to their patients and communities.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Brundage Group Partners with Water Street to Expand Clinical & Revenue Integrity Services for U.S. Hospitals & Health Systems appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

According to Becker’s Hospital Review, which referenced Kaufman Hall’s National Hospital Flash Report, hospitals ended 2025 with an adjusted operating margin of only 1.3%.

This number is well below the usual 3 to 4% margin hospitals need to:

• Maintain infrastructure and physical plants.
• Service debt obligations
• Fund baseline technology investments

With a 1.3% margin, hospitals lack financial stability that could lead to a reduction in services or closure.

Kaufman Hall characterizes the financial challenges facing hospitals in 2026 as a “new normal” defined by:

• Rising labor and supply costs
• Increasing bad debt associated with increasing uninsured and underinsured rates
• A deteriorating payer mix with increased payer friction
• A more complex and acute inpatient population
• Persistent margin compression

The Structural Deficit: Service Lines That Lose Money

The American Hospital Association’s (AHA) data show a deeper problem: core hospital services are losing money, regardless of payer.

These aren’t optional services. They are essential for community care. Hospitals can no longer offset these shortfalls with profits from other areas.

The Only Remaining Lever: Revenue Cycle Integrity

When core services lose money, and the payer mix worsens, hospitals have only one thing they can control.

Collect their earned revenue and fight hard to keep it. This shifts the revenue cycle from an administrative task viewed as a cost center to a margin-protection strategy. Payer friction is driving up the cost of healthcare. The AHA estimates that revenue cycle function account for as much as 40% of hospital costs. If current trends continue, the cost of collecting earned revenue could exceed the cost of delivering patient care.

Why Physician Advisors Are Now Mission-Critical

Hospitals are trying a variety of strategies, with the most common being the implementation of technology. However, the complexity of the inpatient revenue cycle is proving beyond the capabilities of many of these tools. Human intervention is still required. The bottom line is that hospitals need to expect more from their revenue cycle departments. In this environment, defensibility of clinical decision-making becomes the core asset.

Physician Advisors play a central role by:

• Educating admitting physicians about how to document to support medical necessity and accurate billing.
• Supporting status determinations (inpatient vs. observation) with clinical judgment.
• Conducting peer-to-peer reviews with payer medical directors to overturn adverse determinations.
• Leading appeals that convert denials into revenue recovery.

Successful status upgrades or appeals can yield thousands per case—critical when margins are 1.3%. This is a tangible, immediate benefit that accumulates over time.

Revenue Cycle as a Clinical Strategy

Hospitals that succeed in this environment share a common approach.

They treat the revenue cycle as:

• A clinical function, not purely administrative
• Real-time discipline and accountability, not retrospective cleanup
• A strategic capability, not a cost center

This includes:

• Embedding Physician Advisors into utilization management workflows
• Aligning utilization review, CDI, coding, and clinical documentation practices by breaking down silos
• Using data to identify denial patterns and problematic payer behaviors

The Bottom Line

The convergence of:

• Structurally negative service line margins
• Sub-2% operating performance
• Increasingly aggressive payer tactics

…creates a healthcare environment where: Revenue cycle performance is the margin.

Hospitals are fighting for financial stability, not just small improvements.

Hospitals that invest in physician advisors will protect their revenue. Those that don’t will see their margins shrink even faster.

Final Thought

The future of hospitals depends on decisive action. As financial pressures grow and essential service lines lose money, investing in efficient and effective physician-led revenue cycle strategies is not optional; it is vital. Hospitals that make revenue cycle integrity a top clinical and strategic priority will define the next era of healthcare. Defending every earned dollar is the difference between stability and decline. Organizations that act with urgency will lead; those that hesitate will fall behind, risking their mission and their communities. Now is the moment to lead. Protect your hospital’s future by investing in revenue cycle excellence.

The post Why Revenue Cycle Performance Is Now a Clinical Imperative appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – March 25, 2026 

Brundage Group, a physician-led leader in revenue cycle management (RCM) advisory and analytics, has again been recognized on Becker’s Hospital Review’s “385+ Revenue Cycle Management Companies to Know” list for 2026, marking the second consecutive year with this honor.

Becker’s publishes this list each year to highlight organizations nationwide that help healthcare providers manage financial challenges, improve operations, and strengthen revenue integrity. Companies are selected through a nomination process and recognized for making a real difference in the revenue cycle.

Furthermore, this recognition shows how Brundage Group stands out by combining physician expertise with advanced analytics to solve financial and operational challenges in healthcare.

“Being recognized by Becker’s for the second year in a row is a meaningful validation of the work our team does every day,” said Dr. Tim Brundage, Founder and CEO of Brundage Group. Hospitals are facing mounting pressure from reimbursement changes, regulatory complexity, and increasing denials. Our mission is to bring clinical credibility and actionable insights to help our partners protect revenue while maintaining the highest standards of patient care.”

Brundage Group’s solutions focus on the mid-revenue cycle, where clinical and financial performance come together. Moreover, the company offers Physician Advisor services, DRG validation, clinical documentation integrity, coding and audit support, and denial management strategies to help hospitals stay compliant, lower risk, and receive proper reimbursement for the care they provide.

Brundage Group takes a different approach from traditional RCM vendors by using a physician-led model that connects clinical teams with revenue cycle operations. As a result, this leads to more accurate documentation, better resource management, and stronger coding practices, which help reduce denials and improve outcomes.

Being included on Becker’s 2026 list confirms Brundage Group as a trusted partner for hospitals and health systems looking for lasting revenue cycle results in today’s complex healthcare environment.

About Brundage Group
Brundage Group is the trusted choice of hospital systems for revenue cycle management solutions. We support hospitals nationwide with customized solutions, including a full suite of physician advisory services, proprietary level of care analytics, and physician-led education to relay quality care. Our programs help hospital organizations break down departmental silos by unifying all departments in the mid-revenue cycle. Learn more at brundagegroup.com.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

The post Brundage Group Named Becker’s Top RCM Company 2026 appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Dr. Patel’s Career Journey and Path to Leadership

Dr. Patel’s passion for medicine began early, inspired by a blend of scientific curiosity and a desire to serve his community. After medical school at the American University of the Caribbean and clinical rotations in New York, he completed his residency in Chicago, where he first assumed a leadership role as chief resident. His career then took him to New England, where he practiced as a hospitalist before being tapped for a dual clinical and administrative role. The shift to physician advisory work was motivated by a need for stability as he started a family, but also by recognition of his strong interpersonal skills and attention to detail. As Dr. Patel shares, “It worked out perfectly cause my wife and I were expecting our first child later that year. So that was more stability, and that was one of the primary reasons that I took it.” Eventually, Dr. Patel joined Brundage Group, seeking broader exposure to healthcare systems and the flexibility of remote work.

The Role and Impact of Physician Advisors

Physician Advisors serve as the essential bridge between clinical teams and hospital administration. Dr. Patel describes their role as translating the realities of bedside care into actionable insights for the C-suite, ensuring that both patient care and financial sustainability are prioritized. As Dr. Patel puts it, “The importance of why we need to document this way, and the connection between the clinical side and the financial side is lacking.” Their work impacts everything from documentation practices to regulatory compliance and revenue cycle management. By speaking the language of both clinicians and administrators, Physician Advisors help align hospital operations with the realities of patient care, reducing denials and improving outcomes.

Collaboration Between Physician Advisors and Executive Leadership

A central theme in Dr. Patel’s journey is the importance of strong alignment between Physician Advisors and hospital executives, particularly the Chief Medical Officer. Dr. Patel emphasizes that “when leadership delivers unified messages, physicians benefit from clear and consistent direction, minimizing confusion and allowing them to prioritize patient care.” Productive partnerships are rooted in transparent communication, reliance on data-driven strategies, and mutual respect. Dr. Patel believes, “hospitals that empower Physician Advisors and involve them in strategic planning see measurable gains in critical metrics such as length of stay and denial rates, resulting in positive outcomes for both patients and the organization.” This collaborative approach nurtures a culture of shared responsibility and informed decision-making, ultimately elevating both patient care and overall hospital performance.

Future of the Physician Advisor Role

Looking ahead, Dr. Patel envisions the Physician Advisor role as an evolving career path within the medical profession. As he reflects, “I think that it will possibly become a new career path. You go through your medical schooling, you do your training, some bedside rounds or bedside years and then maybe even during your training there’s some portion incorporated, but I see it almost as a dual business administrative and medical degree. This perspective underscores a future where advisory experience is integrated earlier in training, blending clinical expertise with business acumen to prepare future leaders who can navigate both patient care and hospital operations effectively.

Dr. Patel’s journey illustrates the profound impact Physician Advisors can have, not just on individual patients, but on entire hospital systems. His advice to healthcare leaders is clear: prioritize alignment and collaboration between Physician Advisors and the C-suite to drive better outcomes for all. In Dr. Patel’s words, “the true value of this role lies in helping hundreds or thousands of patients by ensuring hospitals remain strong, sustainable, and patient-focused.”

The post Spotlight: Dr. Dhaval Patel—Bridging Clinical Excellence and Healthcare Leadership appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

By Robin Sewell, CDIP, CCS, CIC, CPC, CCDS

In our last Query IQ article, we borrowed a line from The Princess Bride, when the character finally tells Inigo Montoya, “Stop saying that!” after hearing the same phrase repeatedly.

Apparently, we are continuing the Princess Bride theme this month. 

There is another famous line in the movie when Inigo tells Vizzini regarding his constant use of the term “Inconceivable!” 

“You keep using that word. I do not think it means what you think it means.” 

That’s often how CDI specialists and coders feel when a provider documents “sharp debridement.”

In the world of CDI and coding, “sharp” debridement does not necessarily mean that an “excisional” debridement was performed. 

Excisional Debridement 

Inpatient coding guidance has long been clear that describing a debridement as “sharp” or documenting the use of scissors, curettes, or other sharp instruments does not automatically qualify the procedure as “excisional” debridement. The documentation must include an “excisional” tissue removal  to code the root accurately as “excision.”  In the absence of such documentation, the procedure, if coded, is at high risk of denial and DRG downgrade. 

Over the years, CDI specialists and coders have become very good at querying providers to clarify the distinction between excisional and non-excisional debridement.

Identifying the Body Part and Layers Debrided 

However, even when the “excisional” question is resolved, another documentation detail can still create problems: The deepest anatomic layer debrided.

To be fair, documenting the depth of debridement has always been considered best practice. Under ICD-9-CM, however, coders often arrived at the appropriate procedure code through the Alphabetic Index and its sub-terms, where the available codes did not always require the same level of anatomic specificity.

ICD-10-PCS changed that. The coding construct requires coders to select the specific body system and body part directly from the PCS tables, making documentation of the deepest anatomic layer involved critical for accurate code assignment. 

The Payer Denial 

And this is exactly where a recent denial we reviewed came into play. 

In this case, the provider documented that the wound was debrided “down to healthy tissue.”  Well, that doesn’t translate to ICD-10-PCS coding. Therefore, a query for anatomic depth was submitted and answered as “down to fascia”. The payer denied the PCS code, reasoning that since the documentation did not explicitly state that the fascia itself was debrided, the procedure should not be coded at that level, and the DRG should be downgraded. 

Not so fast… 

In ICD-10-PCS, subcutaneous tissue and fascia are grouped under the same body system in the table below. Because these structures share the same body system construct, documentation supporting debridement to either level leads the coder to the same PCS table and body system, meaning the code assignment would not change even if debridement included only subcutaneous tissue. 

The coding is further supported by PCS guideline A10, which states: “And” when used in a code description, means “and/or” except when used to describe a combination of multiple body parts for which values exist for each body part.

Additionally, the phrase “down to” generally implies that the preceding tissue layers were debrided to reach that level. For example, to expose or reach the fascia, subcutaneous tissue would also be debrided, rendering the payer’s rationale for the denied questionable from both clinical and coding perspectives.

While this particular denial may have been a stretch, it highlights an important opportunity for documentation.

Querying for Debridement Procedures in ICD-10-PCS 

When querying providers regarding debridement procedures, it is helpful and compliant to include answer options that clearly identify the deepest anatomic layer debrided, such as: 

• Skin 
• Subcutaneous tissue 
• Fascia
• Muscle
• Bone

Using phrasing such as “down to and including” the specified anatomic layer can eliminate ambiguity and better align the documentation with the ICD-10-PCS coding structure. And of course, don’t forget the other words that still matter: “Excisional.” 

This same principle applies to procedures such as incision and drainage, where the deepest anatomic layer, i.e., the most specific body part, may be distinguished from an anatomic region, thus supplying the most specific code from the PCS coding table. 

Yes, providers may dislike these queries—and frankly, we don’t love sending them either. But when the coding system requires this level of specificity, CDI specialists and coders are simply translating the clinical documentation into the language required by ICD-10-PCS. 

So, the next time a procedure note reads “sharp debridement” and/or “down to” a particular layer, remember the immortal wisdom of The Princess Bride:  “You keep using that word. I do not think it means what you think it means.”

The post Query IQ: “You Keep Saying that Word…” appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

For those in revenue cycle management, clinical documentation integrity, utilization management, and compliance, conferences go beyond education by enabling professionals to connect, share challenges such as denials and reimbursement issues, and learn from peers facing similar issues.

Learning from Real-World Healthcare Revenue Cycle Challenges

At healthcare conferences, professionals discover how organizations address complex operational challenges.

Educational sessions often cover topics such as:

• Denial management strategies
• Clinical documentation improvement (CDI) best practices
• Physician Advisor support
• Utilization management optimization
• DRG Integrity

Exploring the Future of Healthcare Revenue Cycle Management

Healthcare conferences offer insight into industry trends. As technology, data analytics, and AI advance rapidly, organizations need to continually update their strategies.

Conference discussions often highlight emerging trends such as:

• AI-powered revenue cycle analytics
• Automation in utilization management
• Data-driven denial prevention strategies
• Physician-led revenue cycle advisory models

Understanding these trends helps healthcare organizations make informed decisions about modernizing operations and improving financial sustainability.

Continue the Conversation

At Brundage Group, we value the opportunity to meet with healthcare leaders, share insights, and learn directly from the professionals navigating today’s most complex revenue cycle challenges. Interested in engaging with our experts? Visit our conference and events page to schedule a meeting with us at an upcoming event.

The post Why Healthcare Conferences Matter for Revenue Cycle Leaders appeared first on Physician-Led Advisory & Revenue Cycle Analytics.

Pinellas Park, Fla. – March 4, 2026 

Brundage Group, a physician-led leader in revenue cycle management (RCM) consulting and Physician Advisor services, has been recognized by Healthcare Business Outlook as one of the Top 10 RCM Solution Providers in 2025. Additionally, the recognition highlights the firm’s continued leadership in delivering strategic, data-driven solutions that help hospitals and health systems optimize financial performance and revenue integrity.

This acknowledgement shows Brundage Group’s strength in physician advisory services, clinical documentation integrity, coding and auditing, mid-revenue-cycle optimization, denial management, and analytics. By working closely with healthcare organizations and using forward-thinking strategies, the company helps improve compliance, secure earned revenue for care already provided, and better connect clinical and financial operations.

“In today’s environment, healthcare organizations face mounting pressure from regulatory complexity, reimbursement changes, and increasing financial scrutiny,” said Tim Brundage, MD, Founder and CEO of Brundage Group. “Being named one of the Top 10 RCM Solution Providers for 2025 is a meaningful acknowledgment of our team’s commitment to helping our clients achieve sustainable revenue integrity.”

Brundage Group is physician-led, has strong clinical expertise, and is tech-enabled. Furthermore, this approach helps connect providers, coding professionals, and revenue cycle leaders. For instance, by offering hands-on support and leveraging advanced analytics, Brundage Group delivers practical solutions that drive real results in the mid-revenue cycle.

The Healthcare Business Outlook Top 10 RCM Solution Providers list honors organizations that demonstrate innovation, deliver measurable results, and have a proven track record of helping healthcare providers manage financial and operational challenges in a changing industry.

About Brundage Group
Brundage Group is the trusted choice of hospital systems for revenue cycle management solutions. We support hospitals nationwide with customized solutions, including a full suite of physician advisory services, proprietary level of care analytics, and physician-led education to relay quality care. Our programs help hospital organizations break down departmental silos by unifying all departments in the mid-revenue cycle. Learn more at brundagegroup.com.

Media Contact:
Lacey Thompson
Senior Director of Marketing, Brundage Group
lthompson@brundagegroup.com

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