Managing Editor & Author

Dr. Santosh Kumar Guptha

Trainer/Author · Managing Editor, MedicalCodingUpdates.com

Full name: Dr. Meriyala Santosh Kumar Guptha

Credentials

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

Dr. Santosh Kumar Guptha (full name Dr. Meriyala Santosh Kumar Guptha) manages MedicalCodingUpdates.com and serves as its managing editor. He writes and reviews the site's updates on diagnosis and procedure coding, CMS policy, risk adjustment, compliance and the revenue cycle.

Experience

Dr. Guptha has worked in medical coding for more than 22 years. He earned his first credential, the CPC, in 2004, and today holds more than 40 professional credentials spanning outpatient and inpatient coding, specialty coding, auditing, risk adjustment, compliance and billing.

He spent nearly seven years in the United States working with physicians in Florida, New Jersey, New York, Texas and California, and has overseen the coding of approximately one million health records. As an AHIMA Approved ICD-10 Trainer, he has trained more than 30,000 professionals globally in ICD-10-CM, ICD-10-PCS, CPT, HCPCS and related disciplines.

Role at MedicalCodingUpdates.com

Sets editorial standards and approves articles before publication
Reviews updates against the primary source — CMS, CDC/NCHS, AMA, WHO, OIG, the Federal Register and payer policy documents
Oversees corrections and updates when guidance changes
Reviews any AI-assisted drafting before it is published, as required by the editorial policy

Areas of focus

His writing concentrates on what changed, why it matters to coders and billers, and how to apply it compliantly: annual ICD-10-CM/PCS updates, CPT and HCPCS changes, CMS payment rules, HCC risk adjustment documentation, coding audits, clinical documentation improvement, ICD-11 education, and the responsible use of AI in coding.

Contact

Coders, students, physicians and healthcare organizations who need medical coding training or coding services can use the message form on any page. Please do not include patient information in your message.

Articles by Dr. Santosh Kumar Guptha

AI & Coding Guide

AI in Medical Coding: Opportunities, Risks and Human Oversight

How computer-assisted, autonomous and LLM-based coding tools work, where they help, where they fail, and the governance and human validation every organization needs.

Published October 1, 2026Source: HealthIT.gov (ASTP/ONC)

CDI Guide

Clinical Documentation Improvement (CDI): A Practical Guide to Compliant Queries

What CDI programs do, how documentation affects severity, quality and payment, and how to write physician queries that are compliant and non-leading.

Published October 1, 2026Source: AHIMA

CPT Guide

CPT Updates: How Annual CPT Changes Work and What Coders Should Check

How the AMA updates CPT each year, how Category I, II, III and PLA codes differ, and a practical checklist for implementing CPT changes on January 1.

Published October 1, 2026Source: American Medical Association — CPT

ICD-10-CM Coder Alert

Coder Alert: FY 2027 ICD-10-CM Code Set Takes Effect October 1, 2026

The FY 2027 ICD-10-CM code set applies to discharges and encounters from October 1, 2026. Industry summaries of the release report 190 new, 30 deleted and 4 revised codes.

Published October 1, 2026Source: Centers for Medicare & Medicaid Services — ICD-10

CMS & Medicare What Changed?

FY 2027 IPPS/LTCH PPS Final Rule: What Changed?

CMS finalized the FY 2027 inpatient rule (CMS-1849-F), effective October 1, 2026. Here is what changed for hospital payment, MS-DRGs, and the new CJR-X model.

Published October 1, 2026Source: CMS — FY 2027 IPPS Final Rule Home Page

HCC / Risk Adjustment Guide

HCC Risk Adjustment Coding: A Complete Guide for Coders

How CMS-HCC risk adjustment works, what changed with V28, how RAF scores are built, and the documentation and compliance standards HCC coders must meet.

Published October 1, 2026Source: CMS — Risk Adjustment

ICD-11 Guide

ICD-11: What Medical Coders Should Know

What ICD-11 is, how its structure differs from ICD-10 — stem codes, extension codes, postcoordination, the Foundation and linearizations — and its status in the U.S.

Published October 1, 2026Source: World Health Organization — ICD-11

Medical Billing Guide

Medical Billing Denials: Common Causes and How to Prevent Them

Rejections versus denials, how to read CARC and RARC codes, the most common root causes of denials, and a prevention framework for billing teams.

Published October 1, 2026Source: X12 — Claim Adjustment Reason Codes and Remittance Advice Remark Codes

Career Updates Guide

Medical Coding Career Guide: Roles, Certifications and Skills

The main career paths in medical coding and billing, which certifications fit which roles, the skills employers look for, and how AI is changing the work.

Published October 1, 2026Source: U.S. Bureau of Labor Statistics — Occupational Outlook Handbook

CMS & Medicare Guide

Medical Coding Updates: The Complete Guide to When and How Codes Change

ICD-10-CM, PCS, CPT, HCPCS, NCCI and CMS payment rules all change on different cycles. This guide maps the coding year so you know what to watch and when.

Published October 1, 2026Source: Centers for Medicare & Medicaid Services

Medical Billing Guide

Medical Coding vs Medical Billing: What Is the Difference?

Coding translates documentation into standard codes; billing turns those codes into claims and payment. Here is how the two roles differ, overlap and depend on each other.

Published October 1, 2026Source: CMS — ICD-10 and HIPAA code set standards

Compliance Guide

Medical Necessity Explained: NCDs, LCDs, ABNs and Documentation

What 'reasonable and necessary' means under Medicare, how NCDs and LCDs define coverage, when an ABN is required, and how coding and documentation support medical necessity.

Published October 1, 2026Source: CMS — Medicare Coverage Database

Compliance Guide

NCCI Edits Explained: PTP Edits, MUEs and Modifiers

What the National Correct Coding Initiative does, how procedure-to-procedure edits and medically unlikely edits work, and when an NCCI-associated modifier is appropriate.

Published October 1, 2026Source: CMS — National Correct Coding Initiative (NCCI) Edits

Revenue Cycle Guide

Revenue Cycle Management Explained: Stages, Roles and KPIs

A plain-language map of the healthcare revenue cycle — front end, mid-cycle and back end — and how to calculate the KPIs leaders use, from days in A/R to DNFB.

Published October 1, 2026Source: CMS — Medicare billing and payment resources