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By Kacie Geretz, Director of Growth Enablement
September 24, 2025
Key Takeaway: Medical coding guidelines from AMA and CMS change annually through CPT®, ICD-10-CM, and NCCI updates, while payer-specific policies shift constantly throughout the year, creating compliance challenges that disrupt revenue cycles and strain coding teams. This article reveals how Nym's standards-first approach maintains automatic alignment with national coding standards while offering optional payer overlays on request, enabling health systems to navigate update season without operational disruption or compliance gaps.
New coding guidelines create the same operational challenge for most health systems: retraining staff, updating systems, and managing productivity decreases while teams adjust to new requirements.
Here's why getting coding updates right directly impacts your financial performance:
The challenge extends beyond annual updates. Between CPT changes in January, ICD updates in October, and payers continuously adjusting their requirements, organizations face constant guideline management requirements.
Here's what health systems manage throughout the year:
AMA publishes CPT code updates every January with clarifications throughout the year. ICD-10 receives annual updates in October. Meanwhile, CMS continuously updates HCPCS codes, bundling rules, and coverage policies. Organizations must coordinate updates from multiple sources with different timelines and overlapping implications.
Most health systems handle guideline updates the hard way. New guidelines come out, and suddenly everyone's in meetings, creating training materials, and hoping the message reaches every coder on every shift.
Here's what this approach really costs:
Manual updates consume significant resources through coordination meetings, training sessions, and testing across multiple sites. Coding managers get pulled away from strategic work to manage the transition chaos. Because it's so resource-intensive, most organizations only tackle the big updates, letting smaller changes pile up into bigger compliance problems.
Computer-assisted coding systems face similar challenges. They still need manual updates, testing, and retraining. It's the same operational headache with slightly better technology.
Nym's approach addresses guideline updates differently. Instead of treating each change as a disruptive operational event, our team proactively updates our autonomous medical coding engine to maintain continuous alignment with new guidelines, while customer operations continue without interruption.
This approach removes the operational disruption typically associated with guideline updates. Organizations avoid the revenue impact of manual update cycles while maintaining clean claim rates. Our team manages the technical updates while customer teams focus on patient care and strategic priorities.
Your revenue stays steady because you avoid the typical dip in clean claims that happens when staff are learning new rules. Your compliance risk drops because you're automatically following current guidelines. And your team can focus on complex cases instead of scrambling to keep up with routine updates.
When new guidelines are published, our Compliance and Clinical teams review the changes and translate them into technical updates. The system has two main components that get updated: the Clinical Language Understanding piece that reads medical documentation, and the Medical Coding Rules that enforce the guidelines.
National guidelines are just the baseline. Every commercial insurer, Medicare Advantage plan, and Medicaid program adds its own requirements on top. However, since every health system is different when it comes to payer mix and organization-specific procedures, Nym handles payer-specific rules on a customer-by-customer basis upon request.
Nym's autonomous medical coding engine helps eliminate the operational chaos and revenue disruption that manual coding systems create during update season. Health systems achieve continuous compliance, steady cash flow, and reduced administrative burden without training sessions, productivity losses, or version control headaches.
Most organizations see productivity drops during update periods because staff need retraining. Denial rates temporarily increase as everyone adjusts to new rules. Cash flow gets disrupted, and smaller practices get hit hardest because they have fewer resources to manage transitions smoothly.
The top three culprits are missing information, authorization problems, and incomplete patient data. These issues get worse during guideline transitions when teams are adjusting to new requirements while managing their regular workload.
When new guidelines are published, our Compliance and Clinical teams review the changes and translate them into technical updates for Nym's autonomous medical coding engine. All changes are thoroughly validated before going live on the guideline change effective date. Customers can also preview the changes, and Nym's team monitors the engine's output post-go-live to catch any issues as quickly as possible, should they arise.
Yes, Nym's team can set up specialized rules for your key payers when their requirements go beyond national standards. Such rules are implemented on a per-customer basis and only upon request, so there's no confusion with baseline guidelines.
Kacie Geretz, RHIA, CPMA, CPC, CCA is the Director of Growth Enablement at Nym, where she aligns Nym’s product roadmap with the evolving needs of health system partners and serves as the externally-facing expert on Nym’s autonomous medical coding engine. A graduate of The Ohio State University’s Health Information Management program, Kacie brings deep expertise across the revenue cycle—having led revenue integrity programs, built managed care contracting and credentialing infrastructure, and driven denials and A/R process improvement initiatives. She is passionate about advancing healthcare automation and regularly shares insights on coding innovation and RCM transformation.
