CodeCast | Medical Billing and Coding Insights

Medical necessity is defined as services that are reasonable and necessary for diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body member and are not excluded under another provision of the Medicare Program. Unfortunately, we have many practices trying to slide under the radar the experimental and/or […] The post Medicare Rules For Experimental or Investigational Services appeared first on Terry Fletcher Consulting, Inc..

Terry discusses Behavioral Health services, best practices documentation and coding specifics. Also, Terry offers some bonus discussion on RAC auditors trying to bait providers into not responding to ADR requests. Check out this episode for intel on these important topics and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – […] The post Behavioral Health Coding and Documentation appeared first on Terry Fletcher Consulting, Inc..

With all of the AI implementation into EHR and EMR systems, there is concern about how providers rely on these AI shortcuts more than ever. Without proper safeguards, accountability, and compliance perimeters, relying on AI could be problematic. Terry discusses the red flags to look for and how to proceed with caution in this new […] The post Did you know AI is integrated into EMRs? appeared first on Terry Fletcher Consulting, Inc..

The 2023 CPT® Errata and Technical Corrections added a one-liner on Independent Interpretations that responds to the question, “Can a practitioner get credit for both ordering and interpretation of a test, if documented?” In this episode of the CodeCast podcast, Terry answers this question referencing the March 2023 CPT® Errata and Technical Corrections. She also […] The post Can you get credit for ordering and interpretation of a test? appeared first on Terry Fletcher Consulting, Inc..

The 2021/2023 E/M guideline revisions read: “The evaluation and/or treatment should be consistent with the likely nature of the condition.” Before this, the CPT® guidelines did not discuss medical necessity. Guidance was left to the payers, particularly Medicare, via the Social Security Act. CMS's guidance doesn't necessarily hold regulatory authority. However, it often reflects a new, shared […] The post Medical Necessity Comes Before Coding appeared first on Terry Fletcher Consulting, Inc..

It's time for another round of frequently asked questions as Terry's expertise covers orthopedic surgery, imaging, data points for E/M, and administrative charges for practices. She also answers questions relating to multiple E/Ms on the same date by the same and different physicians from the same group practice. Tune in for a lot of good […] The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

We all know the age-old question, “Where does it say that?” In this episode, Terry brings receipts, explaining it's been this way since 2003: “Reviewing results of laboratory tests, phoning results to patients, filing such results, etc., are Medicare-covered services. Payment is included in the physician fee schedule payment for the evaluation and management (E/M) services to […] The post Giving Tests Results to Patients… Where's the Payment? appeared first on Terry Fletcher Consulting, Inc..

An ADR (Additional Documentation Request) is a request from CMS or another insurance payer for additional documentation to review a claim. Most of these requests come from payer investigative units looking for medical necessity support. Terry discusses how to handle these requests, as well as how to ensure they are addressed promptly to meet the […] The post ADR Workflow Tips appeared first on Terry Fletcher Consulting, Inc..

If the provider discusses their preferred management options with the patient, do they receive the “risk” credit even if the patient declines it? If yes, how long do they get to capture it? Terry breaks down, citing references, how to handle this MR element and ensure the providers are receiving the correct “risk” value for […] The post Who Gets the Credit for MDM Risk Element? appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast podcast, Terry discusses the differences between APCM and CCM services and what is needed to report either. Compliance issues are seen with many care management service records. Terry covers how to follow best practices to ensure you follow the published guidance. Subscribe and Listen You can subscribe to our […] The post APCM Focus appeared first on Terry Fletcher Consulting, Inc..

Medical Coding provides standardized language that ensures all healthcare providers involved in a patient's care are on the same page. The coder's role is to be accurate, communicative, insightful and focused on a positive patient outcome. A patient's financial health can impact their clinical health, and medical coders need to be recognized for their role […] The post The Crucial Role of the Coder in Quality Patient Care appeared first on Terry Fletcher Consulting, Inc..

This week's CodeCast summarizes the recent ICD-10-CM documentation guidelines instructions on sepsis, obesity, and COVID-19 reporting. Terry also provides more guidance on E/M risk in prescription drug management and caution with PSAs in patient documentation. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ YouTube […] The post ICD-10-CM April 1st Updates appeared first on Terry Fletcher Consulting, Inc..

More medical claims denials could be avoided if coders took the extra minute to make sure that the diagnoses that need to be linked to a specific line item were pre-billed. Also, when billing for diagnostic procedures on a complaint that moves to a minor, therapeutic, or surgical procedure, denials will happen when the diagnosis […] The post Avoiding Insurance Denials appeared first on Terry Fletcher Consulting, Inc..

Terry takes some inspiration from Stephanie Allard's February 27th for this edition of the CodeCast podcast. Terry discusses the differences and subjective issues between Acute Uncomplicated Illness (or Injury) versus Acute Complicated Illness in the E/M elements of coding and auditing. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 […] The post Acute Uncomplicated vs. Acute Complicated E/M Auditing appeared first on Terry Fletcher Consulting, Inc..

Terry's answering your coding questions in this week's “Top 10” Q&A. In this episode Terry's covering APCM, E/M, skin procedures, lab billing, and even a Telehealth bonus. Tune in for insights you won't want to miss! Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ […] The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

Terry is under the weather this week, so she gives us a quick segment on the E/M Data point, “independent interpretation”. See page 12 of CPT® under independent interpretation, the last sentence.  “A test that is ordered and independently interpreted may count as both a test ordered and interpreted.” Suppose you bill for the professional and […] The post Independent Interpretations of E/M Data Points appeared first on Terry Fletcher Consulting, Inc..

Some coders remain confused about Medically Unlikely Edits (MUEs) — but that's about to change. In this episode, Terry discusses denials from Part B MACs for what you may think is an undetermined reason. However, a possibility is running up against MUEs. The edits, which are designed to prevent over-payments caused by serious billing errors, […] The post How do MUEs Work in Coding? appeared first on Terry Fletcher Consulting, Inc..

The third element of MDM for E/M Services is “Risk of Complications and/or Morbidity or Mortality of Patient Management”. Many believe that only the risk in this element is how you level your E/M, but that is false. There are three elements to a E/M service when using MDM. There are several risks including the […] The post E/M MDM Third Element Complications appeared first on Terry Fletcher Consulting, Inc..

Everyone knows that you cannot routinely waive or fail to collect the obligation of patient cost-sharing. However, we know that there are instances where (1) the patient has a bad experience, (2) the patient will not pay or is not collectible, and (3) the patient has a hardship. Here are several policies your practices can […] The post Professional Courtesy appeared first on Terry Fletcher Consulting, Inc..

The Electronic Medical Record (EMR) has many benefits over handwritten entries in a paper chart. EMR entries are always legible, dated, and timed. Patient information can be available at the point of care and remotely. Some EMR systems include computerized physician order entry and decision-support tools to improve patient care and safety. However, recent audits […] The post EMR Clinical Documentation Integrity appeared first on Terry Fletcher Consulting, Inc..

There's a lot of confusion – and conjecture – on what to do about audio-only Telehealth while the new CMS and HHS administrations settle in under a new President in 2025. The final rule, the federal register, and the last CR made things more vague for this transition. In this episode Terry attempts to clear […] The post Audio-Only Telehealth in 2025 appeared first on Terry Fletcher Consulting, Inc..

When auditing Annual Wellness Visits (AWV), is the concept still the same as preventive exams concerning modifier 25? The AWV does not include managing medications or managing conditions. However, the rules need to see medical necessity for the E/M on the same date with a -25 modifier. Remember, patients do not have a share of […] The post AWV and Medical Necessity Extras appeared first on Terry Fletcher Consulting, Inc..

This New Year's Eve episode of the Top 10 Tuesday Q&A includes E/M Data questions, assistants at surgery, colon screenings, Telehealth extensions, and prescription drug management questions. It's an episode you don't want to miss. Happy New Year Everyone! Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX […] The post Top 10 Tuesday Q&A – Happy New Year Edition appeared first on Terry Fletcher Consulting, Inc..

In the final hour, Congress passed the American Relief Act. Telehealth was addressed and the geographical location was extended through March 2025. Terry give us the details from this HR bill in this short but sweet episode so you can enjoy your Christmas holiday. Subscribe and Listen You can subscribe to our podcasts via: Apple […] The post Did We Get a Congressional Telehealth Gift for Christmas? appeared first on Terry Fletcher Consulting, Inc..

E/M Coding still has confusion when capturing “data points” elements. When deciding to give credit for either an independent interpretation (CAT 2) or a review of test results (CAT 1) is an often misunderstood component of the Medical Decision Making (MDM) table. Proper documentation of independent interpretation is required to impact the MDM, and consequently, […] The post Data Point – Review of Test or Independent Interpretation? appeared first on Terry Fletcher Consulting, Inc..

The 2025 CPT® codes will impact billing and coding across various specialties. The annual CPT® updates include new, revised, and deleted codes and coding guidelines effective Jan 1st, 2025. CPT® 2025 includes 270 new codes, 112 revised codes, and 49 deleted codes. There are no code changes for anesthesia, respiratory, or auditory services. The most […] The post CPT 2025 Looksee appeared first on Terry Fletcher Consulting, Inc..

Becoming a certified medical coder can be very exciting but also disheartening if you thought a job in coding would magically appear once you got your certification. In this episode of the CodeCast podcast, Terry discusses studying and test-taking tips for your certification, common misconceptions of job opportunities, and what it takes to persevere for […] The post Coding Career Opportunities and Challenges appeared first on Terry Fletcher Consulting, Inc..

Terry makes it quick and to the point in this Thanksgiving Day episode of the CodeCast Podcast. Terry gives you a fun list of ICD-10-CM related to our beloved family and friends' holiday. Be safe and careful out there this holiday weekend: and enjoy! Subscribe and Listen You can subscribe to our podcasts via: Apple […] The post Thanksgiving ICD-10-CM: Be Safe and Thankful! appeared first on Terry Fletcher Consulting, Inc..

Terry is back with another Top Ten Tuesday discussion. In this episode, she discusses front desk to billing office workflow mistakes, looking at patient demographics, insurance information, HMO referrals, PA's, and data backups. Tune in to reset your RCM workflows. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify […] The post Top 10 Tuesday Q&A – RCM Workflow Mistakes appeared first on Terry Fletcher Consulting, Inc..

Today on the CodeCast podcast, Terry discusses best practices for the -25 Modifier, where to find her latest blog on the AAPC website, and what the MAHA (Make America Healthy Again) movement means to our country. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ […] The post The 25 Modifier and More appeared first on Terry Fletcher Consulting, Inc..

CMS published the 2025 Final Rule on November 1st. Terry breaks down the highlights and gives you the facts on the Telehealth “mess” that could have 85% of Medicare patients without access to virtual care. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ YouTube […] The post CMS final rule is out and Telehealth is an issue appeared first on Terry Fletcher Consulting, Inc..

Many practices have engaged in coding for TCM (Transitional Care Management) services but are finding that they are receiving more denials than payments. Terry breaks down why that is, and sheds light on what is needed to qualify billing for these services. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – […] The post Why are TCM services receiving more denials than payments? appeared first on Terry Fletcher Consulting, Inc..

Artificial intelligence (AI) has the potential to make substantial progress toward the goal of making healthcare more personalized, predictive, preventative, and interactive. However, AI-based systems raise concerns regarding data security and privacy. Because health records are important and vulnerable, hackers often target them during data breaches. The absence of standard guidelines for the moral use […] The post AI in Medical Coding: What's the Reality? appeared first on Terry Fletcher Consulting, Inc..

HIPAA has many privacy issues that most practices have in their HIPAA compliance manuals. However, current HIPAA violations are coming to light when employees purposefully search patient PHI for personal use or curiosity. This is not only a violation of privacy laws but could have a cascading effect if not stopped in its tracks. In […] The post HIPAA violations your organizations should avoid appeared first on Terry Fletcher Consulting, Inc..

In this edition of the CodeCast podcast, Terry discusses the “subtle changes” to look for in the ICD-10-CM updates effective October 1st. Also, Terry clears up understanding the UHC Gold Card Program, and what CMS looks at when they send you a denial. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts […] The post RCM Updates for 4th Quarter appeared first on Terry Fletcher Consulting, Inc..

According to the AMA, most physicians lack training in “webside manner.” Researchers from the University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System surveyed 1,213 patients from their respective institutions to measure preferences regarding the visual background seen during a video visit. Today's CodeCast podcast brings you the survey results, with […] The post Telemedicine “Webside Manner” appeared first on Terry Fletcher Consulting, Inc..

Many practices offer cash payment options to avoid insurance billing, hoping to reduce administrative burden or boost revenue. However, this practice of charging cash for services that could be billed to and covered by a patient's insurance plan raises serious compliance concerns. Federal law and insurance contracts generally prohibit this practice because it undermines the healthcare […] The post Charging patients cash for “insurance covered” services appeared first on Terry Fletcher Consulting, Inc..

Sometimes there are coding, compliance, and billing questions that we struggle to find answers to in any published guidance or specific regulatory rules. This week on the CodeCast podcast, Terry brings up three specific questions that we are always hunting for answers to and the best way to deal with them. Subscribe and Listen You […] The post Sometimes the rules are as “clear as mud” appeared first on Terry Fletcher Consulting, Inc..

In this episode Terry discusses the importance of ICD-10-CM codes on billing claims. She also clarifies the ICD-10-CM General Guidelines on Borderline Diagnoses, Laterality, Acute versus Chronic Conditions, and when to leave the symptoms off the claim for definitive diagnoses. Listen in for this important information capture. Subscribe and Listen You can subscribe to our […] The post Does ICD-10-CM Codes Claim Position Matter? appeared first on Terry Fletcher Consulting, Inc..

CMS released their FAQ sheet for the add-on code HCPCS G2211, to office visits. The sheet clarifies where denials and grey areas for reporting. Tune in as Terry goes over twelve FAQs from CMS along with her commentary to best practices for this complexity add-on. Subscribe and Listen You can subscribe to our podcasts via: […] The post G2211 CMS FAQ Sheet Released appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast podcast, Terry discusses ABI billing, Level 5 Drug Toxicity options, Aortic Stenosis ICD-10-CM coding, and some questions related to the 2025 CMS proposals. Listen this episode to see if any of your Coding Corner questions made the podcast cut! Subscribe and Listen You can subscribe to our podcasts via: […] The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

CMS proposes expanding the transfer of care modifiers, -54, -55, and -56 to better “value” the global surgery CPT codes. However, this may cause more confusion for surgeons and medical providers who see patients for surgery or post-op only. Terry talks about the proposal and what to expect for 2025. Also, Terry talks about the […] The post Transfer of Care Modifiers appeared first on Terry Fletcher Consulting, Inc..

This edition of the CodeCast podcast focuses on coding heart caths. When coding for cardiac catheterizations, if you don't have a working knowledge of this specialty it can be a bit challenging. That's why it's time to get back to the basics. Terry provides some tips into this coding concept, and what to look for […] The post Coding a Heart Cath appeared first on Terry Fletcher Consulting, Inc..

Terry takes us down memory lane in an E/M refresher. She covers what changed with the CPT E/M section – that was updated in 2019, 2020, and 2021 – to get to what we have today in 2024. Getting back to basics helps you understand why we must ensure updates in our charting workflows and […] The post E&M Comparison appeared first on Terry Fletcher Consulting, Inc..

This week on the CodeCast podcast Terry returns with her Top 10 Tuesday Q&A series. Join us as Terry covers questions covering risk support for E/M, Telehealth in the hospital setting, missed appointments, follow-up testing protocols, shared visit modifiers, and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify […] The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

CMS published their PFS on July 10th. You have 90 days to comment and be heard on these changes including the proposed 2.93% reduction to the Physician Fee schedule. In this edition of the CodeCast, Terry goes over the talking points and what Part B providers can expect coming into the new 2025 calendar year. […] The post CMS Newsroom Update: Physician Fee Schedule 2025 appeared first on Terry Fletcher Consulting, Inc..

Terry discusses when it is and isn't appropriate to report a preventative visit with an office visit on the same date. How did the patient present? What is the share of the cost-to-patient implications? And what will payers want to see for medical necessity? Terry covers it all in this edition of CodeCast podcast. Subscribe […] The post Office Visit with Preventative Med appeared first on Terry Fletcher Consulting, Inc..

In today's episode of the CodeCast podcast, Terry updates you on the latest CMS NCCI Edits, effective July 1st. She gives you the insight on the PTP and MUEs expected, along with some commentary and best practices on charging patients for no-show appointments. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts […] The post NCCI Updates 30.2 and No Show Appointments appeared first on Terry Fletcher Consulting, Inc..

Principal Care Management (PCM) services are services for a single high-risk disease, 30 minutes a month, personally provided by a physician or NPP. This is for patients with one complex chronic condition expected to last three months which places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death. Does your patient […] The post Principle Care Management (PCM) appeared first on Terry Fletcher Consulting, Inc..

Can you guess the main reason why medical billing claims are rejected? According to recent studies, most clinics account for 15-25% of inaccurately submitted monthly claims. Those inaccuracies must be corrected, resulting in an annual loss of revenue worth tens of thousands of dollars. Among the most popular reasons medical claims return to a clinic […] The post Top 10 Coding and Billing Mistakes – Let's Fix It! appeared first on Terry Fletcher Consulting, Inc..

You must make sure your providers and coders understand the overarching LCD criteria for reporting TPIs (Trigger Point Injections). As of April 1st, five MACs have tightened their rules for TPI coding and reporting. There are new frequencies, ICD-10-CM, anatomical territories, and MUE rules for these services. Terry outlines the rules and reminds practices that […] The post Trigger Point Injections and LCDs appeared first on Terry Fletcher Consulting, Inc..