CodeCast | Medical Billing and Coding Insights

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..