CodeCast | Medical Billing and Coding Insights

In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.= […] The post Are you documenting prescription drug management risk? (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..

A split or shared visit is an evaluation and management (E/M) service performed jointly by a physician and a non-physician practitioner (NPP) from the same group in a facility setting. Under applicable laws and regulations, either the physician or the NPP may bill for the service—provided they deliver it independently. Reimbursement goes to the practitioner […] The post Split/Shared Visits Update appeared first on Terry Fletcher Consulting, Inc..

In this week’s episode of the CodeCast Podcast, Terry Fletcher previews potential Telehealth updates and changes set to take effect on October 1. She also discusses how major surgery can be considered a risk factor in Evaluation and Management coding, and explains the importance of properly sequencing ICD-10-CM codes to ensure reimbursement success. Listeners are […] The post Telehealth October 2025 Preview appeared first on Terry Fletcher Consulting, Inc..

In this episode of CodeCast, Terry takes a closer look at the growing issue of undercoding in healthcare. Often misunderstood or overlooked, undercoding involves reporting fewer services than were actually provided, assigning a lower-level code than warranted, or inaccurately documenting patient encounters. While some may view it as a conservative approach to avoid audits or […] The post Undercoding Is Real—And It’s Costing You appeared first on Terry Fletcher Consulting, Inc..

In this episode of CodeCast, Terry dives into the complexities of billing bilateral procedures and the growing tension between Medicare guidelines and commercial payer policies. Modifier 50 is used to report procedures performed on both sides of the body during the same operative session. When billed correctly, the procedure should appear on a single claim […] The post Bilateral Billing Under Fire: Modifier 50 appeared first on Terry Fletcher Consulting, Inc..

Medicare has designated two HCPCS codes for women’s screening services: G0101 – Screening pelvic and clinical breast exam Q0091 – Collection of a screening Pap smear These codes are reimbursable every two years, but they’re not considered comprehensive preventive medicine services. In this episode, Terry breaks down how these screenings fit into the broader billing […] The post G0101 and Preventative Billing appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry dives into the latest findings from the Centers for Medicare & Medicaid Services (CMS) regarding Evaluation and Management (E/M) services. According to the 2023 CERT (Comprehensive Error Rate Testing) data: Insufficient documentation led to 34% of improper payments No documentation accounted for 7.5% Incorrect coding was responsible for a staggering 52.4% […] The post CMS E/M Improper Payment Report appeared first on Terry Fletcher Consulting, Inc..

The FY 2026 ICD-10-CM Official Guidelines are out. In this episode, Terry breaks down the key updates and what they mean for your coding workflow. Tune in as she covers: New considerations for diagnosis coding in heart disease, HIV, and diabetes How to apply the latest guidance across multiple specialties A closer look at inpatient […] The post ICD-10-CM Official Guidelines for FY 2026 appeared first on Terry Fletcher Consulting, Inc..

Join Terry on the latest CodeCast podcast as she tackles your most pressing medical coding and compliance questions in our “Top Ten Tuesday” segment! Terry clears up common misunderstandings and provides clarity on complex ICD-10-CM coding scenarios. Get expert tips to improve your diagnostic coding accuracy. She also discusses how navigating the nuances of telehealth […] The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

In this essential episode, we dive deep into the heightened scrutiny surrounding split/shared visits, particularly high-level 99223 initial hospital visits. Join Terry as she breaks down the latest payer audits impacting these services. We’ll explore critical compliance issues and offer actionable strategies to help your providers and practices proactively protect themselves from unwanted scrutiny and […] The post Navigating Split/Shared Visit Audit Risks appeared first on Terry Fletcher Consulting, Inc..

Determining whether HCPCS code G2211 can be billed when a patient sees a different physician or practitioner within the same group practice, even colleagues in the same specialty, presents an interesting coding challenge. The key consideration revolves around whether the new provider serves as the “continuing focal point for all needed services or provides ongoing […] The post Revisiting G2211 with a Change of Provider appeared first on Terry Fletcher Consulting, Inc..

In today’s episode of the CodeCast podcast, Terry untangles the complexities of Protected Health Information (PHI) and HIPAA as they relate to workers’ compensation cases. She’ll clarify the rights of both patients and employers when requests for PHI reach a healthcare provider’s office. This can be a tricky area, especially given potential state-specific regulations. This […] The post HIPAA and Workers Comp Patients appeared first on Terry Fletcher Consulting, Inc..

A question I’m often asked is, “Why do physicians charge so much?” There’s no easy answer, as there isn’t a fixed price list for medical services. Due to the healthcare system’s complexity and the absence of set prices, providers are largely free to charge what the market will bear. However, can there be consequences for […] The post Can physicians charge whatever they want to Insurance Payers? appeared first on Terry Fletcher Consulting, Inc..

Engaging with “bad actors” in medical billing can have serious consequences for both patients and healthcare providers. More and more providers are engaging without checking. Here’s what could happen. Terry discusses it all with examples. Legal repercussions: Providers can face hefty fines, civil or criminal charges, and even loss of their medical license for engaging […] The post Watch out for “bad actors” on billing advice appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry challenges all medical professionals. What is your role in managing the patient experience? A lack of patient prep can lead to an incomplete encounter for the physician including excessive visits. It can also lead to leakage in all departments, including the RCM staff’s ability to perform their job. Terry offers her […] The post Is the provider “prepared” to see the patient? appeared first on Terry Fletcher Consulting, Inc..

Since the implementation of the No Surprises Act (NSA) in January 2022, out-of-network (OON) reimbursement has become a complex and resource-heavy challenge for hospital and health system revenue cycle leaders. Although designed to shield patients from unexpected medical bills, the legislation has placed continuous financial pressure on physician practices and hospital systems. It has led […] The post No Surprises Act and OON Claims appeared first on Terry Fletcher Consulting, Inc..

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..