CodeCast | Medical Billing and Coding Insights

You receive a payer inquiry questioning level 4 services… so you open the note and see: “Patient here for follow-up. Doing well.” That’s it. Now you’re stuck defending a level of service that the documentation doesn’t support. In this episode of the CodeCast podcast, Terry breaks down a common challenge in healthcare organizations—how to educate providers on documentation without defaulting to scolding or generic feedback that doesn’t stick. Using real-world examples, Terry explains how to shift the conversation from criticism to clarity—helping providers understand how to document the patient story, support medical necessity, and protect reimbursement. If your current education approach isn’t changing behavior—or your providers keep defaulting to template-style notes—this episode will give you practical, effective talking points that actually make a difference. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Educating Physicians Without Scolding appeared first on Terry Fletcher Consulting, Inc..

If you spend your days auditing charts, you’ve seen it: diagnoses are listed, medications are “continued as prescribed,” and a plan is documented — yet something important is missing. In this episode of CodeCast, Terry explains how small documentation improvements can make medical decision making (MDM) clearer and more defensible. Learn how generic or repetitive macro phrases can unintentionally invite payer scrutiny, and what clinicians can do to better reflect the true complexity of the encounter. With payers increasingly using AI tools to review and downcode E/M services, clear documentation is more critical than ever. Every note should answer the essential question: Why is the patient here today? Tune in for practical tips to strengthen your documentation and reduce audit risk. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Moderate MDM — Is It Clear in the Medical Record? appeared first on Terry Fletcher Consulting, Inc..

A recurring question in Advanced Primary Care Management (APCM) is whether practices can bill every month for a patient once they’re enrolled — even if no services were provided during that month. Terry’s stance is clear: no. APCM isn’t a subscription model or a gym membership. These are medically necessary services tied to ongoing clinical need, and billing without documented work invites unnecessary audit risk. On today’s CodeCast, Terry breaks down why monthly billing without services is problematic, how other consultants interpret the rules, and what practices should consider to stay compliant. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post APCM Is Not a Gym Membership appeared first on Terry Fletcher Consulting, Inc..

Are your EMR templates helping—or hurting—your documentation? Terry dives into the difference between pre‑formatted templates and pre‑populated medical records, and why that distinction matters more than most providers realize. Pre‑populated fields can create inaccurate documentation, audit red flags, and even malpractice risk. Terry also reviews a NAMAS article that sheds light on how this issue is showing up in real audits and what practices should watch for. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Pre‑Populated EMRs Are Not Templates appeared first on Terry Fletcher Consulting, Inc..

Modifier 25 remains one of the most audited—and most overused—modifiers in medical coding. But the problem isn’t just coding mechanics. It’s about appropriateness, credibility, and documentation. Designed to represent a significant, separately identifiable E/M service performed on the same day as a procedure, Modifier 25 is too often applied automatically, like scotch tape slapped on to avoid an edit denial. When the documentation doesn’t support it—or when the service isn’t truly separate—misuse doesn’t just trigger denials. It invites deeper scrutiny and puts the entire visit under the microscope. Terry breaks down why Modifier 25 is so frequently misapplied and shares her smart, reliable method for determining when it’s actually necessary. Listen to today’s CodeCast to learn how to protect your claims, your documentation, and your credibility. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Are You Misusing Modifier 25? appeared first on Terry Fletcher Consulting, Inc..

Many EMRs now embed ICD‑10 and CPT codes directly into the medical record. But is that advisable? The safest approach is still to let the documentation stand on its own. The content of the record should support the coding choices, and coders and auditors should base their work on the medical facts as documented. Codes can—and should—be applied only after the documentation is complete. On today’s CodeCast episode, Terry explains that when providers insert billing codes into the note, the intention may be good, but the risk of contradictions or inaccuracies can outweigh any perceived benefit. Should medical record documentation stand alone, without templated teaching language that was never meant to be included? Should codes appear in the record simply to give the impression of accuracy, rather than allowing the documentation to speak for itself? Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Who’s Doing the Coding — Providers or Coders? appeared first on Terry Fletcher Consulting, Inc..

When performing audits, the same macro statements keep appearing in progress notes: ambient AI scribing was used to create the documentation, and the note may contain errors. The pattern mirrors what happened when early talk‑to‑text tools rolled out. From a patient’s perspective—especially someone with little or no understanding of ambient AI scribing—this raises real questions about whether they truly understood what was used during their visit and what they were consenting to. Terry breaks down this issue this week, drawing on an excellent article by Stephanie Allard, RHIT, to explore informed‑consent workflows, compliance expectations, and liability concerns surrounding Ambient AI Scribing. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post The Compliance Gap in Ambient AI Scribing and Informed Consent appeared first on Terry Fletcher Consulting, Inc..

The 2026 updates introduced new and revised PCI CPT codes, and even experienced coders are feeling the impact. With fresh code options and shifting applications, accurately capturing Coronary Intervention services—and protecting revenue—has become more challenging. In this episode, Terry breaks down what’s changed, how to navigate the nuances, and what you need to know about bundling rules to stay compliant and confident. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Cardiology PCI Coding Made Clear appeared first on Terry Fletcher Consulting, Inc..

OpenAI’s launch of ChatGPT Health is reigniting a familiar debate about patient‑facing AI — how much it can empower people to access medical information, and how much it might amplify misinformation, anxiety, or privacy risks. ChatGPT Health allows users to securely enter personal health information and use ChatGPT’s AI to better understand and manage their health concerns. Physicians note, however, that its impact on care will depend heavily on guardrails around accuracy, transparency, and how patients use the tool between visits. In this episode, Terry breaks down the pros and cons of AI in healthcare and highlights what providers should be cautious about as these tools become more common. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post The Pros and Cons of ChatGPT for Healthcare appeared first on Terry Fletcher Consulting, Inc..

Time-based coding can be a powerful, defensible approach for E/M services—when it’s documented the right way. But vague or incomplete time notes can open the door to denials, audits, and compliance problems. In this episode, Terry breaks down the exact language, documentation elements, and inclusions you need to make time-based E/M coding hold up. She also covers Care Management Services, their time requirements, and how to avoid overlapping time pitfalls. Tune in for a clear, practical walkthrough. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Time Based EM and Care Management Compliance appeared first on Terry Fletcher Consulting, Inc..

Telehealth isn’t going anywhere, but many practices still don’t have a solid audit plan in place. With Medicare’s proposed rules now finalized for 2026—and the added uncertainty of another potential government shutdown—it’s easy to see why compliance teams are feeling the pressure. In this episode, Terry breaks down five practical tips to help you strengthen or update your telehealth audit plan, especially if you’re providing office visits via telehealth through January 30, 2026. We also highlight insights from Sonal Patel and her excellent NAMAS article on this very topic. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Telehealth Compliance Tips for 2026 appeared first on Terry Fletcher Consulting, Inc..

Terry kicks off 2026 by clearing up a major misunderstanding in the provider and manufacturer community. Some believed that CMS’s last‑minute withdrawal of the LCD for skin substitute products would delay or stop the 2026 reimbursement changes. That’s not the case. The LCD withdrawal has no impact on the Final Rule, and the new 2026 reimbursement methodology for skin substitutes will move forward exactly as finalized, using an incident‑to payment structure. In this episode, Terry breaks down the difference between the policy halt and the reimbursement rules, and explains what providers need to know about the updated approach to skin substitutes and skin graft products and services. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Skin Substitutes and Grafts LCD vs Reimbursement 2026 appeared first on Terry Fletcher Consulting, Inc..

Terry closes out the year with a deep dive into Medicare’s newly permanent “Virtual Supervision” rule taking effect in 2026, along with a refresher on the current requirements for reporting services under a physician’s NPI versus an NPP’s NPI. She urges listeners to approach this shift carefully, outlining the risks tied to non‑compliance, malpractice exposure, and whether patient‑safety concerns outweigh any potential financial upside. Tune in to get the context you need before jumping into this virtual model. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Is Virtual Supervision a Good Idea for 2026? appeared first on Terry Fletcher Consulting, Inc..

2026 is coming in fast, and with it comes a fresh wave of CPT code changes that every healthcare professional needs to be ready for. On today’s episode of the CodeCast podcast, we break down the newest updates impacting Cardiology, Peripheral Vascular services, and several other key specialties. From what’s changing to why it matters, we’ll walk through the revisions, additions, and potential pitfalls so you can stay compliant and ahead of the curve as the new year approaches. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post 2026 CPT Code Changes Are Coming Fast appeared first on Terry Fletcher Consulting, Inc..

Auditing split/shared encounters can become confusing when providers, auditors, and coders are not aligned. CPT and CMS have both issued guidance to help clarify how these services should be billed. In this episode of the CodeCast podcast, Terry breaks down where to begin when auditing and educating on Split/Shared visits, what payers are currently saying, and how to maintain compliance for physicians and NPPs to prevent payer audits or confidently address them when they occur. She also gives a shout out to Sonda Kunzi, CPC, for her NAMAS article referenced during the discussion. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Audit Tips For Split/Shared Visits appeared first on Terry Fletcher Consulting, Inc..

When auditing risk of management in an E/M note, how are over-the-counter (OTC) medications scored? Under the 1995/1997 guidelines, they were categorized in the “low” risk row. However, the 2021 guidelines provide no examples under minimal or low risk, relying instead on AMA and Medicare guidance. Terry explains this distinction and highlights the difference between an acute uncomplicated illness and an acute illness with systemic symptoms. Take a listen. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post “Risk” E/M Element OTC Medications appeared first on Terry Fletcher Consulting, Inc..

Medical record signatures are more than the macro “electronically signed by Dr. Jack Jones.” A provider’s signature is a legal attestation that the physician or provider performed, reviewed, and/or agreed with the documentation. Is this actually true, or are your EMR auto-signatures taking over? Terry discusses this critical aspect of medical record documentation compliance, with a shout-out to NAMAS for an article that also addresses the topic. Plus, a bonus update on the G0136 add-on code for 2026. Subscribe and Listen You can subscribe to our podcasts via: https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlXhttps://tunein.com/radio/CodeCast–Medical-Billing-p1056702/https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlghttps://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQhttps://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insightshttps://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post MR Signature Compliance appeared first on Terry Fletcher Consulting, Inc..

Across the country, commercial payers are quietly down-coding E/M services without issuing ADRs and without providing notice. Office visit reimbursements are being arbitrarily reduced based on payer algorithms rather than a proper review of documentation for compliance. In today’s CodeCast episode, Terry sheds light on this growing problem and explains how to take proactive steps […] The post Watch for Payer Automatic Down-Coding Without Notice appeared first on Terry Fletcher Consulting, Inc..

When auditing a medical record, a common mistake is viewing it solely from a coding perspective rather than an auditing perspective. True auditing requires examining not just the encounter itself, but also what occurred before, after, and around it. Focusing only on coding can result in missed compliance elements and insufficient support for what was—or […] The post Auditing a record isn’t the same as coding it appeared first on Terry Fletcher Consulting, Inc..

The September 2025 issue of CPT® Assistant raised important questions about how to appropriately level an evaluation and management (E/M) encounter when the presenting problem is an acute, uncomplicated illness or injury. A growing number of providers have been assigning Level 4 codes simply because an antibiotic was prescribed. However, this approach may not be […] The post Leveling a Visit for an Acute Uncomplicated Illness appeared first on Terry Fletcher Consulting, Inc..