CodeCast | Medical Billing and Coding Insights
Taking the Business of Medicine to the next level
Episodes
Few questions get a stronger reaction from Terry than, “How can I get around that rule?”
Wh...
Terry discusses the specialty of Podiatry procedural coding, to include some ankle surgeries, and other complex foot surgeries. She also strongly advises not to add CPT or ICD-10-CM codes to operative reports as this now handcuffing the provider to those codes whether they are over or under coded ...
Obstetric coders have likely started to report E/M visits for newly pregnant patients, but they still have a few months before they need to use the full set of new and revised codes and guidelines for maternity care services as we head into 2027.
Terry brings in some recent questions and answers to to help train your team and determine where more research or training is necessary before the full code system goes into effect Jan. 1,...
CMS has made permanent the policy that allows a practitioner who furnishes Medicare telehealth services from home, even what the height of COVID is over 3 years in the past. There is also confusion is what is listed as the physician’s practice location?
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How does documentation specificity affect diabetes code assignment?
The details included in a medical record can significantly affect ICD-10-CM code assignments. Terry discusses severa...
Terry gives us scenarios that are examples of work that doesn’t amount to an E/M service or can’t be counted toward an E/M service, followed by discussion of the reason why along with similar situations where it might be appropriate to report a stand-alone E/M service or count it towar...
The AMA specifically states that the risk element concerns patient-management decisions made by the physician/QHP reporting the E/M service. It also emphasizes that surgical risk depends on the particular patient...
Today on the CodeCast Podcast, Terry discusses a topic that comes up in auditing conversations frequently: “that an auditor needs to specialize in a certain specialty before they can audit E/M services for that specialty.” That is not necessarily true.
Incident-to Billing Update: More Blue Cross Blue Shield plans, along with the three largest commercial insurance carriers, are tightening their policies on the reporting and reimbursement of services billed under Medicare’s “incident-to” guidelines.
In today’s episode of the CodeCast Podcast, Terry reviews these recent policy changes, highlights key effective dates, and explains what physicians, coders, bill...
With more patients turning to large-language models such as ChatGPT, Gemini, Claude and others to answer their questions about symptoms, medical conditions and more, the American Medical Association (AMA) is offering some go-to advice that will help patients get more out of their experience with AI chatbots while staying safe.
The key to effectively using AI chatbots, is to understand they are not a replacement for a physician. Ter...
In today’s episode of the CodeCast podcast, we’re breaking down why E/M time belongs to the physician or qualified healthcare professional performing the service, why time from other team members cannot be combined to support the E/M level (in the office setting), and an important Medicare reminder: shared visits do not apply in the office or other outpatient setting.
Let’s dive into the rules so you can code with...
Terry tackles a growing compliance issue in telehealth: where the patient is located at the time of the visit. While physicians generally must be licensed or otherwise authorized to practice in the state where the patient is physically located, evolving payer policies and Medicare rules have added new layers of complexity.
From commercial insurance requirements to CMS guidance on services provided outside the United States, Terry e...
Artificial intelligence is advancing faster than the laws designed to regulate it. While individual states continue to enact legislation governing the development and use of AI, the federal government is simultaneously working toward a nationwide regulatory framework that could preempt many state laws.
In this episode of the CodeCast Podcast, Terry examines the evolving legal landscape surrounding AI, the current lack of mandated s...
Every CMS-1500 claim includes a set of certifications, attestations, and legal statements printed on the reverse side of the form. While these statements may seem like standard administrative language that has been around for decades, they carry significant legal and compliance implications.
In this episode, Terry breaks down what these certifications actually mean and why every claim submitted is a legal representation that the se...
Released on June 5, 2026, the ICD-10-CM update includes 190 new codes, 30 deleted codes, and four revised codes. While these changes take effect on October 1, 2026, they are considered part of the FY 2027 ICD-10-CM update because the code set follows the federal fiscal year publication cycle.
In today’s episode, Terry breaks down some of the most notable additions and revisions, explains what healthcare professionals need to ...
A growing concern among auditors, coders, and compliance professionals is the increasing reliance on template driven documentation. While electronic health records have improved efficiency, copied, carried-forward, and pre-populated information can create significant compliance risks when it does not accurately reflect the patient’s current encounter.
Auditors frequently identify contradictory statements, outdated histories, ...
At some point, we have to stop and ask ourselves: What are we truly building for our future? Where is our career in healthcare going?
I have all of these credentials in coding, billing, compliance, practice management, and prior authorization, but what does that really say about me? I want to be clear that I believe credentials matter. I know the work, time, money, and dedication it takes to earn them. However, we also need to be h...
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