CodeCast | Medical Billing and Coding Insights

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 duri...

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 an...

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 dep...

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 o...

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 offic...

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.

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.

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 ...

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 audi...

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 ...

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 addres...

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 to not only challenge it but also prepare for it.

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 will be—billed, potentially trigger...

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 accurate when considering ...

Medical billing and coding encompasses a wide range of responsibilities—from patient registration and claim reimbursement to final payment delivery to the provider. Navigating this process requires close collaboration among billers, coders, insurance companies, patients, and various healthcare professionals.

Although often grouped together as a single discipline, billing and coding are distinct roles that work...

As more practices begin offering screening services, questions around billing for Medicare-specific G codes are becoming more common. In this episode, Terry breaks down when it’s appropriate to bill for preventive services, which providers are eligible, and what requirements must be met.

To bill G codes, providers must be enrolled as Medicare suppliers and follow specific program rules. Eligibility varies by service type—some...

CMS has updated its stance on Medicare payments during the federal shutdown, confirming that only certain claims will be held—reversing earlier guidance that hinted at a wider pause. But what does this mean for Telehealth and other temporary policies that expired on October 1?

Terry breaks down the latest developments, what’s at risk, and what steps to take next on today’s CodeCast Podcast.

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In this episode, Terry tackles a common pitfall in coding and CDI workflows: skipping straight to the Assessment and Plan (A/P) section of an E/M note to determine service level. Are you overlooking key documentation that could support medical decision-making, risk, or time?

She also calls out a frequent habit among surgery coders—coding from the report header instead of the full operative detail. What assumptions are being made ba...

Terry explores the critical role coders and auditors play in holding providers accountable. From reviewing clinical documentation and medical record notes to verifying patient eligibility, addressing cases where minors receive treatment without a parent present, and identifying excessive repeat visits lacking medical necessity, this episode highlights the detailed oversight that ensures provider compliance and quality care.

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