CodeCast | Medical Billing and Coding Insights
Taking the Business of Medicine to the next level
Episodes
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 […]
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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 in […]
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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 […]
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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 […]
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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 […]
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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 […]
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In this episode, Terry breaks down the upcoming Prior Authorization pilot programs launching for Medicare Part B Professional Services on January 1, 2026, and for Ambulatory Surgical Centers starting December 15, 2025. She outlines which medical services will be impacted and what providers need to know as these changes roll out. Terry also shares the […]
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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?...
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?...
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 […]
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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 […]
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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 app...
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 Ter...
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 […]
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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% […]
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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, I...
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 […]
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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 […]
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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 […]
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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 […]
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