CodeCast | Medical Billing and Coding Insights

Terry breaks down a recent social media post that exposed a practice’s compliance issues with time based care management services, drawing exactly the kind of attention no organization wants. Although the original post was quickly deleted after backlash, the situation highlights a bigger issue.

In this episode, Terry emphasizes the importance of using sound judgment online and ensuring time based services are properly documented an...

Modifier 59 (Distinct Procedural Service) continues to face intense scrutiny in 2026 due to widespread misuse, triggering audits, denials, appeals, and payer recoupments tied to medical necessity concerns. With enforcement on the rise, it’s more important than ever for coders to understand when—and when not—to apply this modifier correctly.

On today’s episode of t...

Coding fracture care using CPT and ICD-10-CM can be challenging—especially when documentation from providers lacks key details. In this episode of the CodeCast Podcast, Terry breaks down exactly what coders should look for in physician notes, including essential documentation elements and common gaps. She also shares expert insights and practical tips to help ensure accurate coding, proper reporting, and compliance when working wit...

In medical coding and compliance, attention is often focused on overcoding due to its association with fraud, waste, and abuse. However, undercoding is an equally important—and frequently misunderstood—issue. While it may seem like a safer way to avoid scrutiny, undercoding is still a coding error, a compliance concern, and a reportable variance under both CMS and OIG guidelines.

Recent TPE audits are increasingly targeting underco...

In this episode of the CodeCast Podcast, Terry Fletcher answers key medical coding and billing questions in a detailed Q&A session designed for coders, billers, auditors, and healthcare providers.

This episode covers E/M coding with minor procedures and when services can be billed separately, RTM (Remote Therapeutic Monitoring) for CPAP patients, CO-96 Medicare denials including what they mean and how to properly appeal, along ...

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 does...

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.

...

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 CodeCas...

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 wh...

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. W...

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 explai...

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 ...