CodeCast | Medical Billing and Coding Insights
Taking the Business of Medicine to the next level
Episodes
This week on the CodeCast Podcast Terry dives into the new rules for hernia repair codes. Terry discusses when the 0-global-days and 90-day-global-days services are billed on the same date. What applies? What about co-surgery? What about follow-up visits, or add-on codes for staple/suture removal? Tune in to find out details about these topics and […]
The post Coding Hernia Repairs in 2024 appeared first on Terry Fletcher Consultin...
Some procedures in the CPT book are listed as “separate procedures” meaning they are commonly carried out as an integral component of a total service or procedure that has already been identified. In this episode, Terry discusses if, and when, you can report these with a code for the total procedure if modifiers will help, […]
The post What does “separate procedure” mean in CPT? appeared first on Terry Fletcher Consulting, Inc..
TPE audits from Medicare, along with private and commercial payer audits are on the rise. It is more important than ever to monitor physician records and make sure that when they submit any level of E/M. (Especially level 4’s and level 5’s.) In this episode, Terry reinforces making sure the visit not only meets the […]
The post Is This Really Medically Necessary? appeared first on Terry Fletcher Consulting, Inc..
There will be more over-coding and overreaching with the additional codes Medicare provides to capture services. This episode explains the distinction for code G0136 and why it isn’t a “screening” service (as per CMS) but an assessment. Terry discusses the new SDoH assessment code and when it should and shouldn’t be billed. We previously discussed how […]
The post Revisiting SDoH G0136 Reporting appeared first on Terry Fletcher Con...
In this Top Ten Q&A episode, Terry tackles what the focus of any telehealth audit should be. Auditing Telehealth encounters is more that just looking at the coding. It should also include medical necessity, the technical and procedural aspects of the service, and on patient satisfaction and outcomes. She also recommends an external audit if […]
The post Top 10 Tuesday Q&A – Auditing Telehealth appeared first on Terry Fletcher Consu...
You must have a collaboration agreement in place when hiring mid-level providers or QHPs (such as nurse practitioners, physician assistants, or clinical nurse specialists) to act on your behalf with treating patients. Collaboration agreements are mandatory in most states but rules differ from state to state. Also, due to failed compliance policies, lack of understanding […]
The post Compliance Issues With MD/QHP Collaboration Agree...
Critical care in 2024 can be tricky, with inclusions, carve-outs, and a time component. Are there exceptions when PA/NPs are involved in critical care services? What has to be documented? You may find some rules you didn’t know about. Terry has all of the answers in this episode of the CodeCast podcast, sponsored by Decision […]
The post Critical Care Inclusions and Carve-Outs appeared first on Terry Fletcher Consulting, Inc..
What happens when a provider meets with a family to discuss and develop a care plan for patients? Providers will give the parent the option to have the patient present or just the parent/guardian due to the sensitivity of the discussion. Some scenarios where this may occur are cancer patients where the family wants to […]
The post Can you bill an E/M service when the patient isn’t present? appeared first on Terry Fletcher Consultin...
When a Medicare beneficiary arrives at a hospital in need of medical or surgical care, the physician or other qualified practitioner must decide whether to admit the beneficiary as an inpatient or treat him or her as an outpatient. These decisions have significant implications for hospital payment and beneficiary cost sharing. Not all care provided […]
The post 2-Midnight Rule and MA plans appeared first on Terry Fletcher Consulti...
In this week’s episode of the CodeCast podcast Terry discusses collecting information on medical practice websites. How you collect data on a website is equally as important as the data itself. If a patient doesn’t mention a medical condition, their information may still be considered as PHI. Terry covers requirements, such as PHE and ePHI […]
The post Did you know this is a HIPAA violation? appeared first on Terry Fletcher Consult...
Terry discusses how to be accurate in your documentation when picking the low, moderate or high element(s) of MDM. When listing “problems addressed” in your E/M record, and considering chronic conditions, the definition of a stable, chronic illness, per AMA/CPT states, “stable” to categorize MDM as defined by the specific treatment goals for an individual […]
The post E/M Services: Stable or Unstable Chronic Conditions? appeared fi...
CPT says: “If no specific CPT or HCPCS code exists, then the procedure must be reported using an appropriate unlisted CPT code.” Unlisted CPT codes, when reported with appropriate documentation, should be reimbursed. It is the responsibility of the surgeon, and the coding or billing staff, to report unlisted CPT codes and follow up with […]
The post Coding and Billing The “Unlisted Code” appeared first on Terry Fletcher Consulting,...
Join Terry Fletcher on this week’s CodeCast as her Top 10 Tuesday returns. Terry has a packed podcast as she answers questions about G2211, 99459, and new versus established patients. This is one episode you don’t want to miss for insights and resources to your most important coding, billing, and compliance questions. Subscribe and Listen You […]
The post Top 10 Tuesday Q&A – Coding, Billing and Compliance Questions appeared first ...
Did you know there are CPT codes for online digital E/M services? CPT codes 99421-99423 are for use by physicians, physician assistants, and advanced practice nurse practitioners performing brief online E/M services via a secure platform. (Like a patient portal.) What is required to bill for these services? Consent? Interactive Conversation? Modifiers? POS? And what is […]
The post Reporting eVisits 99421-99423 appeared first on Te...
We have received questions left and right regarding the new Medicare add-on code +G2211 – for complexity and serious condition provider/patient long-term relationship care. We discussed this code in September 2023, when it was a CMS proposal, but now that it is effective let’s look at the realities. The Modifier -25, when reported on an […]
The post Revisiting the G2211 in 2024 appeared first on Terry Fletcher Consulting, Inc..
This episode of the CodeCast is sponsored by DecisionHealth LLC, Part B News. The PHE, public health emergency, ended on May 11th, 2023. However, the confusion on reporting Telehealth services continues. It is imperative to be up-to-date on all of the current published guidance. In this episode, Terry shares her Telehealth services tips and checklist […]
The post 2024 Telehealth Checklist appeared first on Terry Fletcher Consulting...
*** CORRECTED AUDIO *** The generative artificial intelligence (also known as “AI”) boom is in full swing now. Terry has been researching AI in healthcare: some people are thrilled with it, while others are not. Is scraping the web for training data ethical? Who decides whether AI documentation and “expertise” is any good? How should copyright […]
The post Concerns About AI in Healthcare for 2024 appeared first on Terry Fletcher Co...
This week on the CodeCast Podcast, Terry explains the new 2024 CPT add-on code +99459 for pelvic exams when assistant clinical staff is needed to help the physician. Check out today’s episode to make sure you know what the documentation and coding rules are before diving into this situation. Subscribe and Listen You can subscribe […]
The post 2024 Pelvic Exam Add-On Code appeared first on Terry Fletcher Consulting, Inc..
A physician, non-physician practitioner (NPP), or clinical psychologist can assess a patient who they suspect may have unmet needs (defined as Social Determinants of Health or SDoH. In 2024 CMS is adding another G-code for SDoH assessment during an E/M encounter. This is for an assessment: not a screening. This service is not intended to […]
The post When to use the new SDoH add-on code appeared first on Terry Fletcher Consulting, ...
In this episode of the CodeCast Podcast, Terry Fletcher discusses the seven elements of an effective compliance program. Last month, HHS-OIG outlined and updated this guidance. With a broad spectrum of healthcare entities, staff, and providers playing a role in healthcare delivery today, this information can be generally applied across the entire healthcare industry or […]
The post 7 Elements of a Successful Compliance Program via ...
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