Terry discusses when it is and isn’t appropriate to report a preventative visit with an office visit on the same date. How did the patient present? What is the share of the cost-to-patient implications? And what will payers want to see for medical necessity? Terry covers it all in this edition of CodeCast podcast. Subscribe and Listen You can subsc…

In today’s episode of the CodeCast podcast, Terry updates you on the latest CMS NCCI Edits, effective July 1st. She gives you the insight on the PTP and MUEs expected, along with some commentary and best practices on charging patients for no-show appointments. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podc…

Principal Care Management (PCM) services are services for a single high-risk disease, 30 minutes a month, personally provided by a physician or NPP. This is for patients with one complex chronic condition expected to last three months which places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decl…

Can you guess the main reason why medical billing claims are rejected? According to recent studies, most clinics account for 15-25% of inaccurately submitted monthly claims. Those inaccuracies must be corrected, resulting in an annual loss of revenue worth tens of thousands of dollars. Among the most popular reasons medical claims return to a clini…

You must make sure your providers and coders understand the overarching LCD criteria for reporting TPIs (Trigger Point Injections). As of April 1st, five MACs have tightened their rules for TPI coding and reporting. There are new frequencies, ICD-10-CM, anatomical territories, and MUE rules for these services. Terry outlines the rules and reminds p…

How do you know if your role is classified as a Coder or a Biller? Coders typically work in the back end of the facility, focused on interpreting medical records and assigning appropriate codes. Billers interact directly with patients, collecting payments and entering patient information into the appropriate systems. However, there is also a crosso…

All CPT codes have an expected range of complexity and uses, but when a particular procedure or surgery performed has exceeded the normal range of complexity, modifier -22 can come into play. Modifier -22 is defined as increased procedural services and demonstrates when a physician has gone above and beyond the typical framework of a particular pro…

This week on the CodeCast podcast Terry returns with her Top 10 Tuesday Q&A series. Join us as Terry covers questions from Urgent Care to the ER, infusion charges, behavioral health, billing for unlisted codes, preventative med group codes, and more. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple…

Are you a “Subject Matter Expert?” Are you taking on clients, presenting to physicians, or looking for a coding job: with no expertise? Do not “wing it” in the healthcare field. You will hurt yourself or your credibility unless you disclose your limitations to the person you are doing business with. (Not to mention potentially hurting the physician…

Many of the records Terry audits include a disclaimer to protect a physician from liability. However, does this disclaimer shield a physician who has signed a note or authenticated an electronic encounter? (Under the assumption the physician reviewed it?) In this episode of the CodeCast podcast, Terry discusses the protections of a disclaimer and w…

In this episode of the CodeCast podcast, Terry discusses the frequent urgent care center encounters that elevate to the patient going to the ER. Is this considered automatically high risk? So many providers want level 5, but what if it’s to get testing or services unavailable at the UC? Terry discusses the complexities and compliance issues with th…

This week’s CodeCast Podcast is all about coding and billing. Join Terry for a full deck of important information on Coding, Billing, and Compliance. Get answers to our top ten questions including eVisit POS, LE Thombectomy services, SDoH assessment codes, Data Point E/M clarifications, and more. Subscribe and Listen You can subscribe to our podcas…

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 …

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, and what details to pay a…

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 level of service billed, but also…

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 …

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 interna…

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,…

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 Health, LLC. Subscribe …

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 talk to the provider alone on …

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…

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 access, …

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 ind…

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 payors if a…

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 can s…