![CodeCast | Medical Billing and Coding Insights](/img/default-banner.jpg)
- 322
- 110 850
CodeCast | Medical Billing and Coding Insights
United States
Registrace 21. 05. 2018
Terry Fletcher Consulting, Inc. is a specialty-focused coding, billing, education, and auditing firm based in Southern California founded in 1997.
Our industry expert and CEO, Ms. Terry A. Fletcher BS, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMC, QMGC, QMCRC, QMPM, and has an extensive 30+ years background in coding, billing, reimbursement, auditing, and compliance. Ms. Fletcher’s expertise is derived from years of building and maintaining highly successful practices, auditing thousands of patient records, and her continual lead in educating healthcare professionals on new payer rules, guidelines, and Medicare coverage regulations.
Our industry expert and CEO, Ms. Terry A. Fletcher BS, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMC, QMGC, QMCRC, QMPM, and has an extensive 30+ years background in coding, billing, reimbursement, auditing, and compliance. Ms. Fletcher’s expertise is derived from years of building and maintaining highly successful practices, auditing thousands of patient records, and her continual lead in educating healthcare professionals on new payer rules, guidelines, and Medicare coverage regulations.
NCCI Updates 30.2 and No Show Appointments
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 - podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
Spotify - open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX
TuneIn - tunein.com/radio/CodeCast--Medical-Billing-p1056702/
CZcams - czcams.com/channels/oNm5vs6PFMIEDa5Undidlg.html
CZcams Music - czcams.com/play/PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQ.html
Pandora - www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874
Amazon Podcasts - music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
iHeart Radio - www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: www.terryfletcher.net/contact/
Subscribe and Listen
You can subscribe to our podcasts via:
Apple Podcasts - podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
Spotify - open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX
TuneIn - tunein.com/radio/CodeCast--Medical-Billing-p1056702/
CZcams - czcams.com/channels/oNm5vs6PFMIEDa5Undidlg.html
CZcams Music - czcams.com/play/PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQ.html
Pandora - www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874
Amazon Podcasts - music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
iHeart Radio - www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/
If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: www.terryfletcher.net/contact/
zhlédnutí: 121
Video
Principle Care Management (PCM)
zhlédnutí 98Před 21 hodinou
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 decline, or death. Does your patient qualify? Terry...
Top 10 Coding and Billing Mistakes - Let's Fix It!
zhlédnutí 288Před 14 dny
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 clinic are due to incorrectly entered or missing inf...
Trigger Point Injections and LCDs
zhlédnutí 243Před 21 dnem
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 practices that patients need to also be involved...
When To Use The -22 Modifier
zhlédnutí 184Před měsícem
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 procedure. When used appropriately, modifier 22 re...
Top 10 Tuesday Q&A - Coding, Billing, and Compliance Questions
zhlédnutí 269Před měsícem
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 - podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insight...
Are you a real SME?
zhlédnutí 209Před měsícem
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, client, or practice.) Terry discusses this pr...
Is a Medical Record "Errors Disclaimer" Valid?
zhlédnutí 180Před měsícem
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 whether this evades the responsibility, and comp...
Urgent Care to ER Coding
zhlédnutí 293Před 2 měsíci
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 this encounter. Join us. Subscribe and Listen You...
Top 10 Tuesday Q&A - Coding, Billing and Compliance Questions
zhlédnutí 342Před 2 měsíci
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 podcasts via: Apple Podcasts - podcasts.apple.com/us/...
Coding Hernia Repairs in 2024
zhlédnutí 275Před 2 měsíci
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 more in our latest episode. Subscribe and Liste...
What does "separate procedure" mean in CPT?
zhlédnutí 329Před 2 měsíci
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 attention to. As a bonus, the coding question of...
Is This Really Medically Necessary?
zhlédnutí 309Před 3 měsíci
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 that the visit is even medically necessary to ...
Revisiting SDoH G0136 Reporting
zhlédnutí 255Před 3 měsíci
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 to use this code, but now after a quarter o...
Top 10 Tuesday Q&A - Auditing Telehealth
zhlédnutí 292Před 3 měsíci
Top 10 Tuesday Q&A - Auditing Telehealth
Compliance Issues With MD/QHP Collaboration Agreements
zhlédnutí 184Před 3 měsíci
Compliance Issues With MD/QHP Collaboration Agreements
Critical Care Inclusions and Carve-Outs
zhlédnutí 283Před 3 měsíci
Critical Care Inclusions and Carve-Outs
Can you bill an E/M service when the patient isn't present?
zhlédnutí 529Před 4 měsíci
Can you bill an E/M service when the patient isn't present?
Did you know this is a HIPAA violation?
zhlédnutí 362Před 4 měsíci
Did you know this is a HIPAA violation?
E/M Services: Stable or Unstable Chronic Conditions?
zhlédnutí 632Před 4 měsíci
E/M Services: Stable or Unstable Chronic Conditions?
Coding and Billing The "Unlisted Code"
zhlédnutí 449Před 5 měsíci
Coding and Billing The "Unlisted Code"
Top 10 Tuesday Q&A - Coding, Billing and Compliance Questions
zhlédnutí 553Před 5 měsíci
Top 10 Tuesday Q&A - Coding, Billing and Compliance Questions
Concerns About AI in Healthcare for 2024
zhlédnutí 293Před 6 měsíci
Concerns About AI in Healthcare for 2024
I like this hi Terry.
I am a prior authorization specialist getting doctors to comply with the documentation necessary to establish medical necessity for a service being requested is the most difficult part of my job. It seems that some doctors allow their ego as a medical provider to supersede doing what is necessary to get paid. It is excellent compliance in documentation that affords some doctors to be awarded the gold card. Oftentimes it's the lack of amendments to previous doctor's notes that describe the current changes or new occurrences that result in denials on the first submission. This can lead to peer-to-peer reviews with the Medical Director taking time away from patient care. I have the hardest time getting Nurses and Doctors to understand this.
Your videos are realy helpful in terms of healthcare product. Thank you so much. I wish you can have video in regards with incidental by nature / Incidental by total episode of care denials by the insurance. Like DME 😊
There isn’t incidental by nature. Incident to has specific rules.
endocrinologist billed this , uses virtual care for max 15 minutes, sees them twice a year, commercial insurance doesn’t cover it. Absurd!!!
Great episode, Terry! On the parent-child scenario you mentioned, I agree on the risk-reduction rationale when the parent(s) is/are helpful, but there may be times when the presence of a parent can complicate the visit, esp during visits dealing w teen preg or gender reassignment considerations. Parents can become very emotional on these topics, which may add a layer of complexity to the visit.
Love Numbers!!!
This is great! What about idiopathic conditions?
Wow!!!I needed to hear this! Thank you for all your hard work!💕💕
So, what exactly does longitudal relationship and “managing” the patients needs means? Would calling their insurance company to make sure the lab the doctor sends a biopsy to is in-network….would that be considered management of the patients condition and paid for by this code?
This is an absurd code!!!! I pay a copay THEN pay just to have a relationship with my doctor!?!??! Ridiculous!!!!
There is a hack to do a Big Mac Casserole in the Instant Pot with tortillas. It is awesome! Just Google it!! I'm on Weight Watchers and have lost 100 pounds!
Thanks!
Thank you Terry! Good information today and Great job on losing 70lbs! I love the Big Mac hack, I'll try it!
Congrats on the weight loss, that's awesome.
This was my Troponin Levels readout approx. 8 hours after I had a STEMI, my Dr. was so amazed he asked if I minded if he showed his colleagues, I'm guessing this is high? (BECK) Troponin I, HS View trends Normal value: <21 ng/L Value 30,849 Instrumentation: Beckman Coulter
Thank you for this info 🙏🏼
*PromoSM* 😭
how do you access the cpt assistant ?
How to receive CEUs
There are no CEUs for podcasts
I do not understand how come non-physician can judge what physician done right or wrong? Have you ever heard about peer review?
I do not understand how come no-physician cane judge what physician is done right or wrong? Have you ever heard about peer review? That is the mane problem with medicine in this country.
What about billing for 99358, non-face-to-face prolonged care code?
Heyaa! I came across your video, and I have to say it’s really good! Just wanted to mention that this isn’t a completely random comment. 😊 If you don’t mind, I noticed you’ve posted quite a few videos on your channel. You might consider following a healthy structure to improve your reach. If you’re interested, feel free to drop your email I’d love to chat about it over a free call!
Can you please confirm if documentation in the chart note must state if the visit was done using audio-only or audio-video? I see providers simply document "telehealth" and argue that it is not required for them to specify if it was audio-video or audio-only. If there are CMS guidelines that clearly state this requirement, please guide me to the guidelines. Thank you!
Hi Terry I just happened to come across your youtube channel and it has been very informative. Thank you! I have aquestion regarding membership, is the $1800 broken down monthly, 2 payments, or a one time payment, etc?
Yes I was told I had a 160 troponin level but the EKG, Ultrasound and angiogram so I’m totally confused as to if I even have damage. Very strange. But I have struggled with awful anxiety and panic for over 10 years.
Yesssss! The HIPAA vs HIPPA thing makes me insane! I recently heard a well-known physician say "HIPPA" (spelled as such in their video description) stands for "health information privacy & protective act." ... I think my brain exploded. I was baffled.
Hello, this is a really from informative video and appreciate your work on it. Quick question maybe not exactly related to what you know but I thought it wouldn’t hurt to ask. I’m a home health occupational therapist working as a contractor as well as PRN. In my question is, how can home house occupational therapists use telehealth visits as an adjunct to our standard in person visits, and get reimbursed? There is a ton of research that shows when patients consistently monitor, their heart rate, oxygen, saturation, and blood pressure for example, hospital recidivism rates drop significantly. And for patients that have cognition issues. Having a consistent remindercan also affect improvements in working memory. Thanks so much!
How about incident to billing for an MD to MD
This statement gets me and I think confuses people "Review of all materials from any unique source counts as one element" It says ELEMENT! I think people assume it means that no matter what you review from 1 place it counts as 1 POINT. What do you think?
Thank you for the breakdown of this topic! I have a quick question: The E/M guidelines overview has the following guidance: 'These guidelines are for services that require a face-to-face encounter with the patient and/or family/ caregiver.' Furthermore, the Classification of E/M services section states this: 'The place of service and service type are defined by the location where the face-to-face encounter with the patient and/or family/caregiver occurs.' Why would we not accept these as rationale for billing a visit when the patient is not present? Thank you!
I read this too and wondered the same thing.
@@erika8627 Good to know that I am not the only one who interpreted the above guidelines the way I did!! Thank you for commenting!
Some services might fall into caregiver codes (e.g., 97550/97551).
I love these great chunks of information!❤
Thank you for info. Good show on HULU is The Great about Russian Queen Catherine the Great..funny life history.
Numbers was a great show!!
Great reminder, Terry 👍🏼
Suits is awesome. Also like Burden of Truth
Sooo i was just in for chest pain and shortness of breath ...panic attack i believe. Mine was 0.156.. ekg was fine.. echo showed good. They released me after 3 days in the hospital...when i left the last test was 0.161... im not overweight and pretty active but have had panic attacks for yrs. Should i be concerned
Great discussion on JZ/JW Modifiers. I have a very 'intriguing' question on it, does MUE play a certain role for billing J-codes with these Modifiers, say A certain J-codes has MUE of 10 per day, (50mg/ml in 10ml single use vial) but the patient requires 60mg - additional 2 units, how do we bill this? Do we report discarded 40 mgs? (50mg from first vial and 10mg from second).
I hear what you're saying, labeling is a bad practice just like psychology does😮
Don’t hold it against me. I’m from buffalo ❤
Hi , I have a doubt regarding modifier 24 and 57... Can we code them together on the same date of service.... If yes How can we code them together? If not , why can't we code them together?
Yes but it is not typical
I'm a coder and so confused by this new code. If a primary care provider sees a patient for a routine follow up on three chronic conditions...for example, hypertension, hyperlipidemia, and diabetes...all are stable, plan is to continue meds and follow up in three months, does that sound like it would qualify for the G code?
I’m curious to know that as well!
Me three! Please let me know. So many of our patients each have more than one controlled chronic illness/condition that are being treated by our Family Practice providers.@@LaurenMarie-st2fx 🤔
Yes we can code , because there is a longitudinal relationship between physician and patient
Not to me. Thats not enough in my opinion
Agree whole heartily; recently had 2 meetings at work where AI was mentioned as coming to our medical coding department. Upper management stated in their presentation to start looking for other jobs within the organization and we were told we were going to 10 chart audits/monthly starting in January when we only had 1 audit per year. Do you think we will be motivated to give our best to this organization? It only motivates me to look for a job elsewhere and hopefully not in healthcare. We see mistakes all the time with the current CAC codes. Documentation from providers; we have to decipher slang language from the computer scribe. I sincerely hope they slow down in healthcare. This will not save money and only bring headaches to the patient experience having to appeal wrong procedures charged due to AI. I can see health insurance plans denying claims left and right due to wrong dx codes.
Thanks Terry
Love your podcast!!
Thanks Terry. The rules on these codes are very clear, (thankfully) yet many of the value-based care physician groups I've worked with have required repeated education & guardrails to keep these in check.
"Technically" it may be a 4, but I didn't hear you read a story that painted a picture to support the medical necessity of a 4! Last time I looked, medical necessity is STILL the overarching criterion. 🤦♀️
Hi I have question on coding for assessments for psych patients.How many are they and what CPT codes to use? And which modifiers you need to send medical record of the visit? I read or heard modifiers 22, 52, 53 .Also modifier KX is for sex LGBT patients?
Listening from Cozumel. It's great to be able to get real-world insights from anywhere! Thanks for sharing, Terry!!