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 Listen You can subscribe to our podcasts via: * Apple Podcasts –...

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 the day relates to PV procedures. Subscribe and Listen You can subscribe to our podcasts...

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 the day relates to PV procedures. Subscribe and Listen You can subscribe to our podcasts...

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 be able to be billed. Subscribe and Listen You can subscribe to our podcasts via: * Apple...

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 of usage, let’s look at the “when” to report it. Subscribe and Listen You can subscribe to our...

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 internal audits find any irregularities: and Terry Fletcher Consulting, Inc. is here to help if you need us! Subscribe and Listen You can...

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 of state laws, and providers forgetting to report when this relationship ends, the physician may still listed as their...

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 and Listen You can subscribe to our podcasts via: * Apple Podcasts –...

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 treatment options or mortality issues, or pediatric patients where the conversation may be too sensitive to have the child present. But what can...

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 a hospital setting is appropriate for inpatient, Part A payment. Terry discusses the 2-midnight rule, and how that impacts both Part A and...

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, securing data in an encrypted manner or HIPAA-compliant location, and having a system in place to destroy sensitive data that is no longer...

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 patient. A patient who is not at his or her treatment goal is not stable, even if the condition has not changed and there is no...

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 claim is denied. On this episode of the CodeCast Podcast, Terry Fletcher will dive into this topic to help you with successful unlisted...

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 subscribe to our podcasts via: * Apple Podcasts –...

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 CBTS? Tune in as Terry discusses this topic, and more, to find out if this revenue opportunity and patient value-added...

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 E/M claim with the G2211 will be denied. But what about the NCCI edits when you can’t avoid the 25 modifier, such as adding, immunizations or preventative...

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 that will help you stay compliant (primarily for Medicare) in 2024. Terry discusses changes that will impact all medical practices engaged in...

*** 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 law apply to AI-generated work? Where is the oversight to deter biases and hallucinations? In this episode, Terry illustrates the resistance to...

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 law apply to AI-generated work? Where is the oversight to deter biases and hallucinations? In this episode, Terry illustrates the resistance to using AI and asks tough...

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 to our podcasts via: * Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Podcasts –...

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 be a screening done on every patient and cannot be performed via a portal exchange. Tune in this week to learn more about this code, the reimbursement...

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 with small and large medical practices alike. Subscribe and Listen You can subscribe to our podcasts via: * Apple...

In the ICD-10-CM guidelines, there is an entry for only history codes at I.C.21.c.4, and there are two types of history Z codes: personal and family. History codes can be used on any medical encounter regardless of the reason for the visit. A history of an illness may alter what treatment is ordered for a patient, so it is important information to report. This directly supports the medical necessity of the encounter, which is the overarching criteria to report the outpatient or office visit...

Care Management services are being reported at an all-time high but they are not all alike. Before submitting claims, many providers have not read the directions — or CPT-published guidance and criteria. Terry breaks down the confusion and discusses why this is more of a value-based service than a monetary windfall. Listen to this informative episode for more details. Subscribe and Listen You can subscribe to our podcasts via: * Apple Podcasts –...