CodeCast | Medical Billing and Coding Insights
CodeCast is a podcast focused on the business side of medicine, specifically medical billing and coding. Host Terry Fletcher shares practical insights and tips for healthcare professionals to navigate the complexities of billing and coding processes. The show aims to help medical practices improve their revenue cycle and stay updated on industry changes. It serves as a resource for those looking to enhance their understanding of the financial and administrative aspects of healthcare.
Episodes
E/M Auditing Specialty Providers
Today on the CodeCast Podcast, Terry discusses a topic that comes up in auditing conversations frequently: “that an auditor needs to specialize in a certain specialty before they can audit E/M services for that specialty.” That is not necessarily true.
I understand where that thought comes from.
It can absolutely help for an auditor to be familiar with the anatomy, medications, terminology, and co
CMS Fee Schedule Proposals
What are we anticipating for 2027 in the MPFS? This week Terry gives us a rundown on what to expect, how to respond before the comment period ends, and what needs to happen to strengthen our private practice providers. Listen in…
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Incident to Update: Commercial Plans
Incident-to Billing Update: More Blue Cross Blue Shield plans, along with the three largest commercial insurance carriers, are tightening their policies on the reporting and reimbursement of services billed under Medicare’s “incident-to” guidelines.
In today’s episode of the CodeCast Podcast, Terry reviews these recent policy changes, highlights key effective dates, and exp
AI ChatBots Are Not Physicians
With more patients turning to large-language models such as ChatGPT, Gemini, Claude and others to answer their questions about symptoms, medical conditions and more, the American Medical Association (AMA) is offering some go-to advice that will help patients get more out of their experience with AI chatbots while staying safe.
The key to effectively using AI chatbots, is to understand they are not
Can ancillary staff be part of shared services under E/M?
In today’s episode of the CodeCast podcast, we’re breaking down why E/M time belongs to the physician or qualified healthcare professional performing the service, why time from other team members cannot be combined to support the E/M level (in the office setting), and an important Medicare reminder: shared visits do not apply in the office or other outpatient setting.
Let’s dive
Telehealth: Where the Patient is or Where the Provider is?
Terry tackles a growing compliance issue in telehealth: where the patient is located at the time of the visit. While physicians generally must be licensed or otherwise authorized to practice in the state where the patient is physically located, evolving payer policies and Medicare rules have added new layers of complexity.
From commercial insurance requirements to CMS guidance on services provided
How Safe Is AI in Healthcare?
Artificial intelligence is advancing faster than the laws designed to regulate it. While individual states continue to enact legislation governing the development and use of AI, the federal government is simultaneously working toward a nationwide regulatory framework that could preempt many state laws.
In this episode of the CodeCast Podcast, Terry examines the evolving legal landscape surrounding
CMS-1500 Form Compliance
Every CMS-1500 claim includes a set of certifications, attestations, and legal statements printed on the reverse side of the form. While these statements may seem like standard administrative language that has been around for decades, they carry significant legal and compliance implications.
In this episode, Terry breaks down what these certifications actually mean and why every claim submitted is
Preparing for the 2027 ICD-10-CM Updates
Released on June 5, 2026, the ICD-10-CM update includes 190 new codes, 30 deleted codes, and four revised codes. While these changes take effect on October 1, 2026, they are considered part of the FY 2027 ICD-10-CM update because the code set follows the federal fiscal year publication cycle.
In today’s episode, Terry breaks down some of the most notable additions and revisions, explains what heal
E/M Documentation Is Not a Checklist: Tell the Patient’s Story
A growing concern among auditors, coders, and compliance professionals is the increasing reliance on template driven documentation. While electronic health records have improved efficiency, copied, carried-forward, and pre-populated information can create significant compliance risks when it does not accurately reflect the patient’s current encounter.
Auditors frequently identify contradicto
Credentials Alone Are Not a Career Path in Healthcare
At some point, we have to stop and ask ourselves: What are we truly building for our future? Where is our career in healthcare going?
I have all of these credentials in coding, billing, compliance, practice management, and prior authorization, but what does that really say about me? I want to be clear that I believe credentials matter. I know the work, time, money, and dedication it takes to earn
Note Bloat Is an Auditor’s Nightmare
Auditors, coders, billers, and even physicians often find themselves searching through pages of documentation trying to answer one basic question: what was actually evaluated, managed, and medically necessary during a single patient visit?
With note bloat from copied and pasted EMR documentation and pulled-forward notes, it has become increasingly difficult to determine what actually happened “tod
Can Physicians and Clinicians Use Texting for Patient Care?
Text messaging for communicating orders is not prohibited by CMS or The Joint Commission, but there are important HIPAA privacy and security considerations that healthcare organizations must understand before using this method of communication. According to guidance from the AMA, providers must evaluate compliance requirements and safeguards when using text messages in patient care workflows. In t
Notice of Privacy Practices 2026
HHS recently released updated Notices of Privacy Practices (NPPs), introducing changes that go far beyond standard template revisions. The update includes new requirements for health care providers, health plans, and Part 2 patient notices related to sensitive protected health information.
While many in health care associate “NPP” with Non-Physician Practitioner, in this case it refers to patient
Telehealth Modifiers 95 and 93 Compliance
Watch the claims data behind telehealth modifier 95 and audio-only modifier 93 as denial trends for high-volume CPT codes and place of service combinations raise major compliance concerns. Terry breaks down the most common causes of denials, including incorrect POS reporting, documentation gaps, and billing practices that could trigger audit scrutiny. She also explains why relying on coding forums
Incident to Physician Participation Rules
While Centers for Medicare & Medicaid Services does not explicitly define a strict “12-month rule,” its guidance does require that the physician’s involvement reflect ongoing, active participation in the patient’s course of treatment.
That said, legal and compliance experts consistently caution that if a physician has not personally seen a patient within 12–24 months, b
CCM and CoCM Compliance Risks on Social Media
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
Modifier 59 Audits Denials and Post-Op Pain Injections
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 the CodeCast Podcast, Terry Fletche
Fracture Coding Accuracy
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 reporti
Undercoding Is Now a Compliance Risk Providers Can’t Ignore
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
Top 10 Tuesday Medical Coding Q and A
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
Educating Physicians Without Scolding
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 sco
Moderate MDM — Is It Clear in the Medical Record?
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.
In this episode of CodeCast, Terry explains how small documentation improvements can make medical decision making (MDM) clearer and more defensible. Learn how generic or repetitive macro phrases can unintentionally i
APCM Is Not a Gym Membership
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 unneces
Pre‑Populated EMRs Are Not Templates
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
Are You Misusing Modifier 25?
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
Who’s Doing the Coding — Providers or Coders?
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 todayR
The Compliance Gap in Ambient AI Scribing and Informed Consent
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
Cardiology PCI Coding Made Clear
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 sta
The Pros and Cons of ChatGPT for Healthcare
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, howeve
Time Based EM and Care Management Compliance
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 ti
Telehealth Compliance Tips for 2026
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, e
Skin Substitutes and Grafts LCD vs Reimbursement 2026
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.
That’s not the case. The LCD withdrawal has no impact on the Final Rule, and the new 2026 reimbursement methodology for skin substitutes will move forward
Is Virtual Supervision a Good Idea for 2026?
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.
She urges listeners to approach this shift carefully, outlining the risks tied to non‑compliance, malpractice exposure, and whether patient‑safety concerns
2026 CPT Code Changes Are Coming Fast
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 pitf
Audit Tips For Split/Shared Visits
Auditing split/shared encounters can become confusing when providers, auditors, and coders are not aligned. CPT and CMS have both issued guidance to help clarify how these services should be billed.
In this episode of the CodeCast podcast, Terry breaks down where to begin when auditing and educating on Split/Shared visits, what payers are currently saying, and how to maintain compliance for physic
“Risk” E/M Element OTC Medications
When auditing risk of management in an E/M note, how are over-the-counter (OTC) medications scored? Under the 1995/1997 guidelines, they were categorized in the “low” risk row. However, the 2021 guidelines provide no examples under minimal or low risk, relying instead on AMA and Medicare guidance. Terry explains this distinction and highlights the difference between an acute uncomplicated illness
MR Signature Compliance
Medical record signatures are more than the macro “electronically signed by Dr. Jack Jones.” A provider’s signature is a legal attestation that the physician or provider performed, reviewed, and/or agreed with the documentation. Is this actually true, or are your EMR auto-signatures taking over?
Terry discusses this critical aspect of medical record documentation compliance, with a shout-out to NA
Watch for Payer Automatic Down-Coding Without Notice
Across the country, commercial payers are quietly down-coding E/M services without issuing ADRs and without providing notice. Office visit reimbursements are being arbitrarily reduced based on payer algorithms rather than a proper review of documentation for compliance.
In today’s CodeCast episode, Terry sheds light on this growing problem and explains how to take proactive steps to not only chall
Auditing a record isn’t the same as coding it
When auditing a medical record, a common mistake is viewing it solely from a coding perspective rather than an auditing perspective. True auditing requires examining not just the encounter itself, but also what occurred before, after, and around it.
Focusing only on coding can result in missed compliance elements and insufficient support for what was—or will be—billed, potentially triggering a f
Leveling a Visit for an Acute Uncomplicated Illness
The September 2025 issue of CPT® Assistant raised important questions about how to appropriately level an evaluation and management (E/M) encounter when the presenting problem is an acute, uncomplicated illness or injury. A growing number of providers have been assigning Level 4 codes simply because an antibiotic was prescribed.
However, this approach may not be accurate when considering the ful
Claim Denials: Coding Mistake or Billing Oversight?
Medical billing and coding encompasses a wide range of responsibilities—from patient registration and claim reimbursement to final payment delivery to the provider. Navigating this process requires close collaboration among billers, coders, insurance companies, patients, and various healthcare professionals.
Although often grouped together as a single discipline, billing and coding are distinct r
Understanding Who Can Bill Preventive G Codes
As more practices begin offering screening services, questions around billing for Medicare-specific G codes are becoming more common. In this episode, Terry breaks down when it’s appropriate to bill for preventive services, which providers are eligible, and what requirements must be met.
To bill G codes, providers must be enrolled as Medicare suppliers and follow specific program rules. Elig
What the Shutdown Means for Medicare and Telehealth
CMS has updated its stance on Medicare payments during the federal shutdown, confirming that only certain claims will be held—reversing earlier guidance that hinted at a wider pause. But what does this mean for Telehealth and other temporary policies that expired on October 1?
Terry breaks down the latest developments, what’s at risk, and what steps to take next on today’s CodeCast Podcast.
Subscr
Tips on Reviewing MRs for Coding Accuracy
In this episode, Terry tackles a common pitfall in coding and CDI workflows: skipping straight to the Assessment and Plan (A/P) section of an E/M note to determine service level. Are you overlooking key documentation that could support medical decision-making, risk, or time?
She also calls out a frequent habit among surgery coders—coding from the report header instead of the full operative detail.
Coders and Auditors Hold Providers Accountable
Terry explores the critical role coders and auditors play in holding providers accountable. From reviewing clinical documentation and medical record notes to verifying patient eligibility, addressing cases where minors receive treatment without a parent present, and identifying excessive repeat visits lacking medical necessity, this episode highlights the detailed oversight that ensures provider c
Medicare’s Prior Auth Pilot: What It Means for You
In this episode, Terry breaks down the upcoming Prior Authorization pilot programs launching for Medicare Part B Professional Services on January 1, 2026, and for Ambulatory Surgical Centers starting December 15, 2025. She outlines which medical services will be impacted and what providers need to know as these changes roll out.
Terry also shares the latest updates on Telehealth and explains how t
Are you documenting prescription drug management risk? (Fixed Audio)
In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.=
Payers—including MACs, commercia
Are you documenting prescription drug management risk?
In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.=
Payers—including MACs, commercia
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