CodeCast | Medical Billing and Coding Insights

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...

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...

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...

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...

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 unnece...

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...

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 e...

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 today&#82...

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...

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 stay...

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 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 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...

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...

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 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...

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...

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...

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...

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...

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 for...

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 full...

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 ro...

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...

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...