CodeCast | Medical Billing and Coding Insights

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 (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...

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...

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...