The 2024 Medicare Final Rule was published on November 2nd, and the Split/Shared visit guidance will parallel the CPT guidance. However, CMS will still expect the -FS modifier from the billing provider.

Terry breaks down the rules in this episode to ensure misinterpretations do not have providers reporting incorrectly.

Also, Terry takes a look at abdominal aortic coding.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Final Rule 2024 Shared/Split Visit appeared first on Terry Fletcher Consulting, Inc..

Join us for a great Halloween episode as Terry provides the top ten spookiest ICD-10-CM codes. She also discusses preventative and OV on the same date.

And what happens when a Telehealth video visit loses feed?

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Top 10 Tuesday Q&A – Halloween Episode appeared first on Terry Fletcher Consulting, Inc..

CMS recently updated their published guidance, MLN909160 July 2023, with further examples and instructions on how to gather information and documentation when a CERT Audit issues a request for an ADR (Additional Documentation Request).

You don’t want to ignore this, but embrace the process and understand that this oversight helps everyone.

Terry breaks it down. Also, some insights on Telehospital expansions assisting rural communities.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post CMS clarifies how to respond to a CERT audit appeared first on Terry Fletcher Consulting, Inc..

Clinical Documentation Integrity, or CID, is important. Outdated information, or information that doesn’t make sense for that date of service encounter, brings into question the reliability of the entire patient record.

Have you updated the language to fit with the current times?

Terry shares a few examples of issues that can raise red flags during an audit.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Is your CDI compromised by dated EMR entries? appeared first on Terry Fletcher Consulting, Inc..

The 2024 CPT codes have been released. Terry briefly looks at the additions, revisions, and deletions and what the E/M code descriptors are revising.

Terry will also offer her last clarification into MNT coding since there continues to be a push to report these codes when the diagnosis is not covered.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post A Look ahead to the 2024 CPT codes appeared first on Terry Fletcher Consulting, Inc..

The CPT definition of a significant, separately identifiable service relies on determining the correct level of E/M service to be reported.

Terry discusses what questions should be asked before you determine whether an E/M service justifies the use of modifier 25 according to CPT guidelines, CMS rules, and payer policy language.

Also, this episode’s coding question is a reminder of how to use the TCM rules.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Modifier 25 appeared first on Terry Fletcher Consulting, Inc..

Physicians are educated and trained more extensively than any other healthcare professional. A misrepresentation of a practitioner’s level of licensing, i.e., using the clinical term “doctor” when there is no MD or DO behind the term, is not only misleading but can jeopardize patient safety, expectations and outcomes.

Terry dives into this controversial topic, stating where the blurred lines are and the importance of staying in our respective lanes.

Also, this episode’s coding question focuses on the new patient visit 99205.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Are you blurring the lines on who’s a doctor or a nurse? appeared first on Terry Fletcher Consulting, Inc..

Prior authorization in health care is a requirement that a healthcare provider gets approval from an insurance plan before prescribing their patient medication or doing a medical procedure. Insurance providers use prior authorization to make sure that a specific medical service is needed and worth the cost, and that no duplicative services are being performed.

Payers use prior authorization as a way to keep healthcare costs in check. Terry discusses the Medicare, Medicare Advantage, and Commercial Plan terms with PAs and how to make it administratively manageable. Also, a coding question on Smoking Cessation.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Understanding Prior Authorization appeared first on Terry Fletcher Consulting, Inc..

The AMA MDM directions when leveling an E/M (Evaluation and Management) code (also known as office and/or hospital visits) are still confusing many providers, coders and auditors.

In this week’s CodeCast podcast, Terry attempts to bring some clarity into the Data Points discussion, regarding independent interpretations versus reviewed note.

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post EM Data Points Confusion Clarifications appeared first on Terry Fletcher Consulting, Inc..

In 2024, there will be a new add-on code for Medicare. This is a complexity code for specific long-term patients, where the provider is taking the treatment journey with the patient, in a longitudinal way.

Terry goes over what the Federal Register proposal is, and who cannot consider this code in 2024. There is a lot to unwrap here.

Terry also covers a bonus payer announcement that will impact many contracts. Tune in for these important details!

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post What is the G2211 complexity add-on for 2024? appeared first on Terry Fletcher Consulting, Inc..