CodeCast | Medical Billing and Coding Insights

Some coders remain confused about Medically Unlikely Edits (MUEs) — but that’s about to change.

In this episode, Terry discusses denials from Part B MACs for what you may think is an undetermined reason. However, a possibility is running up against MUEs.

The edits, which are designed to prevent over-payments caused by serious billing errors, often confuse even veteran coders.

Terry uncovers the truth about four aspects of these edits to ensure you’re not letting MUEs wreak havoc on your practice’s coding and reimbursement efforts.

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The post How do MUEs Work in Coding? appeared first on Terry Fletcher Consulting, Inc..

The third element of MDM for E/M Services is “Risk of Complications and/or Morbidity or Mortality of Patient Management”. Many believe that only the risk in this element is how you level your E/M, but that is false.

There are three elements to a E/M service when using MDM. There are several risks including the problems addressed and for the management and treatment for the patient.

Terry discusses the difference and how to make sure you don’t over or under-code in the process.

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Everyone knows that you cannot routinely waive or fail to collect the obligation of patient cost-sharing.

However, we know that there are instances where (1) the patient has a bad experience, (2) the patient will not pay or is not collectible, and (3) the patient has a hardship.

Here are several policies your practices can implement to ensure compliance and have good compliance. The NSA can also make things tricky, but Terry clears up what you can and cannot do with professional courtesy.

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The Electronic Medical Record (EMR) has many benefits over handwritten entries in a paper chart. EMR entries are always legible, dated, and timed. Patient information can be available at the point of care and remotely.

Some EMR systems include computerized physician order entry and decision-support tools to improve patient care and safety. However, recent audits reflect that CDI can be compromised when copy-paste or pull-forward information is not updated or reviewed.

Terry discusses the importance of the medical record’s integrity and ensuring your providers listen.

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The post EMR Clinical Documentation Integrity appeared first on Terry Fletcher Consulting, Inc..

There’s a lot of confusion – and conjecture – on what to do about audio-only Telehealth while the new CMS and HHS administrations settle in under a new President in 2025.

The final rule, the federal register, and the last CR made things more vague for this transition.

In this episode Terry attempts to clear up these issues, giving you her best practices to remain compliant until further notice.

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When auditing Annual Wellness Visits (AWV), is the concept still the same as preventive exams concerning modifier 25?

The AWV does not include managing medications or managing conditions. However, the rules need to see medical necessity for the E/M on the same date with a -25 modifier. Remember, patients do not have a share of cost of AWV’s so if you add an E/M it comes out of their pocket too.

Terry also adds more commentary for the audio-only Telehealth rules for 2025.

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The post AWV and Medical Necessity Extras appeared first on Terry Fletcher Consulting, Inc..

This New Year’s Eve episode of the Top 10 Tuesday Q&A includes E/M Data questions, assistants at surgery, colon screenings, Telehealth extensions, and prescription drug management questions. It’s an episode you don’t want to miss. Happy New Year Everyone! Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX […]

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In the final hour, Congress passed the American Relief Act. Telehealth was addressed and the geographical location was extended through March 2025. Terry give us the details from this HR bill in this short but sweet episode so you can enjoy your Christmas holiday. Subscribe and Listen You can subscribe to our podcasts via: Apple […]

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E/M Coding still has confusion when capturing “data points” elements. When deciding to give credit for either an independent interpretation (CAT 2) or a review of test results (CAT 1) is an often misunderstood component of the Medical Decision Making (MDM) table.

Proper documentation of independent interpretation is required to impact the MDM, and consequently, reimbursement.

Terry breaks down the compliance issues and best practices to make sure you are not over-coding. (Also, a shout out to Shannon DeConda and her excellent article on the topic on the NAMAS blog.)

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The post Data Point – Review of Test or Independent Interpretation? appeared first on Terry Fletcher Consulting, Inc..

The 2025 CPT® codes will impact billing and coding across various specialties. The annual CPT® updates include new, revised, and deleted codes and coding guidelines effective Jan 1st, 2025.

CPT® 2025 includes 270 new codes, 112 revised codes, and 49 deleted codes. There are no code changes for anesthesia, respiratory, or auditory services. The most significant changes are to telemedicine evaluation and management (E/M) services, skin substitutes, laboratory and pathology services, and Category III codes.

Terry overviews the changes by section in today’s CodeCast Podcast.

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