CodeCast | Medical Billing and Coding Insights

In this episode of the CodeCast podcast, Terry discusses the frequent urgent care center encounters that elevate to the patient going to the ER. Is this considered automatically high risk?

So many providers want level 5, but what if it’s to get testing or services unavailable at the UC?

Terry discusses the complexities and compliance issues with this encounter. Join us.

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The post Urgent Care to ER Coding appeared first on Terry Fletcher Consulting, Inc..

This week’s CodeCast Podcast is all about coding and billing. Join Terry for a full deck of important information on Coding, Billing, and Compliance.

Get answers to our top ten questions including eVisit POS, LE Thombectomy services, SDoH assessment codes, Data Point E/M clarifications, and more.

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The post Top 10 Tuesday Q&A – Coding, Billing, and Compliance Questions appeared first on Terry Fletcher Consulting, Inc..

This week on the CodeCast Podcast Terry dives into the new rules for hernia repair codes.

Terry discusses when the 0-global-days and 90-day-global-days services are billed on the same date. What applies? What about co-surgery? What about follow-up visits, or add-on codes for staple/suture removal?

Tune in to find out details about these topics and more in our latest episode.

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The post Coding Hernia Repairs in 2024 appeared first on Terry Fletcher Consulting, Inc..

Some procedures in the CPT book are listed as “separate procedures” meaning they are commonly carried out as an integral component of a total service or procedure that has already been identified.

In this episode, Terry discusses if, and when, you can report these with a code for the total procedure if modifiers will help, and what details to pay attention to.

As a bonus, the coding question of the day relates to PV procedures.

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The post What does “separate procedure” mean in CPT? appeared first on Terry Fletcher Consulting, Inc..

TPE audits from Medicare, along with private and commercial payer audits are on the rise. It is more important than ever to monitor physician records and make sure that when they submit any level of E/M. (Especially level 4’s and level 5’s.)

In this episode, Terry reinforces making sure the visit not only meets the level of service billed, but also that the visit is even medically necessary to be able to be billed.

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The post Is This Really Medically Necessary? appeared first on Terry Fletcher Consulting, Inc..

There will be more over-coding and overreaching with the additional codes Medicare provides to capture services. This episode explains the distinction for code G0136 and why it isn’t a “screening” service (as per CMS) but an assessment.

Terry discusses the new SDoH assessment code and when it should and shouldn’t be billed.

We previously discussed how to use this code, but now after a quarter of usage, let’s look at the “when” to report it.

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The post Revisiting SDoH G0136 Reporting appeared first on Terry Fletcher Consulting, Inc..

In this Top Ten Q&A episode, Terry tackles what the focus of any telehealth audit should be.

Auditing Telehealth encounters is more that just looking at the coding. It should also include medical necessity, the technical and procedural aspects of the service, and on patient satisfaction and outcomes.

She also recommends an external audit if internal audits find any irregularities: and Terry Fletcher Consulting, Inc. is here to help if you need us!

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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 – Auditing Telehealth appeared first on Terry Fletcher Consulting, Inc..

You must have a collaboration agreement in place when hiring mid-level providers or QHPs (such as nurse practitioners, physician assistants, or clinical nurse specialists) to act on your behalf with treating patients.

Collaboration agreements are mandatory in most states but rules differ from state to state. Also, due to failed compliance policies, lack of understanding of state laws, and providers forgetting to report when this relationship ends, the physician may still listed as their supervising physician.

Terry uncovers these issues that cost physicians not only money, but possibly their license to practice.

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The post Compliance Issues With MD/QHP Collaboration Agreements appeared first on Terry Fletcher Consulting, Inc..

Critical care in 2024 can be tricky, with inclusions, carve-outs, and a time component.

Are there exceptions when PA/NPs are involved in critical care services? What has to be documented? You may find some rules you didn’t know about.

Terry has all of the answers in this episode of the CodeCast podcast, sponsored by Decision Health, LLC.

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The post Critical Care Inclusions and Carve-Outs appeared first on Terry Fletcher Consulting, Inc..

What happens when a provider meets with a family to discuss and develop a care plan for patients? Providers will give the parent the option to have the patient present or just the parent/guardian due to the sensitivity of the discussion.

Some scenarios where this may occur are cancer patients where the family wants to talk to the provider alone on treatment options or mortality issues, or pediatric patients where the conversation may be too sensitive to have the child present. But what can you bill for?

Terry covers this controversial topic in this edition of the CodeCast podcast.

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The post Can you bill an E/M service when the patient isn’t present? appeared first on Terry Fletcher Consulting, Inc..