CodeCast | Medical Billing and Coding Insights

This week on the CodeCast Podcast, Terry explains the new 2024 CPT add-on code +99459 for pelvic exams when assistant clinical staff is needed to help the physician.

Check out today’s episode to make sure you know what the documentation and coding rules are before diving into this situation.

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The post 2024 Pelvic Exam Add-On Code appeared first on Terry Fletcher Consulting, Inc..

A physician, non-physician practitioner (NPP), or clinical psychologist can assess a patient who they suspect may have unmet needs (defined as Social Determinants of Health or SDoH.

In 2024 CMS is adding another G-code for SDoH assessment during an E/M encounter. This is for an assessment: not a screening. This service is not intended to be a screening done on every patient and cannot be performed via a portal exchange.

Tune in this week to learn more about this code, the reimbursement process, and any frequency rules.

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The post When to use the new SDoH add-on code appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast Podcast, Terry Fletcher discusses the seven elements of an effective compliance program. Last month, HHS-OIG outlined and updated this guidance.

With a broad spectrum of healthcare entities, staff, and providers playing a role in healthcare delivery today, this information can be generally applied across the entire healthcare industry or with small and large medical practices alike.

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The post 7 Elements of a Successful Compliance Program via OIG appeared first on Terry Fletcher Consulting, Inc..

In the ICD-10-CM guidelines, there is an entry for only history codes at I.C.21.c.4, and there are two types of history Z codes: personal and family.

History codes can be used on any medical encounter regardless of the reason for the visit. A history of an illness may alter what treatment is ordered for a patient, so it is important information to report. This directly supports the medical necessity of the encounter, which is the overarching criteria to report the outpatient or office visit at all.

Terry breaks it down for us, along with answering a 25-modifier question.

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The post Patient History = Medical Necessity appeared first on Terry Fletcher Consulting, Inc..

Care Management services are being reported at an all-time high but they are not all alike. Before submitting claims, many providers have not read the directions — or CPT-published guidance and criteria.

Terry breaks down the confusion and discusses why this is more of a value-based service than a monetary windfall. Listen to this informative episode for more details.

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The post Transitional Care Management Services appeared first on Terry Fletcher Consulting, Inc..

After all of the CMS continued updates for Telehealth, we finally got an update from the AMA, that was added to CPT 2024. This gives us the “criteria” on how a service can be CPT considered for Telehealth inclusion.

Terry shares this insight, plus her commentary on how to implement it into your updated compliance programs.

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The post Telehealth CPT 2024 Rules appeared first on Terry Fletcher Consulting, Inc..

Leveling an E/M visit can be considered very subjective. Clinicians and auditors alike can come to one conclusion or another.

It is important that when you take online advice, you also consider “best practices” and payer-published guidance before you do only the minimum (or what is “technically” correct).

Terry makes this clear distinction in today’s CodeCast Podcast.

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The post E/M Leveling with MDM: Right or Wrong? appeared first on Terry Fletcher Consulting, Inc..

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.

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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?

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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.

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