Terry explores the critical role coders and auditors play in holding providers accountable. From reviewing clinical documentation and medical record notes to verifying patient eligibility, addressing cases where minors receive treatment without a parent present, and identifying excessive repeat visits lacking medical necessity, this episode highlights the detailed oversight that ensures provider compliance and quality care.

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In this episode, Terry breaks down the upcoming Prior Authorization pilot programs launching for Medicare Part B Professional Services on January 1, 2026, and for Ambulatory Surgical Centers starting December 15, 2025. She outlines which medical services will be impacted and what providers need to know as these changes roll out.

Terry also shares the latest updates on Telehealth and explains how to access the educational materials from the September 18th webinar if you missed it.

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In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.=

Payers—including MACs, commercial insurers, and Medicaid programs—are increasingly updating their policies to clarify that providers must demonstrate the cognitive effort involved in assessing the risks tied to prescription drug management. Reviewing a medication list without further analysis or context is not sufficient. Instead, documentation should reflect the clinical reasoning, counseling, and risk evaluation discussed with the patient, including potential outcomes related to medication adherence or non-adherence.

Terry breaks down what this means for coding accuracy and compliance, offering insights into how providers can better capture the complexity of prescription drug management in their documentation.

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The post Are you documenting prescription drug management risk? (Fixed Audio) appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast Podcast, Terry addresses a common misconception among medical providers: the belief that simply listing a patient’s medications or repeatedly noting “continue meds” is enough to support a moderate-level evaluation and management visit, such as CPT codes 99214 or 99204. In reality, this documentation alone does not meet the criteria.=

Payers—including MACs, commercial insurers, and Medicaid programs—are increasingly updating their policies to clarify that providers must demonstrate the cognitive effort involved in assessing the risks tied to prescription drug management. Reviewing a medication list without further analysis or context is not sufficient. Instead, documentation should reflect the clinical reasoning, counseling, and risk evaluation discussed with the patient, including potential outcomes related to medication adherence or non-adherence.

Terry breaks down what this means for coding accuracy and compliance, offering insights into how providers can better capture the complexity of prescription drug management in their documentation.

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The post Are you documenting prescription drug management risk? appeared first on Terry Fletcher Consulting, Inc..

A split or shared visit is an evaluation and management (E/M) service performed jointly by a physician and a non-physician practitioner (NPP) from the same group in a facility setting. Under applicable laws and regulations, either the physician or the NPP may bill for the service—provided they deliver it independently. Reimbursement goes to the practitioner who performs the substantive portion of the visit.

However, many practices mistakenly confuse shared visits with “incident to” services, which are fundamentally different. In this episode of the CodeCast podcast, Terry breaks down the distinction and clears up the confusion.

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In this week’s episode of the CodeCast Podcast, Terry Fletcher previews potential Telehealth updates and changes set to take effect on October 1. She also discusses how major surgery can be considered a risk factor in Evaluation and Management coding, and explains the importance of properly sequencing ICD-10-CM codes to ensure reimbursement success.

Listeners are encouraged to check out the latest Telehealth webinar, available now at www.terryfletcher.net.

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In this episode of CodeCast, Terry takes a closer look at the growing issue of undercoding in healthcare. Often misunderstood or overlooked, undercoding involves reporting fewer services than were actually provided, assigning a lower-level code than warranted, or inaccurately documenting patient encounters.

While some may view it as a conservative approach to avoid audits or reduce patient costs, under-coding can lead to serious consequences—including reduced reimbursement, skewed provider data, and potential compliance violations.

Terry breaks down how this practice is being viewed in today’s regulatory landscape and what it means for coders, providers, and healthcare organizations.

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In this episode of CodeCast, Terry dives into the complexities of billing bilateral procedures and the growing tension between Medicare guidelines and commercial payer policies. Modifier 50 is used to report procedures performed on both sides of the body during the same operative session. When billed correctly, the procedure should appear on a single claim line with the CPT or HCPCS code, modifier 50, and one unit of service. Depending on the procedure’s bilateral indicator, Medicare may apply a 150% payment adjustment.

However, commercial payers are increasingly rejecting this standard. Many are now reimbursing only one line item, effectively ignoring the bilateral nature of the procedure. This shift poses serious risks to patient care. Providers may be forced to schedule a second surgery, exposing patients to additional anesthesia and delaying medically necessary treatment.

Terry breaks down the implications of these policy changes and offers strategies for providers to advocate for proper reimbursement. Tune in to learn how to protect your patients and your practice from the fallout of this troubling trend.

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Medicare has designated two HCPCS codes for women’s screening services:

These codes are reimbursable every two years, but they’re not considered comprehensive preventive medicine services. In this episode, Terry breaks down how these screenings fit into the broader billing landscape — including whether they can be reported on the same date as:

If you’ve ever wondered how to navigate these overlapping services without triggering denials or confusion, this one’s for you. Tune in for practical tips and coding clarity.

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In this episode, Terry dives into the latest findings from the Centers for Medicare & Medicaid Services (CMS) regarding Evaluation and Management (E/M) services. According to the 2023 CERT (Comprehensive Error Rate Testing) data:

Terry breaks down what these numbers mean for your practice and shares actionable strategies to reduce denials and improve compliance.

For more details, visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#OtherErrors

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