CodeCast | Medical Billing and Coding Insights

At some point, we have to stop and ask ourselves: What are we truly building for our future? Where is our career in healthcare going?

I have all of these credentials in coding, billing, compliance, practice management, and prior authorization, but what does that really say about me? I want to be clear that I believe credentials matter. I know the work, time, money, and dedication it takes to earn them. However, we also need to be honest with ourselves about something that is becoming increasingly obvious in healthcare: collecting credentials alone is not a career plan. AI is changing healthcare, and we need to start looking at the bigger picture.

Terry discusses what that means in today’s episode of the CodeCast podcast and asks the questions that may be uncomfortable to consider.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Credentials Alone Are Not a Career Path in Healthcare appeared first on Terry Fletcher Consulting, Inc..

Auditors, coders, billers, and even physicians often find themselves searching through pages of documentation trying to answer one basic question: what was actually evaluated, managed, and medically necessary during a single patient visit?

With note bloat from copied and pasted EMR documentation and pulled-forward notes, it has become increasingly difficult to determine what actually happened “today.” In this episode of the CodeCast Podcast, Terry breaks down this compliance challenge and explains how providers can better manage documentation to ensure accuracy, clarity, and compliance.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Note Bloat Is an Auditor’s Nightmare appeared first on Terry Fletcher Consulting, Inc..

Text messaging for communicating orders is not prohibited by CMS or The Joint Commission, but there are important HIPAA privacy and security considerations that healthcare organizations must understand before using this method of communication. According to guidance from the AMA, providers must evaluate compliance requirements and safeguards when using text messages in patient care workflows. In this episode, Terry explains the details of using text messaging for orders, what organizations need to know to remain compliant, and practical considerations for implementation. Plus, hear about a newly accepted AMA CPT Committee decision for 2027 that could impact future coding and reporting.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Can Physicians and Clinicians Use Texting for Patient Care? appeared first on Terry Fletcher Consulting, Inc..

HHS recently released updated Notices of Privacy Practices (NPPs), introducing changes that go far beyond standard template revisions. The update includes new requirements for health care providers, health plans, and Part 2 patient notices related to sensitive protected health information.

While many in health care associate “NPP” with Non-Physician Practitioner, in this case it refers to patient privacy notice requirements involving highly sensitive health information, including substance use disorders (SUD), reproductive health information, and mental health records.

These updated privacy notice requirements became effective February 16, 2026, and covered entities must comply by July 1, 2026. In this episode, Terry breaks down what has changed, what practices need to update immediately, and how to ensure your organization remains compliant with both HIPAA and the new federal privacy requirements surrounding sensitive PHI.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Notice of Privacy Practices 2026 appeared first on Terry Fletcher Consulting, Inc..

Watch the claims data behind telehealth modifier 95 and audio-only modifier 93 as denial trends for high-volume CPT codes and place of service combinations raise major compliance concerns. Terry breaks down the most common causes of denials, including incorrect POS reporting, documentation gaps, and billing practices that could trigger audit scrutiny. She also explains why relying on coding forums for definitive coding advice can create serious compliance risks for providers and practices.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Telehealth Modifiers 95 and 93 Compliance appeared first on Terry Fletcher Consulting, Inc..

While Centers for Medicare & Medicaid Services does not explicitly define a strict “12-month rule,” its guidance does require that the physician’s involvement reflect ongoing, active participation in the patient’s course of treatment.

That said, legal and compliance experts consistently caution that if a physician has not personally seen a patient within 12–24 months, billing subsequent non-physician practitioner (NPP) visits as “incident to” may present elevated audit risk. Terry breaks down the lack of clear regulatory thresholds and outlines practical steps to help protect your practice if an audit inquiry occurs.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Incident to Physician Participation Rules appeared first on Terry Fletcher Consulting, Inc..

Terry breaks down a recent social media post that exposed a practice’s compliance issues with time based care management services, drawing exactly the kind of attention no organization wants. Although the original post was quickly deleted after backlash, the situation highlights a bigger issue.

In this episode, Terry emphasizes the importance of using sound judgment online and ensuring time based services are properly documented and driven by medical necessity, not simply billed because they can be.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post CCM and CoCM Compliance Risks on Social Media appeared first on Terry Fletcher Consulting, Inc..

Modifier 59 (Distinct Procedural Service) continues to face intense scrutiny in 2026 due to widespread misuse, triggering audits, denials, appeals, and payer recoupments tied to medical necessity concerns. With enforcement on the rise, it’s more important than ever for coders to understand when—and when not—to apply this modifier correctly.

On today’s episode of the CodeCast Podcast, Terry Fletcher breaks down proper Modifier 59 usage, common pitfalls leading to audits, and key documentation requirements to support compliant coding. She also covers post-operative pain injections, including when they can be reported and which providers are eligible to bill for them.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Modifier 59 Audits Denials and Post-Op Pain Injections appeared first on Terry Fletcher Consulting, Inc..

Coding fracture care using CPT and ICD-10-CM can be challenging—especially when documentation from providers lacks key details. In this episode of the CodeCast Podcast, Terry breaks down exactly what coders should look for in physician notes, including essential documentation elements and common gaps. She also shares expert insights and practical tips to help ensure accurate coding, proper reporting, and compliance when working with fracture treatment cases.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Fracture Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..

In medical coding and compliance, attention is often focused on overcoding due to its association with fraud, waste, and abuse. However, undercoding is an equally important—and frequently misunderstood—issue. While it may seem like a safer way to avoid scrutiny, undercoding is still a coding error, a compliance concern, and a reportable variance under both CMS and OIG guidelines.

Recent TPE audits are increasingly targeting undercoding, as it signals a failure to accurately report services and can negatively impact compliance, data integrity, and reimbursement. In this episode, Terry breaks down why undercoding is now on the radar and why providers need to address it immediately.

Find all of Terry’s official links in one place: https://www.terryfletcher.net/links

The post Undercoding Is Now a Compliance Risk Providers Can’t Ignore appeared first on Terry Fletcher Consulting, Inc..