CodeCast | Medical Billing and Coding Insights

The September 2025 issue of CPT® Assistant raised important questions about how to appropriately level an evaluation and management (E/M) encounter when the presenting problem is an acute, uncomplicated illness or injury. A growing number of providers have been assigning Level 4 codes simply because an antibiotic was prescribed.

However, this approach may not be accurate when considering the full scope of the encounter and its required documentation elements.

Terry examines this trend and explains why many payers have responded by implementing automatic down-coding policies to address potential overcoding.

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The post Leveling a Visit for an Acute Uncomplicated Illness appeared first on Terry Fletcher Consulting, Inc..

Medical billing and coding encompasses a wide range of responsibilities—from patient registration and claim reimbursement to final payment delivery to the provider. Navigating this process requires close collaboration among billers, coders, insurance companies, patients, and various healthcare professionals.

Although often grouped together as a single discipline, billing and coding are distinct roles that work in tandem to support the healthcare revenue cycle. If you’re considering a career in medical billing and coding, it’s essential to understand that these are separate professions, each demanding unique skills and personality traits. Terry breaks down the individual roles and how they work together to keep the system running smoothly.

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The post Claim Denials: Coding Mistake or Billing Oversight? appeared first on Terry Fletcher Consulting, Inc..

As more practices begin offering screening services, questions around billing for Medicare-specific G codes are becoming more common. In this episode, Terry breaks down when it’s appropriate to bill for preventive services, which providers are eligible, and what requirements must be met.

To bill G codes, providers must be enrolled as Medicare suppliers and follow specific program rules. Eligibility varies by service type—some require enrollment in specialized programs like the Medicare Diabetes Prevention Program (MDPP). For instance, pharmacists can only bill for certain services if certified as DSMT practitioners.

Tune in for real-world examples and expert guidance on navigating preventive service billing.

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The post Understanding Who Can Bill Preventive G Codes appeared first on Terry Fletcher Consulting, Inc..

CMS has updated its stance on Medicare payments during the federal shutdown, confirming that only certain claims will be held—reversing earlier guidance that hinted at a wider pause. But what does this mean for Telehealth and other temporary policies that expired on October 1?

Terry breaks down the latest developments, what’s at risk, and what steps to take next on today’s CodeCast Podcast.

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The post What the Shutdown Means for Medicare and Telehealth appeared first on Terry Fletcher Consulting, Inc..

In this episode, Terry tackles a common pitfall in coding and CDI workflows: skipping straight to the Assessment and Plan (A/P) section of an E/M note to determine service level. Are you overlooking key documentation that could support medical decision-making, risk, or time?

She also calls out a frequent habit among surgery coders—coding from the report header instead of the full operative detail. What assumptions are being made based on titles alone? What critical elements might be missed or misinterpreted?

Terry breaks down why accuracy isn’t enough. Coders must be diligent, thorough, and intentional in their medical record reviews and extrapolation processes. Lazy shortcuts can lead to compliance issues, missed revenue, and flawed data.

Tune in for practical insights on how to elevate your coding practices and avoid costly oversights.

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The post Tips on Reviewing MRs for Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..

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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The post Coders and Auditors Hold Providers Accountable appeared first on Terry Fletcher Consulting, Inc..

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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The post Medicare’s Prior Auth Pilot: What It Means for You 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? (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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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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