CodeCast | Medical Billing and Coding Insights

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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The FY 2026 ICD-10-CM Official Guidelines are out. In this episode, Terry breaks down the key updates and what they mean for your coding workflow. Tune in as she covers:

Whether you’re a seasoned coder or just brushing up for the new fiscal year, this episode is packed with practical insights to keep you accurate and audit-ready.

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Join Terry on the latest CodeCast podcast as she tackles your most pressing medical coding and compliance questions in our “Top Ten Tuesday” segment!

Terry clears up common misunderstandings and provides clarity on complex ICD-10-CM coding scenarios. Get expert tips to improve your diagnostic coding accuracy. She also discusses how navigating the nuances of telehealth billing can be tricky. We’ll demystify the Primary Care Exception and offer essential guidance for telehealth services compliance.

Plus, that persistent G2211 add-on code is back! Terry breaks down its proper application and helps you avoid common errors, ensuring you’re using this evaluation and management (E/M) add-on code correctly.

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

In this essential episode, we dive deep into the heightened scrutiny surrounding split/shared visits, particularly high-level 99223 initial hospital visits.

Join Terry as she breaks down the latest payer audits impacting these services. We’ll explore critical compliance issues and offer actionable strategies to help your providers and practices proactively protect themselves from unwanted scrutiny and audit risk.

Don’t let coding complexities expose your practice. Whether you’re a medical coder, healthcare provider, or practice manager, this episode provides the vital information you need to confidently navigate split/shared visit guidelines and maintain audit readiness.

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Determining whether HCPCS code G2211 can be billed when a patient sees a different physician or practitioner within the same group practice, even colleagues in the same specialty, presents an interesting coding challenge. The key consideration revolves around whether the new provider serves as the “continuing focal point for all needed services or provides ongoing care for that complex or serious single condition.”

Expert analysis by specialists like Terry is crucial in breaking down these nuances to ensure accurate coding for the G2211 complexity add-on. The code’s intent is to recognize the inherent complexity of visits that are part of a longitudinal patient-provider relationship, either where the practitioner is the primary point of contact for all healthcare needs, or where they manage a single, serious, or complex condition over time.

When a patient transitions to a new provider within the same group, even in the same specialty, the question arises whether the new provider has established or intends to establish the same level of consistent, ongoing care that would justify billing G2211. This requires careful consideration of the documentation and the nature of the relationship being built with the new practitioner.

Terry, our coding expert, unpacks these nuances to help you avoid over or under-coding. Tune in to ensure your practice is accurately capturing the true complexity of patient care!

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In today’s episode of the CodeCast podcast, Terry untangles the complexities of Protected Health Information (PHI) and HIPAA as they relate to workers’ compensation cases. She’ll clarify the rights of both patients and employers when requests for PHI reach a healthcare provider’s office.

This can be a tricky area, especially given potential state-specific regulations. This episode could be an invaluable resource for navigating these complicated scenarios.

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