CodeCast | Medical Billing and Coding Insights

We all know the age-old question, “Where does it say that?” In this episode, Terry brings receipts, explaining it’s been this way since 2003:

“Reviewing results of laboratory tests, phoning results to patients, filing such results, etc., are Medicare-covered services. Payment is included in the physician fee schedule payment for the evaluation and management (E/M) services to the patient. The CPT lists different levels of E and M services for both new and established patients and describes services that are included as E/M services. Such activities include obtaining, reviewing, and analyzing appropriate diagnostic tests.”

Tune in to this episode for an in-depth discussion as Terry details trying to report a telehealth visit for giving test results may be considered double-dipping: and can get you into hot water!

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The post Giving Tests Results to Patients… Where’s the Payment? appeared first on Terry Fletcher Consulting, Inc..

An ADR (Additional Documentation Request) is a request from CMS or another insurance payer for additional documentation to review a claim. Most of these requests come from payer investigative units looking for medical necessity support.

Terry discusses how to handle these requests, as well as how to ensure they are addressed promptly to meet the deadlines typically associated with them.

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The post ADR Workflow Tips appeared first on Terry Fletcher Consulting, Inc..

If the provider discusses their preferred management options with the patient, do they receive the “risk” credit even if the patient declines it? If yes, how long do they get to capture it?

Terry breaks down, citing references, how to handle this MR element and ensure the providers are receiving the correct “risk” value for their encounter. Listen to this episode for all of the details.

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The post Who Gets the Credit for MDM Risk Element? appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast podcast, Terry discusses the differences between APCM and CCM services and what is needed to report either.

Compliance issues are seen with many care management service records. Terry covers how to follow best practices to ensure you follow the published guidance.

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The post APCM Focus appeared first on Terry Fletcher Consulting, Inc..

Medical Coding provides standardized language that ensures all healthcare providers involved in a patient’s care are on the same page.

The coder’s role is to be accurate, communicative, insightful and focused on a positive patient outcome. A patient’s financial health can impact their clinical health, and medical coders need to be recognized for their role in this process.

Terry shares her thoughts on what makes a coder valuable, even if they are less visible than the providers.

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The post The Crucial Role of the Coder in Quality Patient Care appeared first on Terry Fletcher Consulting, Inc..

This week’s CodeCast summarizes the recent ICD-10-CM documentation guidelines instructions on sepsis, obesity, and COVID-19 reporting.

Terry also provides more guidance on E/M risk in prescription drug management and caution with PSAs in patient documentation.

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The post ICD-10-CM April 1st Updates appeared first on Terry Fletcher Consulting, Inc..

More medical claims denials could be avoided if coders took the extra minute to make sure that the diagnoses that need to be linked to a specific line item were pre-billed.

Also, when billing for diagnostic procedures on a complaint that moves to a minor, therapeutic, or surgical procedure, denials will happen when the diagnosis for the latter procedure is not updated.

Terry covers all the issues with denials that can be avoided with a careful step back.

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The post Avoiding Insurance Denials appeared first on Terry Fletcher Consulting, Inc..

Terry takes some inspiration from Stephanie Allard’s February 27th for this edition of the CodeCast podcast.

Terry discusses the differences and subjective issues between Acute Uncomplicated Illness (or Injury) versus Acute Complicated Illness in the E/M elements of coding and auditing.

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The post Acute Uncomplicated vs. Acute Complicated E/M Auditing appeared first on Terry Fletcher Consulting, Inc..

Terry’s answering your coding questions in this week’s “Top 10” Q&A.

In this episode Terry’s covering APCM, E/M, skin procedures, lab billing, and even a Telehealth bonus.

Tune in for insights you won’t want to miss!

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

Terry is under the weather this week, so she gives us a quick segment on the E/M Data point, “independent interpretation”. See page 12 of CPT® under independent interpretation, the last sentence.  “A test that is ordered and independently interpreted may count as both a test ordered and interpreted.”

Suppose you bill for the professional and technical components, meaning you are billing for the test ordered. In that case, you can’t double dip or get additional credit for the order, the review, or a professional interpretation.

You can get credit for ordering a test and for an independent interpretation, as long as your documentation meets the criteria for what an independent interpretation is.

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The post Independent Interpretations of E/M Data Points appeared first on Terry Fletcher Consulting, Inc..