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Obstetric coders have likely started to report E/M visits for newly pregnant patients, but they still have a few months before they need to use the full set of new and revised codes and guidelines for maternity care services as we head into 2027. Terry brings in some recent questions and answers to to help train your team and determine where more research or training is necessary before the full code system goes into effect Jan. 1, 2027. A contributing article in Part B news from 9/28 also was used for this episode. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Obstetrics Coding for 2027 appeared first on Terry Fletcher Consulting, Inc..

Emergency Department and Critical Care Services are often incorrectly coded because the documentation lacks clarity. Terry discusses the elements necessary to have compliant ER documentation and also what CC services need to make sure they are supported for billing. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post ER and Critical Care Services Coding appeared first on Terry Fletcher Consulting, Inc..

CMS has made permanent the policy that allows a practitioner who furnishes Medicare telehealth services from home, even what the height of COVID is over 3 years in the past. There is also confusion is what is listed as the physician’s practice location? Terry discusses the answer to this question, as the CCHPCA has now a specific position, and also talks about the difference between Medicare enrollment vs. POS where services are performed. Different rules apply when the practitioner or group operates virtually and has no other physical practice location, and teleradiology is subject to separate enrollment rules. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Telehealth when the physician is at home appeared first on Terry Fletcher Consulting, Inc..

How does documentation specificity affect diabetes code assignment? The details included in a medical record can significantly affect ICD-10-CM code assignments. Terry discusses several examples to show how documentation specificity, provider links between conditions, and medication use can influence diabetes coding. There are certain conditions for which a cause-and-effect relationship with diabetes can be assumed under coding guidelines; however, not every condition can automatically be considered related to diabetes. When a provider specifically links a condition to diabetes, that documentation can provide crucial support for accurate code assignment. Tune in today for some insights into the frequent, although challenging condition to code. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post ICD-10-CM Coding for Diabetes appeared first on Terry Fletcher Consulting, Inc..

Terry gives us scenarios that are examples of work that doesn’t amount to an E/M service or can’t be counted toward an E/M service, followed by discussion of the reason why along with similar situations where it might be appropriate to report a stand-alone E/M service or count it toward an E/M service. We have to make sure we are not caught in the FWA that is happening all over the country. Listen in this week to protect your practice. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post E/M Coding: What Not To Do appeared first on Terry Fletcher Consulting, Inc..

The AMA specifically states that the risk element concerns patient-management decisions made by the physician/QHP reporting the E/M service. It also emphasizes that surgical risk depends on the particular patient’s circumstances and risk factors as assessed by that physician. Terry discusses “pre-op clearance” visits today and their level of risk, along with the billing of 76937 controversy. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Technically correct and pre-ops appeared first on Terry Fletcher Consulting, Inc..

Terry discusses the 1op 10 Coding Corner Membership questions of the quarter, including Telehealth, the reality of voice recognition transcription disclaimers and some of the new proposals from CMS slated for 2027. Tune in to get the rundown. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Top 10 Tuesday Medical Coding Q and A appeared first on Terry Fletcher Consulting, Inc..

Today on the CodeCast Podcast, Terry discusses a topic that comes up in auditing conversations frequently: “that an auditor needs to specialize in a certain specialty before they can audit E/M services for that specialty.” That is not necessarily true. I understand where that thought comes from. It can absolutely help for an auditor to be familiar with the anatomy, medications, terminology, and common treatment plans within a specific specialty. That knowledge can make the note easier to follow. It may also help the auditor know when they need to ask a question or do additional research. But does it also create a bias? Let’s chat about this today on the CodeCast. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post E/M Auditing Specialty Providers appeared first on Terry Fletcher Consulting, Inc..

What are we anticipating for 2027 in the MPFS? This week Terry gives us a rundown on what to expect, how to respond before the comment period ends, and what needs to happen to strengthen our private practice providers. Listen in… Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post CMS Fee Schedule Proposals appeared first on Terry Fletcher Consulting, Inc..

Incident-to Billing Update: More Blue Cross Blue Shield plans, along with the three largest commercial insurance carriers, are tightening their policies on the reporting and reimbursement of services billed under Medicare’s “incident-to” guidelines. In today’s episode of the CodeCast Podcast, Terry reviews these recent policy changes, highlights key effective dates, and explains what physicians, coders, billers, and practice managers need to know before submitting claims. Tune in to learn how these evolving payer requirements could impact your reimbursement and the compliance steps you should be taking now. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Incident to Update: Commercial Plans appeared first on Terry Fletcher Consulting, Inc..

With more patients turning to large-language models such as ChatGPT, Gemini, Claude and others to answer their questions about symptoms, medical conditions and more, the American Medical Association (AMA) is offering some go-to advice that will help patients get more out of their experience with AI chatbots while staying safe. The key to effectively using AI chatbots, is to understand they are not a replacement for a physician. Terry discusses the AMA 5 steps to AI ChatBot safety and what physician practices need to do to protect patients in this uncertain and sometimes, unchecked reality. AI chatbots are not as a substitute for the evidence-based, personalized guidance of an actual doctor. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post AI ChatBots Are Not Physicians appeared first on Terry Fletcher Consulting, Inc..

In today’s episode of the CodeCast podcast, we’re breaking down why E/M time belongs to the physician or qualified healthcare professional performing the service, why time from other team members cannot be combined to support the E/M level (in the office setting), and an important Medicare reminder: shared visits do not apply in the office or other outpatient setting. Let’s dive into the rules so you can code with confidence and avoid a common compliance pitfall. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Can ancillary staff be part of shared services under E/M? appeared first on Terry Fletcher Consulting, Inc..

Terry tackles a growing compliance issue in telehealth: where the patient is located at the time of the visit. While physicians generally must be licensed or otherwise authorized to practice in the state where the patient is physically located, evolving payer policies and Medicare rules have added new layers of complexity. From commercial insurance requirements to CMS guidance on services provided outside the United States, Terry explains what providers need to know to remain compliant and avoid costly reimbursement pitfalls. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Telehealth: Where the Patient is or Where the Provider is? appeared first on Terry Fletcher Consulting, Inc..

Artificial intelligence is advancing faster than the laws designed to regulate it. While individual states continue to enact legislation governing the development and use of AI, the federal government is simultaneously working toward a nationwide regulatory framework that could preempt many state laws. In this episode of the CodeCast Podcast, Terry examines the evolving legal landscape surrounding AI, the current lack of mandated safeguards, and the ongoing tension between state and federal oversight. She also discusses the compliance and operational risks healthcare organizations should be considering now, along with practical best practices to help mitigate those risks as AI becomes increasingly integrated into healthcare. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post How Safe Is AI in Healthcare? appeared first on Terry Fletcher Consulting, Inc..

Every CMS-1500 claim includes a set of certifications, attestations, and legal statements printed on the reverse side of the form. While these statements may seem like standard administrative language that has been around for decades, they carry significant legal and compliance implications. In this episode, Terry breaks down what these certifications actually mean and why every claim submitted is a legal representation that the services billed were properly documented, medically necessary, accurately coded, and provided in compliance with applicable regulations. She also explains why understanding these attestations is essential to maintaining a strong revenue cycle management (RCM) workflow, reducing compliance risk, and helping organizations avoid costly payer audits. Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post CMS-1500 Form Compliance appeared first on Terry Fletcher Consulting, Inc..