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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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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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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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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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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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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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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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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* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
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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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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:

* G0101 – Screening pelvic and clinical breast exam
* Q0091 – Collection of a screening Pap smear

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:

* Preventive care codes
* Annual Wellness Visits (AWVs)
* Evaluation and Management (E/M) services

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:

* Insufficient documentation led to 34% of improper payments
* No documentation accounted for 7.5%
* Incorrect coding was responsible for a staggering 52.4%
* Other errors made up the remaining 6.1%

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:

* New considerations for diagnosis coding in heart disease, HIV, and diabetes
* How to apply the latest guidance across multiple specialties
* A closer look at inpatient discharge codes 99238 and 99239—are you using them compliantly?

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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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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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

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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* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
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If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

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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You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX
* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/
* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg
* YouTube Music – https://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQ
* Pandora – https://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

A question I’m often asked is, “Why do physicians charge so much?” There’s no easy answer, as there isn’t a fixed price list for medical services. Due to the healthcare system’s complexity and the absence of set prices, providers are largely free to charge what the market will bear.
However, can there be consequences for over-pricing or egregiously overcharging payers? Yes. It’s crucial to pay close attention to this issue, as it could lead to trouble not only legally but also in terms of regulatory compliance.
Subscribe and Listen
You can subscribe to our podcasts via:

* Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627
* Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX
* TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/
* YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg
* YouTube Music – https://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQ
* Pandora – https://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874
* Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights
* iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/