CodeCast | Medical Billing and Coding Insights

Effective November 4th, 2019, the Federal Register posted that CMS has new authority to revoke physicians’ billing and reporting privileges if they find that they have any direct or indirect affiliation with other providers, or entities that have had their privileges revoked in the past or if they have past due money due the government. Also, the new billing rules for Advanced Diagnostics will cause many offices to change their processes in how to get approval and report these services. Check out the latest CodeCast as Terry Fletcher reveals all of this week’s breaking news. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

In this month’s Top Ten Tuesday episode, Terry dives into coding questions regarding SDOH and HCC capture, along with the new ICD-10-CM for vaping injuries. Also on this broadcast is the discussion of patient portals and how HIPAA protected are they really? This is an information-packed episode you do not want to miss! Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

There are many ways in which mid-level provider visits can violate the incident-to rules. Without an audit, your Medicare carrier won’t know that the rules have been violated since a claim for an incident-to service looks exactly like a claim from the supervising provider. However, audits are triggered when CMS sees a significant number of services for a single physician because both the provider and the APP are billing under the physician’s National Provider Identifier (NPI). CMS is frustrated with the continued non-compliance in this area. Listen in this week, as Terry clarifies the rules, regulations, and how to be audit-proof when reporting Advanced Practice Providers services under the incident to billing rule. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

This week Terry spotlights the 22-modifier in claims that need an extra reimbursement from an “Increased Procedural Service”. She will give you tips on how to be successful in the use of the 22-modifier, along with some insight on how to show your credibility with payers. Also, Terry discusses how to deal with information overload when returning from a conference. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

ICD-10-CM introduced new concepts that were both straightforward, and confusing. One concept that is often debated is how to select the correct 7th digit character, which represents the episode of care. (This term is applicable to most injuries, poisonings, and other external causes.) Terry explores this concept and shows you how to tell the complete patient clinical story through this 7th digit. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

Did you know Prescription Drug Management MUST include an actual prescription? There is a constant struggle to explain to physicians that providing a “script” to a patient does not always qualify your E/M service as a level 4. We need to do away with that myth and focus on what PDM really means to Medical Decision Making, and how MDM contributes to code level choices. If there is no prescription given, then where is the management? Terry will give you the insight on this topic to make sure you are compliant in your coding and documentation efforts. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

Terry discusses the need for coding audits on the staff; to ensure quality along with good production efforts. What is being looked at in these audits? And how it can help healthcare professionals grow in their job to reach a high standard of job performance? Terry will talk about these topics, as well as conflicts with coders and administrators, and how to rise above those situations. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

In the latest edition of the CodeCast Top 10 Tuesday, the “Modifier Spotlight” series returns. On this edition, Terry will focus on Modifiers, 51, 52 and 53: appropriate use, best practices for reimbursement, and the pitfalls of assigning them to the wrong CPT code. Terry also covers how to understand coding for “easy bruising” under ICD10CM. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

There are 6 after-hours/special services codes in the Special Service, Procedures, and Reports section of CPT. Four of these codes tend to present a challenge for coders because the vagueness of the guidelines or the inexplicit code descriptors leave coders wondering: “Can we charge for these?” Terry gives some examples and guidance on if and when you can code for these adjunct codes and which payers may be open to paying for them. She also covers a special report on the top EHR systems physicians prefer. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

What are the patient’s expectations in medical practices today? Terry lists all of the “wants” of patients and discusses whether they are really “needs” of your practice. ‘ Also, it is a challenging time to be a physician. Recent studies report nearly 45% of doctors feel burnout in their work, more than other US workers. Burnout has serious consequences for physicians and patients, including loss of professionalism, medical errors, decreased patient satisfaction, and even depression and suicidal ideation. Terry gives you the Mayo Clinic and Marshall Field references on the “ten commandments” of physician wellness that we can all benefit from for healthy practices. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg 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 spotlight series episode, the focus is on the trickiest modifier of them all: Modifier 59. Terry dedicates an entire episode to this modifier, which also includes the X-modifiers or the subset modifiers that have been effective since 1/7/2015. The most common reason the 59 modifier should be used is to indicate that two or more procedures were performed at the same visit but to different sites on the body. Unfortunately, it is one of the most misused modifiers. Many times it is used to prevent a service from being bundled, or added in with another service, on the same claim. It should never be used strictly to prevent a service from being bundled or to bypass the insurance carrier’s edit system. Terry will clarify its use as well as discuss the Subset X-Modifiers for compliant coding and maximized reimbursement. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg 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 ever-changing patient profile, it is important that healthcare professionals embrace an attitude of change. We must recognize that staff needs training on more than the ICD-10-CM associated conditions for LGBTQ+ patients: they also need training on inclusive-language in the practice for intake forms and conversations in general. Terry discusses what it takes to make your practice LGBTQ friendly for this new alternative medicine patient population. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

CPT Modifiers are valuable coding tools that explain to payers the specific work that was done by a physician during treatment of a patient. CPT modifiers 25 and 26, are mandatory to justify services performed. More specifically, these codes deal with the intent of other services performed at the same encounter, as well as location of services for the 26 modifier. Terry will help dispel some of the confusion, and explore some of the most common uses of these modifiers, the reimbursement impact, and when and how to utilize them correctly. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

Changes are coming for ICD-10-CM. Terry summarizes the new, revised, and deleted codes for 2020, along with a frequently asked question: “Can we use the result of a diagnostic test as the patient diagnosis? Or do we have to use the clinical indication for the test upon presentation for the test?” Ms. Fletcher will cover the AHA policy and also address the CDI implications for ICD-10-CM coding while getting back to basics. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The rules surrounding signing a physician note are from the general E/M documentation guidelines. The main concern is the timely completion of medical records. This issue has both billing and compliance ramifications. While the issue of legibility has been largely addressed by increased utilization of electronic health records (EHRs), completion of the record through the inclusion of proper documentation and a dated signature continues to be of concern. What does it mean for a medical record to be complete?  Is the record complete when it contains the documentation of the patient encounter but is not signed and dated? Tune in as Terry covers these topics and more in her latest CodeCast. Subscribe and Listen You can subscribe to our podcasts via: * iTunes – https://itunes.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 * Google Play Music – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga * Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX * Stitcher – http://www.stitcher.com/s?fid=156874 * TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ * YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/