The CodeCast Podcast | Medical Billing & Coding Insights

The Business Side of Medicine ~ Coding, Reimbursement and Compliance for Physician Practices

National Speaker and Healthcare Consultant, Auditor and Educator, Terry Fletcher CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, knows from over 25 years medical reimbursement industry experience that Coding, Billing and Compliance for physician practices and hospitals can be tough to navigate. Her CodeCast® Podcast series will share insights to current rules and regulations the Medicare payer requires, along with Commercial insurance plans’ rules and reimbursement challenges. Discover revenue opportunities to maximize reimbursement in your medical practice, focusing on different medical specialties and platforms each episode.

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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.

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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.

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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.

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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.

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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.

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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.

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In the latest edition of the CodeCast Top 10 Tuesday, Terry takes us through Spine ICD-10 coding challenges. From Critical Care situations to Transgender coding (that has been a new topic of late) tune in as Terry responds to the coding and billing questions of the month.

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Are your physicians asking you to “Patient here to establish care” and trying to bill this as a Level 5 visit…  when it is actually Preventative Services?

Terry clarifies the difference between Preventative Services and EM Problem-oriented Services.

She also discusses the billing of both services and the patient share of cost impact, as well as a rant about sleep deprivation. (Are you experiencing it?)

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There are ways to represent professionalism: but what does it really mean to you?

On today’s episode, Terry discusses ways to be inspired on the job to best show professionalism in a Healthcare environment. Her tips will help you feel inspired at your job, but she also goes the extra distance to discuss how professionalism can be perceived by the way patients view your office. What are some of the tell-tale signs that a practice may need a makeover?

Those signs fall into three broad categories: space, appearance, and productivity.

Terry discusses how to identify if your practice is costing you patients simply from a design and workflow situation, and how to fix it.

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Despite the increased resources and references for critical care billing, critical care reporting issues persist.

Medicare data analysis continues to identify 99291 as high risk for claim payment errors, perpetuating prepayment claim edits for outlier utilization and location discrepancies.

In this episode, Terry tackles this topic with documentation recommendations to keep you audit-proof with tips for how to code these high ticket items.

Also, do you know what the ICD-10-CM code X34.XXXA is?

Yep… there is an earthquake in there somewhere!

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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/