Watch the claims data behind telehealth modifier 95 and audio-only modifier 93 as denial trends for high-volume CPT codes and place of service combinations raise major compliance concerns. Terry breaks down the most common causes of denials, including incorrect POS reporting, documentation gaps, and billing practices that could trigger audit scrutiny. She also explains why relying on coding forums for definitive coding advice can create serious compliance risks for providers and practices.

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The post Telehealth Modifiers 95 and 93 Compliance appeared first on Terry Fletcher Consulting, Inc..

While Centers for Medicare & Medicaid Services does not explicitly define a strict “12-month rule,” its guidance does require that the physician’s involvement reflect ongoing, active participation in the patient’s course of treatment.

That said, legal and compliance experts consistently caution that if a physician has not personally seen a patient within 12–24 months, billing subsequent non-physician practitioner (NPP) visits as “incident to” may present elevated audit risk. Terry breaks down the lack of clear regulatory thresholds and outlines practical steps to help protect your practice if an audit inquiry occurs.

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The post Incident to Physician Participation Rules appeared first on Terry Fletcher Consulting, Inc..

Terry breaks down a recent social media post that exposed a practice’s compliance issues with time based care management services, drawing exactly the kind of attention no organization wants. Although the original post was quickly deleted after backlash, the situation highlights a bigger issue.

In this episode, Terry emphasizes the importance of using sound judgment online and ensuring time based services are properly documented and driven by medical necessity, not simply billed because they can be.

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The post CCM and CoCM Compliance Risks on Social Media appeared first on Terry Fletcher Consulting, Inc..

Modifier 59 (Distinct Procedural Service) continues to face intense scrutiny in 2026 due to widespread misuse, triggering audits, denials, appeals, and payer recoupments tied to medical necessity concerns. With enforcement on the rise, it’s more important than ever for coders to understand when—and when not—to apply this modifier correctly.

On today’s episode of the CodeCast Podcast, Terry Fletcher breaks down proper Modifier 59 usage, common pitfalls leading to audits, and key documentation requirements to support compliant coding. She also covers post-operative pain injections, including when they can be reported and which providers are eligible to bill for them.

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The post Modifier 59 Audits Denials and Post-Op Pain Injections appeared first on Terry Fletcher Consulting, Inc..

Coding fracture care using CPT and ICD-10-CM can be challenging—especially when documentation from providers lacks key details. In this episode of the CodeCast Podcast, Terry breaks down exactly what coders should look for in physician notes, including essential documentation elements and common gaps. She also shares expert insights and practical tips to help ensure accurate coding, proper reporting, and compliance when working with fracture treatment cases.

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The post Fracture Coding Accuracy appeared first on Terry Fletcher Consulting, Inc..

In medical coding and compliance, attention is often focused on overcoding due to its association with fraud, waste, and abuse. However, undercoding is an equally important—and frequently misunderstood—issue. While it may seem like a safer way to avoid scrutiny, undercoding is still a coding error, a compliance concern, and a reportable variance under both CMS and OIG guidelines.

Recent TPE audits are increasingly targeting undercoding, as it signals a failure to accurately report services and can negatively impact compliance, data integrity, and reimbursement. In this episode, Terry breaks down why undercoding is now on the radar and why providers need to address it immediately.

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The post Undercoding Is Now a Compliance Risk Providers Can’t Ignore appeared first on Terry Fletcher Consulting, Inc..

In this episode of the CodeCast Podcast, Terry Fletcher answers key medical coding and billing questions in a detailed Q&A session designed for coders, billers, auditors, and healthcare providers.

This episode covers E/M coding with minor procedures and when services can be billed separately, RTM (Remote Therapeutic Monitoring) for CPAP patients, CO-96 Medicare denials including what they mean and how to properly appeal, along with real-world coding scenarios and expert guidance to help improve reimbursement and reduce claim denials.

If you’re looking to stay compliant, optimize your coding practices, and better understand payer requirements, this episode delivers practical, actionable insights you can use immediately.

Be sure to subscribe to the CodeCast Podcast for weekly updates on medical coding, billing, and compliance.

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The post Top 10 Tuesday Medical Coding Q and A appeared first on Terry Fletcher Consulting, Inc..

You receive a payer inquiry questioning level 4 services… so you open the note and see:

“Patient here for follow-up. Doing well.”

That’s it.

Now you’re stuck defending a level of service that the documentation doesn’t support.

In this episode of the CodeCast podcast, Terry breaks down a common challenge in healthcare organizations—how to educate providers on documentation without defaulting to scolding or generic feedback that doesn’t stick.

Using real-world examples, Terry explains how to shift the conversation from criticism to clarity—helping providers understand how to document the patient story, support medical necessity, and protect reimbursement.

If your current education approach isn’t changing behavior—or your providers keep defaulting to template-style notes—this episode will give you practical, effective talking points that actually make a difference.

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The post Educating Physicians Without Scolding appeared first on Terry Fletcher Consulting, Inc..

If you spend your days auditing charts, you’ve seen it: diagnoses are listed, medications are “continued as prescribed,” and a plan is documented — yet something important is missing.

In this episode of CodeCast, Terry explains how small documentation improvements can make medical decision making (MDM) clearer and more defensible. Learn how generic or repetitive macro phrases can unintentionally invite payer scrutiny, and what clinicians can do to better reflect the true complexity of the encounter.

With payers increasingly using AI tools to review and downcode E/M services, clear documentation is more critical than ever. Every note should answer the essential question: Why is the patient here today?

Tune in for practical tips to strengthen your documentation and reduce audit risk.

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The post Moderate MDM — Is It Clear in the Medical Record? appeared first on Terry Fletcher Consulting, Inc..

A recurring question in Advanced Primary Care Management (APCM) is whether practices can bill every month for a patient once they’re enrolled — even if no services were provided during that month.

Terry’s stance is clear: no. APCM isn’t a subscription model or a gym membership. These are medically necessary services tied to ongoing clinical need, and billing without documented work invites unnecessary audit risk.

On today’s CodeCast, Terry breaks down why monthly billing without services is problematic, how other consultants interpret the rules, and what practices should consider to stay compliant.

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The post APCM Is Not a Gym Membership appeared first on Terry Fletcher Consulting, Inc..

Are your EMR templates helping—or hurting—your documentation? Terry dives into the difference between pre‑formatted templates and pre‑populated medical records, and why that distinction matters more than most providers realize. Pre‑populated fields can create inaccurate documentation, audit red flags, and even malpractice risk.

Terry also reviews a NAMAS article that sheds light on how this issue is showing up in real audits and what practices should watch for.

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The post Pre‑Populated EMRs Are Not Templates appeared first on Terry Fletcher Consulting, Inc..