2023 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2022-The Key to Economic Success: Perfecting Proper Documentation for Medical Necessity

Video Transcription

Video Summary

The video discusses various topics related to medical necessity, documentation, and billing in the context of endoscopy procedures. The speaker emphasizes the importance of documenting medical necessity to ensure pre-authorization and prevent claim denials. Several payers require pre-authorization for endoscopies, and lack of documentation supporting medical necessity can lead to delays in scheduling and non-payment. The video also highlights specific indications for diagnostic EGDs and emphasizes the need for detailed documentation of symptoms and therapeutic measures already attempted. The speaker mentions that payers are closely reviewing ICD-10 codes for specificity and lack of specificity can lead to claim denials. The importance of complete and legible documentation is emphasized, including the reason for the encounter, relevant history, physical exams, assessment, impression, diagnoses, and plan of care. The speaker also briefly discusses coding for medical necessity, highlighting the need for specific diagnosis codes and documentation supporting the level of service billed. Tips are provided for endoscopy billing, including coding for snare and biopsy, infusion services, EM visits, and specific procedures such as double balloon enteroscopy and ERCP. The video concludes by reminding listeners to submit documentation in a timely manner, keep up to date with payer policies, and emphasize the importance of accurate and specific documentation in order to ensure proper reimbursement.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QGMC, CCS-P, ICD-10 Proficient

Keywords

medical necessity

documentation

billing

endoscopy procedures

pre-authorization

claim denials

diagnostic EGDs