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

Pdf Summary

This document emphasizes the importance of proper documentation for medical necessity in order to achieve economic success in the healthcare industry. It discusses various areas of focus for payers, including diagnostic EGD, infusion services, hemorrhoid treatments, and multiple endoscopy procedures, among others. Specifically, with regards to diagnostic EGD, it is essential to have specific documentation in the patient's medical record regarding symptoms and a complete patient history in order to avoid delays in scheduling and preauthorization issues. The document also emphasizes the significance of documenting and coding for medical necessity and specificity in accordance with payer policies and ICD-10 codes. It provides examples of specific documentation requirements for various procedures and conditions. Additionally, the document highlights the importance of accurate and complete documentation for evaluation and management (E&M) services, as well as the importance of reviewing and correcting errors in high-level visits prior to claim submission. It advises providers to pay close attention to the core elements of E&M services and to code for comorbidities and risk factors that impact medical decision making. The document also provides guidance on documentation and coding for endoscopy procedures, including tips for correct billing practices and potential bundling issues. Overall, the document emphasizes the need for thorough and accurate documentation to ensure proper reimbursement and avoid denials or recoupments.

Asset Subtitle

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

Keywords

proper documentation

medical necessity

economic success

diagnostic EGD

infusion services

hemorrhoid treatments

multiple endoscopy procedures

patient's medical record

ICD-10 codes

evaluation and management services