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

Video Transcription

Video Summary

In this video, the speakers discuss various topics related to medical necessity and documentation for billing purposes. They emphasize the importance of ensuring that the documentation supports why certain procedures are being performed and why patients are being seen. They mention that payers often require pre-authorization for procedures and that without medical necessity, services may not get paid or may even face recoupment of previously paid services.<br /><br />The speakers cover specific topics such as medical necessity for diagnostic EGD, infusion services, hemorrhoid treatments, multiple endoscopy, pathology and special stains, screening versus diagnostic colonoscopy, and evaluation and management services. They provide examples and tips for each topic, highlighting the need for specific and detailed documentation to support the medical necessity.<br /><br />They also discuss the principles of medical record documentation, emphasizing the importance of complete and legible documentation that includes the reason for the encounter, relevant history, physical exam, diagnostic test results, assessment and plan of care, and identity of the observer. They stress the need for accurate coding based on the documentation in the medical record.<br /><br />The speakers provide coding tips for various procedures including snare and biopsy, infusion services, ERCP, endoscopic mucosal resection, and hemorrhoid treatments. They discuss bundling of certain procedures and the need for specific documentation to support separate billing when applicable.<br /><br />Overall, the video highlights the importance of accurate and detailed documentation to support medical necessity and ensure proper reimbursement for services rendered.

Asset Subtitle

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

Keywords

medical necessity

documentation

billing purposes

pre-authorization

diagnostic EGD

infusion services

hemorrhoid treatments