ED Coding & Reimbursement Alert - 2017 Issue 8
Compliance: Receive a 99215 Denial? Expert Advice Will Show You What You Did Wrong
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Article Overview
This compliance-focused article explains why certain high-level office and outpatient evaluation and management claims may be denied or reduced and outlines broad documentation and review issues that practices should consider. It is aimed at coders, compliance staff, and physician educators who work with evaluation and management documentation, claim accuracy, and medical necessity. The article also covers general guidance on improving physician documentation habits, reviewing component-level requirements, and avoiding common recordkeeping problems associated with electronic medical records.
Why This Topic Matters
Understanding these documentation and compliance themes can help practices reduce denials, improve claim accuracy, and support more consistent evaluation and management billing processes.
Article Sections
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Make Time for Physician Education
Discusses the value of ongoing physician education and documentation clarification in the coding workflow. The section focuses on communication between coders and providers and the role of education in supporting accurate records.
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Look at Individual Components
Covers a component-by-component approach to reviewing documentation rather than treating the record as a single issue. The section highlights broad discussion areas such as history, time-based considerations, and review of systems.
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Always Strive for Accuracy
Addresses the coder’s responsibility for claim accuracy and the broader compliance risks tied to submitting inaccurate claims. The section discusses general fraud and submission concerns without getting into code-selection details.
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Check Medical Decision-Making and Medical Necessity
Focuses on the relationship between documentation, medical decision-making, and medical necessity in evaluation and management billing. The section also addresses reviewing records before billing and identifying discrepancies with the billed level.
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Voluminous Documentation Does Not Drive Higher Service Level
Discusses problems that can arise when electronic records include excessive or irrelevant information. The section emphasizes keeping the note focused on the current encounter and clinically relevant information.
What You Will Learn
- Why documentation review matters for high-level evaluation and management claims
- How physician education supports better coding compliance
- What broad documentation components should be reviewed separately
- How medical decision-making and medical necessity relate to claim support
- Why excessive electronic note content can create documentation problems
Who Should Read This
- Medical coders
- Compliance officers
- Physician educators
- Revenue cycle staff
- Practice managers
Codes Discussed
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