Outpatient Facility Coding Alert - 2023 Issue 12
Reader Question: See Red Flags on This Patient Visit Proposition
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Article Overview
This article explains a billing and documentation scenario involving a new patient encounter divided across three separate days, with a mix of video and in-person services. It is aimed at coding and reimbursement professionals who need to understand how multi-day encounter documentation, evaluation and management billing elements, and payer scrutiny can affect claim handling. The discussion focuses on general guidance for separating work by date of service and the risks associated with incomplete or redundant visit components.
Why This Topic Matters
Multi-day patient encounters can create documentation and billing risk if services are split across dates without meeting evaluation and management requirements. Understanding the scope of the issue helps coders and billers recognize when claims may be problematic and when payer review may be triggered.
What You Will Learn
- How a new patient encounter split across multiple days is viewed from a billing perspective
- How telehealth and in-person components can create documentation challenges
- Why evaluation and management elements must be considered by date of service
- What types of claim patterns may raise payer scrutiny
Who Should Read This
- Medical coders
- Coding auditors
- Billing specialists
- Practice managers
- Compliance staff
- Revenue cycle professionals
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