Wiki Documentation Question

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Dakota Dunes, SD
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I code for a facility. We are getting denials for a specific procedure because the documentation by the Doctor is not including all of the aspects the insurance requires. Did I miss this in my coding classes? Is this my responsibility to check the documentation for medical necessity documentation?
 
While medical necessity it not necessarily a requirement when coding, we find that it helps when the coding, billing, and physicians work together on these types of issues. If it becomes apparent that specific documentation is required for a code to be payable sharing this information with the coding division as well as the physician can avoid delays and payment issues. By looking for this information prior to billing it can help to bring the issue to the attention of the provider sooner and avoid costly appeals.

In this case I would view it as a teamwork issue and something to be aware of when reviewing the documentation. Work with your supervisor on how they would like this communicated with billing and the provider so that it can be addressed proactively.
 
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