Wiki Eus/egd

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CMITCHELL510

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Good afternoon! I need some advice. An Office Mgr contacted and asked if they perform an EUS, but it does not meet Medical Necessity guidelines for Medicare, can we bill it as EGD, since they have a wider range of medically necessary approved diagnosis codes.
I have always been taught, document what you do, bill what you document. Does anyone have a source for me to reference on the subject of changing the procedure in this circumstance?
Thanks so much for your help!
 
coder's golden rule

Your are right...If it not documented, it was not performed.;) Coding just to get reimbursement without supporting documentation is wrong!!
 
Code from the operative report!!! DO NOT alter your codes just for payment. If it does not meet medical necessity guidelines prior to the procedure, you may wish to have the patient sign an ABN and hold them responsible for payment should the case be denied.
 
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