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Wiki Outpatient Facility Coding for Medical Necessity

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naturegirl1978

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Hi, I work in Pre-bill Coding within Outpatient Facility. Our department codes to help support medical necessity per insurance coverage policies, while still trying to maintain quality and stay within current coding guidelines. Is anyone aware of any rules that state that we can't go outside of a current encounter's documentation? What I mean by this is; is it okay to go to an associated encounter for like when a patient is referred for a study or procedure, etc.? Any help would be appreciated and if you happen to have any links to support your answer, that would be most helpful! Thank you in advance!
 
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