Strong Documentation Gets Your E/M Claims Paid

Strong Documentation Gets Your E/M Medical Billing Claims Paid

When billing a medical claim, the diagnosis code is one of the most important elements to prove medical necessity. As soon as a payer gets a claim, it automatically goes through their system and is either paid, denied, or sent to review. Billing with strong documentation to back up medical current procedural terminology codes will get claims paid quicker.

Many times with simple evaluation and management visits, the only thing needed in billing a claim is the medical CPT code and the ICD-9 code. When this is the case, it is very important that these codes not only correctly correspond, but are also the most descriptive codes available. An ICD-9 code, for example, can have anywhere from three to five digits. The more digits, the more descriptive the code. Three digit codes are very rarely paid without a request for more information. Many insurance companies will automatically deny these three digit claims and wait for a more descriptive medical billing to be completed.

There are other evaluation and management visits that are more complex and require more then just a CPT and ICD-9 code for medical billing purposes. In these situations medical providers must provide documentation of medical necessity when billing. In these situations it is best for the medical biller to submit all information that could be pertinent to the claim. The payer may miss something important if it is not clearly and accurately documented by the physician or medical billing personnel.

No payer would pay a claim that wasn’t medically necessary. Accurate CPT and ICD-9 coding, as well as complete documentation will prove a claim’s medical necessity. Strong documentation and coding will ensure medical billing for a certain claim to be done one time, and one time only.

View all Articles by: Melissa Clark, CCS-P