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Ep procedure Documentation

Ep procedure Documentation
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ACCURATE REIMBURSEMENT REQUIRES COMPLETE DOCUMENTATION Consistent, detailed, accurate and timely documentation in the medical record is the basis for obtaining appropriate reimbursement. With complete information in the record, coders can effectively analyze, code and report necessary information for physician and facility claims. OPTIMIZE REIMBURSEMENT, MINIMIZE DENIALS Timely and appropriate payment for services is important for your institution and your practice. This guide provides recommendations to facilitate accurate claims processing. APPROPRIATE DOCUMENTATION IS ESSENTIAL For accurate reimbursement, the medical record must contain documentation that fully supports the procedures performed. Appropriate documentation is essential and will allow: DETERMINATION OF INPATIENT OR OUTPATIENT STATUS EP procedures may be performed as either inpatient or outpatient services. Documentation must include sufficient detail to help the coding staff capture all services and to ensure assignment to the correct patient status. For the inpatient setting, the chart must include a physician order demonstrating medical necessity for inpatient admission, such as the severity of the patient's signs and symptoms, medical predictability of an adverse event, the need for diagnostic studies that appropriately are outpatient services, and/or the expectation of a two-midnight stay. ASSIGNMENT TO CORRECT DRG For each admission, the assignment of the MS-DRG is driven by principal diagnosis, secondary diagnoses and procedures performed. To ensure correct MS-DRG assignment, documentation should include: • All diagnoses, procedures, complications, comorbidities and abnormal test results • Suspected conditions and any tests performed to investigate these conditions ICD-10-CM / ICD-10-PCS More detailed and precise information in the record is often necessary to accurately assign codes in ICD-10-CM/ICD-10-PCS. The ICD-10 updates for the Fiscal Year (FY) 2019 reflect continued refinement of the new system, with hundreds of new and revised codes. CMS and other reviewers may use coding specificity as the reason for an audit or a denial of a reviewed claim. THIRD PARTY PAYER AUDITS In addition to the RAC post-payment reviews, Medicare Administrative Contractors (MACs) and commercial payers also perform pre-payment and post-payment reviews on select claims. Documentation is reviewed to ensure the service meets plan coverage criteria, is properly coded, assigned to the correct patient status, and compliant with documentation rules.

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COMMUNICATE AND EDUCATE A cross-functional team with a common goal that practices open communication is essential for optimizing reimbursement and minimizing denials. Provide coding staff with clinical education and case observation to enhance their understanding of EP procedures. This will improve their accuracy when processing claims. Additionally, provide clinical staff with reimbursement and coding resources to assist with capturing comprehensive product and procedure data. Communication and education are keys to an effective reimbursement process. THERMOCOOL® Navigation Catheters are...

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