Medical Necessity in Documentation & New Prolonged E/M Coding Updates 2025

Event Materials (Key Required)

Course Description

Learn how proper documentation will not only help with medical necessity, but also compliance concerns. Coding staff will understand the correct way to query, while providers will learn the importance of accurate documentation. In healthcare documentation, medical necessity justifies the use of specific services or interventions, ensuring that they are consistent with the patient’s clinical needs, supported by evidence, and aligned with accepted clinical practice.

A well-documented statement of medical necessity includes:

• Clear Diagnosis: The condition being treated or investigated must be clearly identified and documented.
• Reason for Treatment: A detailed explanation of why the treatment, test, or service is required, including how it directly addresses the patient’s clinical situation.
• Evidence-based Justification: References to current clinical guidelines, studies, or recognized protocols that support the treatment plan.
• Expected Outcome: Documentation of the anticipated benefits or goals of the treatment in relation to the patient's health improvement or condition stabilization.

This documentation is crucial for insurance purposes, ensuring that the services provided are eligible for reimbursement, and for compliance with regulatory and ethical standards.

Learning Objectives

• Define Medical Necessity
• How Documentation Affects Code Assignment
• Discuss Difference Between Medical Necessity and Medical Decision Making (MDM)
• How Medical Necessity Affects Diagnosis Coding
• Medical necessity and HCC Capture via M.E.A.T.
• Challenges to Obtain Proper Documentation for Medical Necessity
• Real Chart Examples to Demonstrate Importance of Medical Necessity

Areas Covered in the Session

• 2021/2023 E/M Guidelines
• Diagnosis Documentation
• HCC Capture via M.E.A.T. Documentation
• Comparative Billing Reports (CBR)
• Social Drivers of Health (SDoH)
• Add on Complexity Code – G2211
• E/M with Minor Procedure
• Live Q&A Session

Suggested Attendees

• Healthcare Providers or Physicians
• Administrators
• Medical Billers
• Claims Coders
• Revenue Cycle Managers
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Office Managers
• Practice Manager
• Chief Financial Officers
• In and Out of Network Providers
• Medical Billing Companies
• Hospitals and Facilities
• Insurance Companies
• Healthcare Attorneys
• HIM Staff

About the Presenter

Susan Rohde, RHIT, CCS-P, CPC, has more than 28 years of experience in health care industry with an emphasis in coding, health information management, medical necessity and documentation. Susan is currently serving on the education committee for NSCHBC. Her other memberships include AHIMA, NDHIMA, AAPC, NSCHBC, HFMA and MGMA. She specializes in reviewing documentation for accurate reimbursement within Evaluation and Management (E/M) and all surgical specialties, including Interventional Radiology, Anesthesia, Neurosurgical, and Orthopedics, for both ICD-10-CM and CPT codes. Susan helps navigate the ever-changing coding and documentation world and can help your organization in maximizing its coding potential via proper documentation, provider and coding staff education, and understanding of guidelines and regulations.

Additional Information

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live? No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience.

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

Purchase Order Form - Click Here to download PO form. 

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