Coding and Reporting Medical Necessity:
Essentials for Coders and Other Healthcare Professionals
Wednesday, April 26, 2017
1:00-2:30 p.m. Eastern
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC
Level of Program:
Coders and physicians or other clinicians may have completely different interpretations and definitions of medical necessity. Third-party insurance payers—and patients themselves—may have still other understandings and applications of the term. Getting everyone on the same page can be very complex, but for coders, billers, and clinicians, it’s crucial to reimbursement. If clinicians are not documenting appropriately per medical necessity guidelines, coders and billers will not be able to report the most accurate codes to support a service.
Join expert speaker Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA-approved ICD-10-CM/PCS trainer, as she explains how to find and interpret local coverage determinations (LCD) and national coverage determinations (NCD). Participants will also be able to enhance their facilities’ operation through knowledge gained from this program’s real-life medical necessity case studies and denial and appeal examples.
At the conclusion of this program, participants will be able to:
- Define medical necessity as it relates to patients, payers, and providers
- Recognize the relationship between coding and medical necessity
- Locate and interpret LCDs and NCDs
- Explain documentation details necessary to prove medical necessity
Who Should Listen?
- Coding managers and staff
- HIM managers and staff
- Finance staff and billers
- CDI managers and staff
- What is medical necessity?
- The importance of medical necessity
- Definitions for CMS, third-party payers, and physicians
- Third-party payers
- Pre-authorization and referrals
- Medical necessity denials
- Medical necessity appeals
- Documenting medical necessity in ICD-10
- CDI—office/outpatient care—place of service
- CDI—inpatient/critical care
- Important ICD-10-CM coding guidelines
- Case studies
- Bariatric medicine cases
- Capsule endoscopy versus traditional endoscopy for colon cancer
- Breast reduction surgery (male and female)
- Sclerotherapy—varicose veins
- Live Q&A
Meet the Speaker
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA-approved ICD-10-CM/PCS trainer, is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist with more than 20 years of experience. Her coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding.
Webinar system requirements and program materials:
To fully benefit from the webcast experience, please note you will need a computer equipped with the following:
Internet: 56K or faster Internet connection (high-speed connection recommended)
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices
Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location.
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