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

Event Materials (Key Required)

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

Presenter Biography:

---

Additional Information:

System Requirement:

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

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

---

Purchase Order Form – Click Here to download PO form.

---

Snippet From Our Previous Session