Question: Why is it so important for our documentation to be complete if it isn’t being sent out with the claim?
Full documentation allows coders and billers to properly submit claims to insurance companies with accurate and correct codes. Even in this day and time, when claims are sent electronically to the insurance, it is the responsibility of the provider to make sure all the information submitted is complete. In the event the insurance company decides they need documentation of the claim prior to payment, they will suspend payment until they receive what is needed from the provider.
Example: Multiple post-op pain blocks – provider performed an adductor canal block (64447) at surgeon request after a total knee replacement. Hours later patient is still in severe pain so surgeon requests an additional femoral block is placed (also 64447). Both blocks can be billed but insurance will likely deny one or both of them without proper documentation.