DecisionHealth, DecisionHealth - 2024 Issue 5 (May)

MAC demand: Medical necessity controls coverage of preop E/M visits

Pay close attention to medical necessity when a provider schedules a patient for a preoperative visit and you code the E/M visit. Even though a hospital may require preoperative clearance for surgery patients, Medicare controls whether it will pay for the visits. Surgeons may have more leeway than specialists when they perform certain preoperative visits, but they must still support medical necessity to protect their patients from an unexpected bill and the practice from unexpected denials.

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