tci ED Coding & Reimbursement Alert - 2017 Issue 11

You Be the Coder: Know How to Demonstrate Medical Necessity

Question: In your previous issue, there was an article about how the OIG downcoded a claim in which the ED made the decision to admit a patient to the hospital ("This ED Error Is Among CMS's Examples of How Not to Report Claims"). In the article, you noted that the OIG determined there was no medically necessary reason for that admission. We've been in situations when this has happened as well and are wondering what we can do to show why an admission was medically necessary? Supercoder.com Subscriber Answer: The best way to demonstrate medical necessity is with...

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