tci Medicare Compliance & Reimbursement - 2021 Issue Q3

Documentation: Manage Claims Success With Medical Necessity Smarts

Tip: Clear and concise documentation can validate medical necessity, too. A firm grasp of what medical necessity means can not only bolster your coding, but it can help you avoid denials and audits. Additionally, understanding the concept of medical necessity is crucial to confidently incorporating the 2021 office/outpatient E/M service codes and perfecting the accuracy of your coding. Know the Nuanced Definitions for ‘Medical Necessity’ Definitions of the term are, unsurprisingly, varied — and vague. However, there is some consensus among various medical institutions, according to Kim Huey, MJ, CPC, CPCO, COC, CHC, CCS-P, PCS, president, KGG Coding...

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