tci Part B Insider - 2015 Issue 23

Part B Coding Coach: Ensure Medical Necessity Before Leveling Your E/M Services

Key: MDM and medical necessity are not the same. If you are reporting high level E/M codes because your provider says that the patient was very ill or the case was highly complex, but you don’t have the documentation to back it up, your claim could cost your practice time and money. Medical necessity is the key to successful coding and reimbursement, and if you can’t support your code choice with documented medical necessity, your payer will toss the claim back on your desk without appropriate reimbursement. Review these expert tips to ensure you understand what medical...

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