AHA Coding Clinic® for HCPCS - 2004 Issue 2

Coding for medical necessity

While the issue of coding for medical necessity may focus on ICD-9-CM diagnosis coding and the focus of this publication is HCPCS coding, we have received many questions in the past few months regarding this topic. Therefore, we are publishing this article as a service to our readers. What is medical necessity? Medicare is required by statute to pay for services that meet medical necessity. This is defined as services and items found to be reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member. Types of...

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