Lack of Medical Necessity

by  ChiroCode
November 19th, 2016

(from page 210 in chapter 3.5 of the 2017 DeskBook) One of the biggest problems providers face when audited is that many services are deemed not medically necessary and are routinely denied. Much of the proof falls back on the medical record.

Here are some specific situations as they may relate to audits. 

Two of the most common services performed on a routine basis, without medical necessity, include 97010 (hot or cold packs) and 97012 (mechanical traction). For more help on audit issues and how to avoid them, see chapter 3.5 of your 2017 DeskBook.

Lack of Medical Necessity. (2016, November 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/lack-of-medical-necessity-34794.html

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