BC Advantage - 2020 Issue 7
Medical Necessity, MDM, and 2021 E/M Changes
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Article Overview
This article explains the relationship between medical necessity, medical decision making, and the 2021 evaluation and management changes for office and outpatient CPT services. It is intended for coding professionals and others who need to understand the broader documentation and compliance context behind E/M leveling under CPT and Medicare guidance.
Why This Topic Matters
The article helps readers understand that coding level selection is not solely a matter of MDM scoring and that payer expectations for medical necessity remain central. This matters for compliant E/M documentation, internal policy development, and correct interpretation of the 2021 office/outpatient changes.
What You Will Learn
- How medical necessity fits into office and outpatient E/M service selection
- How 2021 E/M changes altered the approach to MDM
- How Medicare guidance is referenced in the context of E/M leveling
- Why organizations create internal policies related to medical necessity and documentation review
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Practice managers
- Clinical documentation specialists
- Billing staff
Codes Discussed
Code Ranges Discussed
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