decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 7 (July)
MDM not officially “required,” but-
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Article Overview
This article addresses a coding question about established patient office visits that use two of three key E/M components. It summarizes a Medicare carrier response and explains the general documentation and medical necessity context that matters to coders working with evaluation and management services.
Why This Topic Matters
It helps coders, auditors, and compliance staff understand how payer guidance may affect E/M documentation review and code selection for established patient visits.
What You Will Learn
- How a payer frames the role of medical decision-making in established patient E/M documentation
- Why medical necessity remains important in visit support
- How Medicare carrier guidance can inform documentation review for E/M services
- What broad documentation components are discussed for established patient visits
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physician documentation staff
- Billing professionals
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