decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 11 (November)
Medical necessity drives E/M level, not MDM, AMA says
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Article Overview
This article explains a Medicare- and AMA-referenced interpretation of evaluation and management (E/M) coding, focusing on how medical necessity relates to the documented components of a patient encounter. It is intended for coders, billers, compliance staff, and physicians who want a better understanding of E/M documentation concepts, including how the presenting problem fits into overall service-level determination.
Why This Topic Matters
Understanding the relationship between medical necessity and E/M leveling helps coding and clinical staff align documentation with the level of service reported and reduces confusion around how E/M support is assessed.
What You Will Learn
- How AMA and Medicare guidance frame medical necessity in E/M coding
- How the presenting problem relates to overall documentation review
- How different documentation elements are discussed in the context of E/M level selection
- Why coders and physicians may interpret E/M leveling guidance differently
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physicians
- Practice managers
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