Medical Necessity / Let medical necessity drive all of your code choices

Article Overview

This article discusses evaluation and management coding from a payer-oriented perspective, focusing on how medical necessity shapes billable service levels. It explains the role of the presenting problem within CPT E/M documentation concepts, why history and exam alone may not support the billed level, and why coders and clinicians need to consider whether services are tied to the reason for the encounter. The piece is aimed at those involved in E/M documentation, coding, and reimbursement review.