Understanding E/M: Determining medical necessity for high-level visits

Article Overview

This article explains how medical necessity affects E/M code selection for office visits, especially when documentation appears comprehensive but the clinical situation does not support a higher level of service. It is aimed at physicians, coders, and compliance staff who review established patient visit coding and want clearer expectations around documentation, medical decision making, and payer scrutiny. The discussion focuses on general E/M guidelines, auditing habits, and training approaches that help align documentation with the encounter.