Unravel the differences between medical necessity and MDM

Article Overview

This article explains the distinction between medical necessity and medical decision-making in the context of professional coding and reimbursement. It is aimed at coders and physicians who need to understand how chart documentation supports payment, how E/M service levels are assessed, and why payer defense depends on documenting the service appropriately. The discussion centers on broad coding and documentation concepts, with examples drawn from CPT-based services and evaluation and management visits.