tci E/M Coding Alert - 2019 Issue Q3

Reader Question: Know How to Determine Medical Necessity

Question: My practice has had a couple of claims denied. The payers said the services rendered by our practice’s physician were not “medically necessary.” I’m sure the physician thought the services were medically necessary — otherwise he wouldn’t have ordered or performed them. What definitions are payers working from? Delaware Subscriber Answer: According to the American Medical Association’s (AMA’s) 2011 report to the Institute of Medicine’s Committee on Determination of Essential Health Benefits, the AMA defines medical necessity as “Health care services or products that a prudent physician would provide...

To read the full article, sign in and subscribe to tci E/M Coding Alert.


Stay informed, get answers to your E/M coding and documentation questions, and find the help you need to bank your deserved pay with your subscription to TCI’s E/M Coding Alert.

  • Current newsletters added each month
  • Fully searchable archives - over 500 articles
  • ALL years/issues back to 2013 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles
Access to this feature is available in the following products:
  • tci E/M Coding Alert +Archives

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.