tci Part B Insider - 2010 Issue 7

PART B CODING COACH: Beef Up Your Diagnosis Know-How for Medical Necessity

Keep these guides in mind to help prove your case. With payers tightening the reins on reimbursement, establishing medical necessity for your doctor's services can be one of your biggest coding challenges. Follow our real-world tips for choosing the best diagnosis to establish the need for anesthesia and help keep your reimbursement intact. Study the Patient's Circumstances Medicare defines "medical necessity" as services or items reasonable or necessary to diagnose or treat an illness or injury, or to improve the functioning of a malformed body member. Payers consider each case individually to determine if the treatment method is reasonable...

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