Physicians Practice: Proper Coding Can Help Prove Medical Necessity

Submitting claims for payment can be challenging; a provider must document the diagnosis reported to help support medical necessity of the procedure. AAPC Director of Education Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, was recently highlighted by Physicians Practice discussing what documentation is required from a provider for the proper code to be reported and to ensure the claim is paid.

“For a service to be considered medically necessary, it must be reasonable and necessary to diagnosis or treat a patient’s medical condition,” she says. “When submitting claims for payment, the diagnosis codes reported with the service tells the payer “why” a service was performed.” The article then expands on what must be done and the challenges to overcome when submitting claims.

Read the full article.


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