Mar 30th, 2017
Since electronic medical records (EMR) have become prevalent, there has been concern whether documentation in the patient record accurately reflects medical necessity and the services provided. When I started working in the healthcare setting, we always told providers, “Not documented, not done.” Now, when I review a chart note, the question I have to ask ...
What is the primary driver of an E/M level? Find out what lands the knockout punch. By Brian Meredith, CPC Per the CPT® codebook, medical decision-making (MDM) “refers to the complexity of establishing a diagnosis and/or selecting a management option as measured by” three criteria categories. MDM can be quantified according to this criteria, and ...
Two Medicare cases illustrate the importance of NCDs and LCDs. Proving medical necessity is really no secret at all: Medicare national coverage determinations (NCDs) and local coverage determinations (LCDs) dictate which diagnosis codes must be documented by clinicians to support the medical necessity of most services or supplies they provide to patients. Coders who are ...
In Audit
Jul 1st, 2014
Medicare’s Claims Processing Manual, section 30.6.1.A, stipulates, “Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code.” But in the everyday struggle to assign E/M codes, medical decision-making (MDM) is usually the best indicator of the E/M service level. When two of three components ...
In Billing
Mar 3rd, 2014
When evaluating documentation for the history component of an evaluation and management (E/M) service, keep in mind: A chief complaint is a medically necessary reason for the patient to be meeting with the physician. A readily identifiable chief complaint is the first step in establishing medical necessity. Without a chief complaint, the service is preventive. ...