Wiki Medical Necessity Coding

[elizabeth24]

In regards to coding and meeting medical necessity, specifically in the ER, if a patient presents with CP, SOA and edema, and the physician orders a BNP, but the tests rule out CHF or MI, and final dx is COPD exacerbation, would you all pick up the SOA as a symptom in order to meet medial necessity?

 

[clayjagod1]

In regards to the medical necessity of the service, I would check with your MAC. I found numerous LCD's defining which diagnoses meet medical necessity. Palmetto GBA and CGS were both slightly different in what they considered as medically necessary diagnoses.