Medicare medical necessity for SI injection, etc

[slochbihler@ppmnow.com]

Good morning!

I am fairly new in the pain arena and was hoping to get some clarification on this issue. Does Medicare medical necessity have to be met each time a procedure is performed (ex. failed 3 months of conservative therapy, meds, PT) or is it appropriate when it is documented in their new patient visit? My co-worker and I are interpreting this a little differently as to what needs to be documented each time a procedure is performed. Thanks!

 

[SharonCollachi]

Yes, medical necessity always has to be met. Does it have to be met in YOUR practice, or can it be met elsewhere, is I think the real question you are asking. If the patient failed three months of conservative therapy and is referred to you for injection, you don't have to start the three months over.