There isn't medical necessity per se. That could be consider fraud if they already knew what they were going in for. In other words, if it has already been DX'd than there isn't medical necessity for a DX laps. and is fraud. With that said, if it's truly a DX you should be OK. If that's the case, code it and put a V64.41 as a secondary on the open. Either way you need to use V64.41 to show your conversion.
CCI is not a perfect system so don't rely on it for everything. They don't always bundle procedures that have already existing policies or guidelines.
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