Question

What is medical necessity? Explain in detail how you can provide medical necessity in coding. Provide one example of how codes work to identify medical necessity. in 300 words

Answer 1

WHAT IS MEDICAL NECESSITY:

it is a united states legal doctrine ,related to activities which may be justified as reasonable ,necessory ,and appropriate based on evidence based clinical standards of care.

how can you provide medical necessity in coding:

It plays main role in the coding ,,,,

• For a sevice to be considered medically necessary ,it must be reasonable to diagnosis ,to treatment a patient condition .
• codes reported with the services tells the payer why a service was performed
• it will help in summbmitting the claims forpaymenyt.
• medical necessity help to evaluating ,diagnosing or treating an illness ,injury.
• medical coding help the insurer to claim the numbers for any diagnostic evaluation
• for example : a patient present to the office with chest pain and physician orders an ECG.A 12 lead ecg performed in the office and interpretted by the physician is reported withCPT CODE 93000=
• . The reason the physician orders the ECG is because the patient is cimplaining of chest pain .the diagnosis code for unapecified chest pain is 786.59.