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Medical Necessity Comes Before Coding

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Manage episode 480953617 series 2490675
Content provided by Terry Fletcher. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Terry Fletcher or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://staging.podcastplayer.com/legal.

The 2021/2023 E/M guideline revisions read: “The evaluation and/or treatment should be consistent with the likely nature of the condition.” Before this, the CPT® guidelines did not discuss medical necessity. Guidance was left to the payers, particularly Medicare, via the Social Security Act.

CMS’s guidance doesn’t necessarily hold regulatory authority. However, it often reflects a new, shared understanding that medical services reported should meet documentation standards for level selection. Those standards should also appropriately indicate why the patient is visiting the provider, based on the presenting problems.

This episode of the CodeCast echoes Terry’s insights that auditors, coders, and medical professionals focus on medical necessity first, then look to coding.

Subscribe and Listen

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Medical Necessity Comes Before Coding appeared first on Terry Fletcher Consulting, Inc..

  continue reading

70 episodes

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iconShare
 
Manage episode 480953617 series 2490675
Content provided by Terry Fletcher. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Terry Fletcher or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://staging.podcastplayer.com/legal.

The 2021/2023 E/M guideline revisions read: “The evaluation and/or treatment should be consistent with the likely nature of the condition.” Before this, the CPT® guidelines did not discuss medical necessity. Guidance was left to the payers, particularly Medicare, via the Social Security Act.

CMS’s guidance doesn’t necessarily hold regulatory authority. However, it often reflects a new, shared understanding that medical services reported should meet documentation standards for level selection. Those standards should also appropriately indicate why the patient is visiting the provider, based on the presenting problems.

This episode of the CodeCast echoes Terry’s insights that auditors, coders, and medical professionals focus on medical necessity first, then look to coding.

Subscribe and Listen

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing: https://www.terryfletcher.net/contact/

The post Medical Necessity Comes Before Coding appeared first on Terry Fletcher Consulting, Inc..

  continue reading

70 episodes

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