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The all-encompassing guide to medical necessity

Procedures, and the reasons for performing them, are the core of establishing medical necessity.

While coders are responsible for reporting procedures with the correct codes, they must coordinate with billers and physicians to ensure documentation includes the proper diagnoses to meet payers’ medical necessity requirements.

Reporting a code for a procedure that is not deemed medically necessary by payers, including CMS and third-party companies, means that code will not be paid—even if the physician believes the procedure was clinically necessary.

The Complete Guide to Medical Necessity: JustCoding’s Training and Education Toolkit, by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, combines a book-length PDF, a full-length webinar, and other essential tools and downloadable information to provide coders with the training they need on properly coding while staying compliant with medical necessity requirements.

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