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“Medical necessity” is difficult to define, with as many different interpretations as there are payers; however, most definitions incorporate the idea that healthcare services must be “reasonable and necessary” or “appropriate,” given a patient’s condition and the current standards of clinical practice. Yet typically, the decision as to whether services are medically necessary is made […]
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When preparing medical documentation and coding medical conditions, keep these 10 principles in mind to demonstrate medical necessity for services reported: List the principal diagnosis, condition, problem, or other reason for the medical service or procedure. Be specific when describing the patient’s condition, illness, or disease. Distinguish between acute and chronic conditions, when appropriate. Identify […]
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