Health Information Management

Pay-per-view: Identify elements for appropriate E/M level

APCs Insider, November 22, 2013

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Medical necessity justifies E/M level selection. CMS defines medical necessity as the "services or items reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the ­functioning of a malformed body area."

Medical necessity is often determined on a case-by-case basis. A patient comes in with a broken arm. A patient with documented history of osteoporosis will need different care than an otherwise healthy teenager who fell off a skateboard and broke his arm.

Patients who suffered a traumatic event, such as a motor vehicle accident, may need to be admitted while a patient who is injured in a minor accident at home may not. 

Continue reading Identify elements for appropriate E/M level on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the November issue.

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