6. Define medical necessity as it applies to procedural and diagnostic coding. (IX.C.5) 7.Describe how to…
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Question “6. Define medical necessity as it applies to procedural and diagnostic coding. (IX.C.5) 7.Describe how to…”
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6. A physician can provide any healthcare service that is reasonable in clinical judgment to a patient as medical necessity. The healthcare service must be used to diagnose, treat, or prevent an injury or illness. A medical necessity is an essential element for any medical service. The diagnostic coding (ICD), and procedural (CPT), codes are used to indicate the medical necessity. The procedure code describes the medical procedures that were performed during the visit to the healthcare facility. It includes radiology, laboratory, radiology and surgical procedures. While the diagnostic code is a doctor’s diagnosis and description of a condition or disease, the diagnostic code refers to the physician’s diagnosis. These codes are used during billing to determine medical necessity.
7. Effectively using the most recent procedural coding system involves reading, analysing, and abstracting all services or procedures in the patient’s medical record. The operative report and any other patient-detail documentation are then used to verify that all procedures have been recorded. The alphabetic index search of CPT codes will identify the correct codes and allow you to assign them. CPT (Current Procedural Terms) codes consist of five characters. They are mostly numeric, or have a fifth alpha character.
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