nmlalagirl
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It has been taught that Medical Decision Making drives the level of the visit. Can anyone show me in CMS or Novitas where this is documented? Is this incorrect?
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Wiki Medical Decision Making - Is this incorrect
- Thread starter nmlalagirl
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RebeccaCross*
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While some carriers may have this policy, CMS' guideline is medical necessity.
Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported. The service should be documented during, or as soon as practicable after it is provided in order to maintain an accurate medical record.
Page 39
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
Check with your MAC/carriers for their policy...
Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. Documentation should support the level of service reported. The service should be documented during, or as soon as practicable after it is provided in order to maintain an accurate medical record.
Page 39
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
Check with your MAC/carriers for their policy...
nmlalagirl
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Thanks Rebecca, this helps!
I know Trailblazer had this policy but could not find in Novitas.
I know Trailblazer had this policy but could not find in Novitas.