Wiki Medical Necessity

[mlandrus]

I am reviewing an I&D and the note states "I did not recommend I&D, but the patient's wife insisted."

Since this doesn't appear to be medically necessary according to the provider, I am wondering if it's even billable to Medicare?

This was for a shingles outbreak and no ABN was obtained.

Thank you in advance for your help!

 

[thomas7331]

I would not draw that conclusion from this statement alone. Providers may recommend against something for reasons other than medical necessity, for example, because the risks outweigh the potential benefits. Since the provider opted to do this and it is not a cosmetic procedure, I would query or discuss it with the provider to get their input if you feel the documentation does not support the necessity of the procedure. It's always best to leave decisions about medical necessity to the clinicians.