Medical Necessity ≠ Medical Decision Making

E&M code selection depends on understanding the difference

Mary LeGrand, RN, MA, CCS-P, CPC

When coding evaluation and management (E&M) services, coders—including physicians—may experience some confusion related to the terms “medical necessity” and “medical decision making.” The two terms are not synonymous for the purpose of selecting E&M codes, and failure to understand the difference between them can lead to incorrect coding of E&M services, as well as cause problems in physician education and billing audit services.

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