CodingQuestion 15 of 100
In coding, 'medical necessity' generally means that a service is:
a.Reasonable and necessary for the diagnosis or treatment of the patient's condition
b.The most expensive option available to the provider
c.Requested by the patient regardless of clinical indication
d.Always covered by every insurance plan
Explanation
Medical necessity is the standard that a service must be appropriate and needed to evaluate or treat the patient's documented condition to qualify for payment. The diagnosis code must support the procedure code billed. Services deemed not medically necessary are commonly denied even when correctly coded.
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