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Differentiating between Medical Necessity and Medical Decision Making
Evaluation and management (E/M) services are the most vulnerable to billing errors because it is complicated to select the proper code for the level of service captured in the documentation. A firm grasp of the differences between medical decision making (MDM) and medical necessity can improve your claims payment rate, as well as make the external audit process much easier, should an audit occur. MDM is a key component of an E/M service, in addition to history and physical exam.
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