AAPC
CPB · Question #233
Which scenario would most likely result in a claim denial for lack of medical necessity?
The correct answer is B. Diagnosis code does not support the procedure. Medical necessity denials occur when the diagnosis does not justify the billed service.
Querying and Performance
Question
Which scenario would most likely result in a claim denial for lack of medical necessity?
Options
- AMissing modifier
- BDiagnosis code does not support the procedure
- CLate filing
- DIncorrect patient demographics
How the community answered
(38 responses)- A3% (1)
- B84% (32)
- C8% (3)
- D5% (2)
Explanation
Medical necessity denials occur when the diagnosis does not justify the billed service.
Topics
#medical necessity#claim denial#diagnosis-procedure alignment#coding
Community Discussion
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