Last month I wrote about how important it is to get ready for dual coding. That is critical for any successful transition to ICD-10. This month, let’s focus on physicians, who are another driving force in this area.

One of the issues that keeps cropping up when working with hospitals and physician groups is that physicians are asking “what’s in it for me?” That is quite an obstacle to overcome. Granted, there is no monetary return associated with ICD-10 for the practitioners, but they need to understand that the diagnoses and the conditions they are treating need to be supported by medical necessity – and according to the Centers for Medicare & Medicaid Services (CMS) medical necessity is the “overarching criterion.” Without evidence of medical necessity, it does not matter what CPT/HCPCS code is submitted; the claim will not be paid. 

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