Identify linkage between diagnosis and procedure codes in relation to medical necessity
Apply medical necessity guidelines to real life scenarios in order to ensure accuracy in coding
Apply knowledge of coding principles by assigning accurate and precise outpatient procedure codes
Task: Read the following scenario and apply knowledge of coding principles to assign accurate and
precise procedure codes, utilizing medical necessity guidelines.
Standards: Perform this objective within 30 minutes with a minimum score of 74.
PART I: Define medical necessity as it relates to diagnostic and procedural coding.
(Answers must be written in complete sentences).
PART II: Read the following scenario and answer the questions that follow, using the CPT Manual and your
knowledge of medical necessity guidelines.
On 10/15/2022, patient, Jason Jones visited his surgeon, Dr. Mariah Keith. The patient had been
experiencing occasional rectal bleeding. The surgeon performed a colonoscopy that extended to the
cecum. A biopsy was taken of tissue from the ascending colon. The source of the bleeding was not
found. At this visit, the patient also complained of lower back pain and the surgeon ordered a lower
back x-ray. The x-ray was done at this same visit. The diagnosis submitted for the visit was rectal
a) Assign CPT codes for all procedures performed during this encounter.
b) Utilizing medical necessity guidelines, discuss any issues with the linkage between diagnosis and
procedure codes submitted for this encounter. Will the provider be reimbursed for all procedures?
Why/why not? Please be specific in your response.