Which involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service?

Answer 1

The process of linking every procedure or service code reported on a claim to a condition code that justifies its necessity is known as medical coding or medical necessity documentation. This ensures that the services billed are appropriate and necessary for the patient's diagnosed condition, which is critical for reimbursement by insurance companies. Accurate coding helps prevent claim denials and ensures compliance with healthcare regulations. Ultimately, it supports the integrity of the healthcare billing process.