Medical Necessity

I am reviewing an I&D and the note states "I did not recommend I&D, but the patient's wife insisted."

Since this doesn't appear to be medically necessary according to the provider, I am wondering if it's even billable to Medicare?

This was for a shingles outbreak and no ABN was obtained.


  • You are correct. If the provider did not document that it was medically necessary to perform the I&D, the procedure is not billable to Medicare.

    And without an ABN you probably will not be able to bill the patient either.

    Sent from my iPhone

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