Alexus Robinson
MCCG212- Medical Necessity W6
Scenario #1
- ICD-10-CM Code(s): Z01.419 Encounter for gynecological examination (general) (routine)
without abnormal findings, N92.4 Excessive bleeding in the premenopausal period, N94.6
Dysmenorrhea, unspecified. Medical necessity has been met in this scenario. The Gynecologist has
ordered an abnormal ultrasound because the patient has come with complaints of painful cramps during
menstruation and an abnormally heavy flow. Amy is also expressing symptoms of an abnormal iron level
as she is feeling weak and tired when she is on her period.
Scenario #2
– ICD-10-CM Code(s): W10.8XXA Fall (on) (from) other stairs and steps initial encounter,
M79.662 Pain in left lower leg, M25.572 Pain in left ankle and joints of left foot, E10 Type 1 diabetes
mellitus
Scenario #3
– In this case I believe the auditor Annmarie is correct. The doctor should not be ordering
test for every over 50 ever year if they are not at risk with close relatives that have been diagnosed with
prostate cancer.
Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher
anything lower should be every 2 years.
Scenario #4
– In this case I don’t believe medical necessity has been met. Karen has tried different
methods to relieve pain and nothing has provided any relief, however there isn’t any evidence that she
to move forward with a spinal nerve ablation in her lower lumbar and sacral area. The orthopedic
specialist should recommend further diagnostic tests, therapy or medication before moving forward with
this option.
