Does AAPC expect examinees to select the E/M code based on medical necessity?

The expectation regarding the selection of Evaluation and Management (E/M) codes does not hinge solely on medical necessity in the context provided by the AAPC for coding standards. While medical necessity is a fundamental principle in the broader healthcare coding process, which ensures that services provided are appropriate and necessary, the AAPC's emphasis in an examination context may instead focus on the accurate selection of codes based on the specific elements and criteria outlined in the code descriptor and accompanying guidelines.

E/M coding involves various components such as the level of history, examination, and medical decision making, all of which contribute to determining the appropriate code. These elements must be thoroughly documented and meet the criteria set forth by the coding guidelines to qualify for a particular level of service. Therefore, while medical necessity is important in overall healthcare service provision, the coding exam focuses on understanding the procedural and documentation requirements needed for correct code selection, rather than applying medical necessity as a standalone criterion.

This understanding underscores the significance of adhering to specific coding guidelines rather than exclusively relying on medical necessity when selecting E/M codes in an examination context.