If the Reported Services Are Deemed NOT Medically Necessary at the Level

question 42

Multiple Choice

If the reported services are deemed NOT medically necessary at the level reported, the claim will be:

• A) denied.
• B) downcoded.
• C) upcoded.
• D) pended.

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Definitions:

Nasal Cannula

A device used to deliver supplemental oxygen or increased airflow to a patient in need of respiratory help, consisting of a lightweight tube that splits into two prongs placed in the nostrils.

Pneumonia

An infectious disease characterized by the inflammation of the air sacs in one or both lungs, filling them with fluid or pus.

Fever of Unknown Origin (FUO)

A medical condition characterized by a prolonged fever of at least three weeks duration without an established cause after initial investigation.

Febrile

Relating to or characterized by an elevated body temperature, indicating fever.