Question

In your opinion, is each of the following procedures likely to be considered medically necessary by a payers health care claims examiner? Why?

A. Diagnosis: Deviated septum

Procedure: Nasal surgery

B. Diagnosis: Mole on a female patients cheek, questionable nature

Procedure: Surgical removal and biopsy

C. Diagnosis: Male syndrome hair loss

Procedure: Implant hair plugs on scalp

D. Diagnosis: Probable broken wrist

Procedure: comprehensive fully-body examination, with complete set of lab tests, chest X-ray, and ECG

Answer 1

A- Yes, a deviated septum can only be fixed by a nasal surgery. The deviated septum in some cases may lead to complications such as difficulty in breathing, nose bleeding, facial drips, sinus problems. the only way to cure it is to repair the septum through a surgery

B- Yes it is necessary to remove or biopsy the mole which is unusual or susceptible to be cancerous such as atypical mole, congental mole or Spitz nevus because it may lead to melanoma which is deleterious to her health

C- No, The primary medication for hair loss includes using topical applications which can regain the hair growth or stop hair fall. Hair transplant is suggested only if the hair loss is not preventable by other methods. But hair transplantation is not successful for everyone

D- No, for a probable broken wrist there is no need to perform whole body test and lab tests. X-ray in the particular site is enough for diagnosing and providing treatment for it.