E/M Level Selection

Which E/M service component is the overarching criterion for E/M level selection among History, PE, MDM and Time?

Per Medicare Manual Ch.12 Section 30.6.1 A."Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT® code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed."

Bit confused on Medical Necessity and MDM. Please explain.

re: E/M Level Selection

Just came back from a Medicare conference where this was discussed. It would be difficult to have medical necessity without MDM as one of your components to carry your code with an established pt or subsequent hospital visit. You could have a comprehensive history and exam for a person with a nose bleed, and it would not be considered high medical decision making; therefore, not medically necessary to bill a higher level visit. Does that help?