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If you're uncertain whether the E/M qualifies as separately identifiable, document your medical necessity clearly and be prepared to justify it

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This limitation of standard lab testing approaches stems from how reference ranges are calculated

Abstract In neuroinflammatory disorders such as multiple sclerosis, the physiological function of the blood-brain barrier (BBB) is perturbed, particularly in demyelinating lesions and supposedly secondary to acute demyelinating pathology

But it may also indicate liver or bile duct problems, according to Mayo Clinic