medical necessity

I recommended the best practice for the surgeon who orders MAC anesthesia to document the reason (medical necessity) for cases which may be done under moderate sedation. This would be a statement which would include the co-morbidities in the Carriers LCD. I also recommended the CRNA document the medical necessity and told the coders they could code from the CRNA's record.

I am being challenged by my recommendations for the surgeons, although they order it and plan for MAC or general they do not want to document why it is medically necessary for cases in which moderate sedation would normally be the standard. (i.e. minor integumentary, diagnostic colonoscopy and I even saw one vasectomy case).

I have searched but so far have not found any CMS or other formal documents to back me on the surgeon needed to document.

I would appreciate any help or suggestions.

Thanks in advance!

medical necessity