Start documenting before the procedure to help win the bottom line battle.
Selecting the correct anesthesia code for a surgical procedure can be tricky enough some days when you’re reporting for a well-defined surgery. However obtaining appropriate payment for unlisted procedures still remains the biggest challenge for all. To accurately report for the enlisted procedures with Pre-Authorization start tackling procedures that don’t align with an anesthesia code. Keep these suggestions in mind and bolster your chances at reimbursement.
Plan for Pre-Authorization
Take steps toward payment before the procedure occurs. Try to obtain pre-authorization from the payer in writing, and include any relevant documentation.
Example: You’re trying to obtain pre-authorization for a pain management procedure for which you’ll submit an unlisted code. Describe the patient’s condition and how the pain is impacting her life and health. Include any information related to clinical trials for the procedure conducted by recognized physicians, and a lay-term description of the procedure so anyone reading the letter can understand. Educate the payer on the anticipated cost of care with and without the procedure; let the payer know if how much money could be saved if the procedure is done to reduce the chance of future, more expensive procedures. Finally, include CPT codes with comparable levels of work and risk to help set reimbursement.
Remember: Payers consider claims with unlisted procedure codes on a case-by-case basis, and determine payment based on the documentation you provide. Unfortunately, claims reviewers frequently do not have a high level of medical knowledge, and physicians don’t always dictate the most informative notes.
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