Anesthesia Coding Alert

Pursue pre-authorization from payers to help ensure payment. Obtaining payment for unlisted procedures can be problematic for any pain management or anesthesia practice. There are steps you can take, though, to increase your chances of reimbursement. "It's not unheard of to get paid for unlisted procedures, but it's just not always easy," says Joanne Mehmert, CPC, CCS-P, in Kansas City, Mo. "The insurance company has its own definition of medical necessity." Go Straight to Payer With Unlisted Request Try to obtain pre-authorization from the payer in a letter. If you have clinical trials that have been conducted by recognized bodies of physicians, make sure you include that information in your pre-authorization letter requesting approval for a pain management procedure for which you will be using an unlisted code. Your letter also should include any current CPT codes that are similar in work and risk. "Describe the condition of the patient -- [...]