Payer rules keep changing, so keep up with what they want. Getting appropriate reimbursement for spine surgery has challenged physicians and coders for years, but recouping payment becomes even trickier when payers routinely change their own guidelines and policies. Your best defense is a good offense: Ensure surgeons thoroughly document each component up front to get the pay they deserve. Catch Up With Ever-Changing Guidelines Payers use different sets of guidelines for covering spine surgery, which means you must be familiar with each insurer's policies. Example:
Think "Documentation" Through Every Step
One of the top reasons payers deny spinal surgery claims is not proving the procedure was medically necessary. Your best way to avoid that accusation is to encourage clear documentation of each phase of treatment.
Medications and simple therapies:
Sometimes over-the-counter or prescription medications such as naproxen (Aleve®) will help relieve a patient's back pain. Rest, heat or ice applications, and gentle stretching might be other first steps of treatment.Failed physical therapy:
If basic medications and other first-level treatments fail, the physician might prescribe a more intense, focused physical therapy plan over a period of several months.Spinal injection trials:
The next step in treating chronic back pain could be administering epidural steroid injections. Choose your codes based on whether the physician injected the cervical/thoracic or lumbar/sacral spine. Common options could include: