LaurenBrooke
Contributor
Curious-
Has anyone had surgery auth denials for final coding not being what was anticipated and auth'd prior to surgery that they've appealed successfully?
Example:
Surgery paperwork may states "Knee arthroscopy, diagnostic, meniscectomy"
CPTs: 29870, 29881 called on/submitted for surgery authorization by surgery schedulers.
DOS provider gets in the knee and a meniscal repair is done rather than a meniscectomy.
CPT: 29882 billed
Denies no auth on file and *will not retro auth*. Does not drop PR.
Office is requesting an appeal stating the auth we had on file was the anticipated surgery and it changed once surgery started. -Fair, but has this approach worked for payers who do not retro?
Has anyone had surgery auth denials for final coding not being what was anticipated and auth'd prior to surgery that they've appealed successfully?
Example:
Surgery paperwork may states "Knee arthroscopy, diagnostic, meniscectomy"
CPTs: 29870, 29881 called on/submitted for surgery authorization by surgery schedulers.
DOS provider gets in the knee and a meniscal repair is done rather than a meniscectomy.
CPT: 29882 billed
Denies no auth on file and *will not retro auth*. Does not drop PR.
Office is requesting an appeal stating the auth we had on file was the anticipated surgery and it changed once surgery started. -Fair, but has this approach worked for payers who do not retro?