Please verify for us that we should use 99080 (or suggest alternate code) for performing the following tasks for a patient to obtain pre-determination (not precertification) from their insurance for weight loss surgery. The tasks that would be encompassed in this one time charge for performing pre-determination process include:
1. Complete the tool (form) provided by the insurance company to include clinical and demographic information about the patient (each insurance company has their own form so they vary in content)
2. Obtain the list of items required from the insurance company to be completed by the patient and then documented before requesting pre-determination.
3. Gathering the documentation of the completion of these items from various providers.
4. Composing a medical necessity letter to explain the procedure planned, medical necessity of the procedure, planned education and outpatient follow up and current research indicating the efficacy of the procedure.
5. Interaction with the insurance companies utilization management staff including nurses and physicians for additional information regarding new research that indicates a patient may require a procedure that is outside their baseline criteria or other information as requested.
6. Obtain any additional information requested by the insurances utilization management team. This may include information from other providers or examinations or additional testing.
7. Filing appeals of the original decisions with additional information as required.
1. Complete the tool (form) provided by the insurance company to include clinical and demographic information about the patient (each insurance company has their own form so they vary in content)
2. Obtain the list of items required from the insurance company to be completed by the patient and then documented before requesting pre-determination.
3. Gathering the documentation of the completion of these items from various providers.
4. Composing a medical necessity letter to explain the procedure planned, medical necessity of the procedure, planned education and outpatient follow up and current research indicating the efficacy of the procedure.
5. Interaction with the insurance companies utilization management staff including nurses and physicians for additional information regarding new research that indicates a patient may require a procedure that is outside their baseline criteria or other information as requested.
6. Obtain any additional information requested by the insurances utilization management team. This may include information from other providers or examinations or additional testing.
7. Filing appeals of the original decisions with additional information as required.