neecen
Networker
Good afternoon!
I have a provider's office attempting to prior auth a sleep study and the insurance (MMO) will not approve the prior auth because the provider hasn't diagnosed the patient with Sleep Apnea. The reason for the sleep study is to determine if the patient does indeed have Sleep Apnea. I looked for a code to rule out and found Z03 - Encounter for medical observation for suspected diseases and conditions ruled out, however I don't know if this can be used for a prior auth. Does anyone have any insight or experience to share?
TIA
Denise
I have a provider's office attempting to prior auth a sleep study and the insurance (MMO) will not approve the prior auth because the provider hasn't diagnosed the patient with Sleep Apnea. The reason for the sleep study is to determine if the patient does indeed have Sleep Apnea. I looked for a code to rule out and found Z03 - Encounter for medical observation for suspected diseases and conditions ruled out, however I don't know if this can be used for a prior auth. Does anyone have any insight or experience to share?
TIA
Denise