Wiki United Healthcare and post op block denials

[ABorchardt]

Is anyone else having issue with United Healthcare insurance for non-payment for post op block services by anesthesia providers? We are getting denials even after submitting documentation with the claims. Am I missing something?

G89.18 is attached as Dx code for the block
-59 modifer is attached to the block code

 

[LisaAlonso23]

As an anesthesia coder, I can tell you that there are several nuances to billing blocks. I would need to see all coding, the anesthesia record and possibly the op note to know if the claim was coded correctly.

 

[CBLENNIE]

The insurance company I work for uses a vendor to perform post-payment audits for us and they constantly find post-op blocks billed and it is documented that block was done but the issue is there was no order/request from the surgeon for post-op pain control.

The auditor's rationale is that there was no documented medical necessity for the block because it has to be requested by the surgeon. I'm sure we've had anesthesiologist refute this audit finding however I haven't seen one because they go directly to the vendor, so I'm not sure what exactly the provider provided in the documentation in order to get the post-op pain block paid.

So, this might be an explanation from what UHC is doing here, but it could be something completely else and without the info @LisaAlonso23 stated would help drill down into what is happening to your claims here.

 

[LisaAlonso23]

The insurance company I work for uses a vendor to perform post-payment audits for us and they constantly find post-op blocks billed and it is documented that block was done but the issue is there was no order/request from the surgeon for post-op pain control.

The auditor's rationale is that there was no documented medical necessity for the block because it has to be requested by the surgeon. I'm sure we've had anesthesiologist refute this audit finding however I haven't seen one because they go directly to the vendor, so I'm not sure what exactly the provider provided in the documentation in order to get the post-op pain block paid.

So, this might be an explanation from what UHC is doing here, but it could be something completely else and without the info @LisaAlonso23 stated would help drill down into what is happening to your claims here.

I work with an auditing company, and we were never instructed to look for the surgeon's order for a block. However, the block note does need to state that the block was requested by the surgeon for post-operative pain management.