PA for WWN (bcbs hmo)

[meli990618@gmail.com]

I would like clarification regarding authorization requirements for new patients scheduled exclusively for annual preventive gyn examinations. Currently we request authorization for CPT 9938X w/ dx code Z01.419. We are considering adding CPT codes 9920X, 9921X, 9800X to the same auth request under the same preventive dx, even when the pt has no specific complaint or additional problem requiring evaluation. I believe isn't appropriate, I would like to hear any recommendation or experiences.

 

[nielynco]

I would like clarification regarding authorization requirements for new patients scheduled exclusively for annual preventive gyn examinations. Currently we request authorization for CPT 9938X w/ dx code Z01.419. We are considering adding CPT codes 9920X, 9921X, 9800X to the same auth request under the same preventive dx, even when the pt has no specific complaint or additional problem requiring evaluation. I believe isn't appropriate, I would like to hear any recommendation or experiences.

Are you saying that all of your new patients require prior authorization before they can schedule a preventive exam? What kind of insurance are you dealing with? If the reason for visit is strictly preventive and authorization is required, then that is all you should be asking for in my opinion. The patient should be informed that this is the purpose of this visit and that if she also wishes to discuss any complaints with the provider, that will have to be addressed at a different visit, or at least to let you know in advance so that you can ask for authorization for a new problem E/M service in addition.