Wiki Authorization Denials, Surgery

LaurenBrooke

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Location
Rocky Mount, NC
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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?
 
This has happened to us, particularly with one or two insurances. We've appealed stating that we got the prior auth for the basic code, and that there's no way for the physician to know in advance that he'll need the additional service. We've been able to get them paid.
 
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