Hello,
As a Utilization Review coordinator, I'm having a hard time with InterQual criteria and getting a post op EGD/ESD approved under an observation admission. Typically the codes for these cases are Outpatient/same day procedures. Many providers are writing overnight monitoring as "risk for" complications however, not meeting criteria for advanced polyp removal, for example. Would anyone happen to have further insight into something I may be missing?
As a Utilization Review coordinator, I'm having a hard time with InterQual criteria and getting a post op EGD/ESD approved under an observation admission. Typically the codes for these cases are Outpatient/same day procedures. Many providers are writing overnight monitoring as "risk for" complications however, not meeting criteria for advanced polyp removal, for example. Would anyone happen to have further insight into something I may be missing?