Wiki Inpatient changes for Spine Surgeries?

[claudiabalderrama]

Has anyone had issues getting auths for spine surgeries in an Inpatient Setting? ex codes: 22842,22633,22634..63030,63035. We are being told that these are no longer accepted in an inpatient setting and would have to be done in an outpatient setting. Thank you in advance for any info shared ..

 

[jek521]

Since these are not inpatient-only codes, does the patient have comorbidities which require an inpatient level of care, rather than observation or outpatient? Perhaps that additional information would better support medical necessity for inpatient care.

 

[claudiabalderrama]

Honestly, most of my providers patients are elderly with their own other set of diagnosis where he feels it best to do these surgeries in an Inpatient setting.

 

[jek521]

Unfortunately, your providers aren't alone in experiencing challenges with authorizations based on their medical expertise. I suggest checking if the payer has an escalation process, such as peer-to-peer review, where the provider could make the case for inpatient vs. observation/outpatient.

 

[claudiabalderrama]

Unfortunately, your providers aren't alone in experiencing challenges with authorizations based on their medical expertise. I suggest checking if the payer has an escalation process, such as peer-to-peer review, where the provider could make the case for inpatient vs. observation/outpatient.

Yes, we do the peer to peer.. and that's what ends up happening. Just checking in to see if we are doing all we can and not missing anything new out there..Thank you for your help. Much appreciated.