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Prior Authorization Question

sevolution

Contributor
Messages
14
Location
Suffolk
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Can anyone tell me if there are written rules stating you only need to prior authorize the primary procedure code when doing multiple procedures? I understand you lead with the highest RVU valued code however, is it true or untrue you only need to list your primary procedure when submitting a prior authorization? Any expertise, resources, references, etc would be much appreciated.
 
Messages
4,466
Location
Milwaukee WI
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We list ALL the planned procedures

We list ALL the planned procedures in our Prior Auth request.

We have had situations where due to circumstances discovered intraoperatively an additional procedure has been performed and denied as not authorized.

Just had a denial yesterday ... but I have a written response from insurance with authorization number that lists BOTH procedure codes.

Better safe than sorry.

F Tessa Bartels, CPC, CEMC
 
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