Wiki Prior Authorization

[sripriyasuresh6@gmail.com]

There are a number of codes which are Inpatient Codes only. My question is for a Prior Authorization, how do we take authorization if the code is Inpatient Code only. Do I request for authorization as Inpatient or Outpatient Procedure. These codes that I'm asking for is related to Pediatric Urology. For example specific codes like 50405, 50220, 50780, 50845 are considered Inpatient Code only. Very confusing when our provider does schedule patients for Outpatient Procedure but this is an Inpatient code only. Some of these codes does require Observation as well after surgery is performed. Any help would greatly be appreciated.

 

[Papitha]

We should raise a clarification with details that these CPTs cannot be authorised as outpatient procedures as these fall under 'Inpatient Codes only'. As per my experience, my team used to get the responses for the raised clarifications from the facility either to convert the CPTs (few cases) or to update the location of inpatient facility in a few cases.