This is not my area of expertise, but I do work for surgeons ...
If the surgeon lets us know immediately that s/he did something other than what was planned, we call the insurance company immediately and ask to amend the auth because of medical necessity and intraoperative findings.
Most of the time, however, the physician doesn't let us know ...
If I get a denial for "no auth," I appeal with a letter of explanation and the operative report that shows what happened and the medical necessity of doing an additional procedure as a result of intraoperative findings.
Hope that helps you.
F Tessa Bartels, CPC, CEMC
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