Anesthesia Procedures: Pursue Pre-authorization From Payers To Help Ensure Payment

By Author: Celena Rose
Total Articles: 146
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As a coder, you'll encounter various challenges in your anesthesia and pain management coding. For one, obtaining payment for unlisted procedures can be problematic for any pain management or anesthesia practice. However, there are steps you can take to increase your chances of reimbursement. Although it's possible to get paid for unlisted procedures, it's not always easy.

Go direct to the payer with unlisted request


Strive to obtain pre-authorization from the payer in a letter. If you have clinical trials that have been conducted by recognized bodies of physicians, make sure you include that information in your pre-authorization letter requesting approval for a pain management procedure for which you will be using an unlisted code. Your letter should also include any current CPT codes that are similar in work and risk.


Describe the condition of the patient: What's the level of their suffering? What's the impact of this pain on the patient's life? Include a layman's description of the procedure in ...
... your letter so that whoever reads the letter can understand it.


Example: Pulse radiofrequency uses radio waves to intermittently affect the tissues around a painful nerve without nerve destruction. For pulse radiofrequency of any anatomic region, any nerve, you should use 64999 (Unlisted procedure, nervous system), according to CPT Assistant August 2005. Documenting the patient's level of pain and why nerve destruction is not feasible may help in obtaining pre-authorization.


Try to relate the procedure performed to an existing CPT code as support for reimbursement. Explain how your procedure differs to show why you didn't choose an existing code.


Finally, ensure the payer understands the anticipated cost of the care with and without that procedure. The payers have money on their mind and you need to tell them how much he's going to save if the procedure is done to minimize the risk of future, more expensive procedures.


Taking AAPC's CANPC certification exam will help you get on top of problems like these and other anesthesia and pain management coding challenges. There are also various training camps that'll help you pass the exam.

Codingcert.com provides selected trainers that gives you hands-on training for CANPC certification exam and about anesthesia and pain management coding at our CPC training camps to assist YOU to pass the American Academy of Professional Coders (AAPC) certification exam to become a Certified Professional Coder (CPC).