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medical-coding procedure-for pre-operative insurance clearance

Medical Coding Procedure for Pre-Operative Insurance Clearance 

The patients who are in critical condition are brought to the hospital. In such cases, the doctors have to provide medical care to such patients immediately. As the patients will have insurance coverage, it is essential to start the pre-operative and post-operative clearances from the insurance company. The authorization is possible after determining the medical condition, but for the pre-operative checkup, you should file for insurance clearance. 

Many medical coders fail to properly file the insurance clearance for a pre-operative checkup. The insurance companies are quite strict about issuing reimbursement for the same. That’s why proper billing and coding is essential. In this article, we will learn the correct medical coding procedure for pre-operative clearances. 

Medical Coding Procedure for Pre-Operative Insurance Clearance

medical-coding procedure-for pre-operative insurance clearance

Pre-Op Clearance and Authorization Issues 

Most of the insurance companies do not provide pre-op clearance. The insurance companies don’t treat the pre-operative checkups as a necessity. In rare cases, the companies offer approvals to the doctors. Some of the medicare checkups are covered under the insurance. Sometimes, the companies don’t accept the claims even if they are known as the medical necessities under different acts. 

Pre-Op Clearance Requirements 

According to the experts, getting clearance from the insurance companies is a tedious task. That’s why they’ve prescribed the requirements that ensure timely issuance of the authorization. Here are the pre-operative clearance claim requirements. 

1.Reference to the request of pre-operative checkup requirements. 

2.The specific Medical Condition that requires the pre-operative checkup by the Physician. 

3.Request or recommendation from the Physician for conducting the pre-operative checkups as a medical necessity. 

Procedure for Obtaining Pre-op Clearance 

When the patient is presented to the hospital with the preexisting medical condition and the checkup requirement, the standard operating protocol should be followed. Here is the exact procedure for filing the claim for pre-op clearance. 

1. Collect the documents with the patient’s name and medical condition evaluation. 

2. Forward a copy of the documents to the evaluations and management service. After that, send the same to the surgeon or Physician. So, they will provide a recommendation for the procedure.

3. Use the correct Medical code for Primary Diagnosis. 

4. Use the appropriate medical code for secondary diagnosis. (If Any).

5. Code any other diagnostics if prescribed by the Physician. It is essential not to miss any condition before filing the claims for clearance. 

Using appropriate medical codes is essential. Without the same, it is doubtful that the patient will get medical clearance from the insurance company. There are different ICD-10 codes for various pre-operative conditions. 

According to industry experts, doctors can bill for standard pre-op procedures. The condition for the same is to reduce the overall package. So, the pre-operative charges can be adjusted in the bills. It is possible in emergencies, but the medical companies don’t allow the same. 

Final Words 

Getting insurance authorization for the pre-operative conditions is essential. As the people who have eye surgery might require treatment for hypertension, getting reimbursement for the same is beneficial. That’s why it’s an integral part of medical coding to do the perfect coding and billing. In this post, the coders will get an idea for preparing the exact coding for obtaining pre-op checkup clearance from the companies. 

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