Prior Authorization Can Get More Medical Billing Claims Paid

More and more often, medical billing claims that include saphenous vein ablation are getting very close scrutiny by carriers before reimbursements will be allotted.

One of the biggest red flags is that most payers, including Medicare, will only cover payment for a very limited number of specific varicose-vein diagnoses. Samplings of the commonly and correctly reported procedures covered are as follows:

* 454.0–Varicose veins of lower extremities; with ulcer
* 454.1–… with inflammation
* 454.2–… with ulcer and inflammation
* 454.8–… with other complications.

However, when these are reported correctly, you should have detailed documentation to why the procedure was needed and documentation of the failure of non-surgical treatments that were used previously leading up to the necessity of the patient’s vein ablation.

If you are presented with a patient who is in need of vein ablation, best bet is to get prior authorization for the treatment to be administered from the carrier. Document who approved it and the time and date of your call, follow up with a faxed form in your medical billing package to add further punch to the legitimacy of your medical billing claim.

Prior authorization and strong documentation will insure that you get the best reimbursement possible for your medical billing claims and avoid paybacks and fees.

View all Articles by: Melissa Clark, CCS-P