Diagnosis codes for pre-op testing
We have experienced a large number of payer denials for pre-op testing with the reason "uncovered diagnosis code" . We were using Z01.810-Z01.818. We tried using the diagnosis code for the condition that prompted the surgery and are now getting denials for lack of medical necessity. Are you seeing denials for pre-op visits and what have you done to address this issue?
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Preop tests have always given me heartburn, even before I got into revenue integrity. As a doctor, when I was asked to do preop evaluation and testing on patients undergoing cataract surgery, I used to write back- "the patient has a beating heart and a cataract. They may proceed to surgery without any further testing." I was not popular to say the least.
So, preop tests should stand on their own as medically necessary for some condition, such as hypertension or diabetes. If the test is being done because the hospital requires it, then the cost of the test should be the responsibility of the hospital, not the payer.