Health Information Management

Tip of the Week: Preauthorize stereotactic radiosurgery procedures

APCs Insider, June 22, 2007

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Cindy Parman, CPC, CPC-H, RCC, principal of Coding Strategies, Inc., in Powder Springs, GA says successful preauthorization of stereotactic radiosurgery (SRS) is best achieved through the following three-step process: specify the exact procedure(s), detail all of the patient's diagnoses, and perform diligent advance planning of future courses of treatment.

1. Be as specific as possible when preauthorizing SRS. For example, if you call and ask whether the patient has coverage for radiation therapy for a brain metastasis, the payer may say yes. But if you ask a more specific (and more accurate) question (e.g., Does the patient have coverage for radiosurgery? Does the patient have coverage for robotic radiosurgery using a CyberKnife®?), the answer may be no.

2. Know all of the diagnosis information prior to preauthorization. An insurance company may tell you that a policy will not cover a patient seeking SRS for three brain metastases but, Parman says, may cover the patient if you provide the following information about his or her cancer history:

The patient had primary lung cancer, which is under control with no evidence of other metastatic disease. The patient has a good Karnofsky Performance Scale, and the SRS will make a difference, as opposed to chemotherapy or whole brain radiation.

3. Preauthorize all procedures that may potentially be used in treatment of the patient. For example, if the physician says he won't treat the patient using SRS, but may at some point down the road, find out now whether the patient's insurer will cover it. "I always tell hospitals to preauthorize everything up front," says Parman. "You don't want to preauthorize twice--get all the information and log it into your insurance payer system."

(The above tip appeared in the July issue of Briefings on APCs).



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