Pre-Authorization of the Airway is Not Required
- If the insurer requires “pre-authorization” for the surgical procedure, do not specifically request permission to use the Reltok Clear-Flo Nasal Airway! Since the service carries a 30999-59, by report, code, such a request will only slow and complicate the pre-authorization process.
- Insurers require only the lead diagnosis or diagnoses and identification of the anticipated main or primary surgical procedure. There is no requirement to pre-authorize any secondary, tertiary, etc., procedure that is planned or contemplated. In over 200 insurance cases, no carrier ever failed to honor the charge because of a lack of pre-authorization specifically for the Reltok Clear-Flo Nasal Airway.
- Insurers cannot dictate what procedure(s) your surgeon must perform. What the surgeon chooses to do at the time of surgery is solely within his/her discretion. As long as an anticipated main or primary procedure, e.g. CPT 30520, nasal septoplasty, has been “approved”, additional or ancillary procedures cannot be rejected by the carrier. Even if the “findings at surgery” mandated a different (but related) procedure, e.g., open reduction nasal septal fracture with septal reconstruction, CPT 21335, the claim should not be disqualified. The key, as usual, is op report documentation, the findings at surgery, the “what was done and why it was done”.
HCFA 1500 Billing Form
- Be sure to list “Insertion and Fixation of Intranasal Airway Prosthesis” as another line item charge for professional services.
- Box 19—any additional comments (limited to 49 characters) insert the following:
“CPT30999-59 FDA Cleared Safety Device”. - Click here to view a sample form. Note the completed Box 19. Note the line item billing for the airway below the primary and secondary surgical procedures. This is the independent professional fee for the surgeon’s additional time and skill to insert and remove the airway. Fees within the range of up to $875 have been honored.
Applicable CPT Code for Airway
- Applicable CPT code “30999-59, by report” for the surgeon’s professional service. CPT code, 30999-59, “unlisted procedure on nose”, requires documentation/written explanation for, and description of, the airway insertion. Either in the op report or as a separate report. Failure to include such may be a cause for no payment.