I'm trying to get pre-approved through my insurance but I can't get the doctor to figure out code or insurance. If anyone knows code or if there's another name for it. I'd be much appreciated!!
My Best,
Mandee
Hi Mandee,
CPT (Procedure Codes) 101- I am not making this a joke. I am trying to educate you & others.
The facility where you have the diagnostic test or the ordering Dr. will get the prior authorization. Did your doctor ask you specifically to get the CPT Code so he can get a pre auth? Or are you contacting your insurer to see if it is a covered procedure & trying to get a Pre Auth on your own? You should absolutely not be getting the code. Each code has variations, that only the ordering Dr. or Radiologist can define. It can be very involved. What kind of Dr. is ordering the CINE MRI. A NS or NL should know the codes I would really leave this to the ordering Dr. If he doesn't know the procedure code have him contact either the facility where you are having the test or his Provider Rep for your Insurer. This is not your responsibility. You can always call your insurer to check on the Pre Auth status once the Dr. has requested the pre auth. The insurer will even mail you a letter to let you know their decision. I can make a call and get you a CINE MRI CPT Code, but there are different CINE MRI CPT Codes & I would need the ICD9(Diagnosis Code) they will be using. If I pick the wrong Procedure code & the Dr. gets a Pre Auth using that code it is a hassle to change & get paid in a timely manner. You should also find out who the Radiologist is & if they participate with your Insurer & type of policy. There is a large percentage of Radiologist that do not practice with all insurers.
Please ask me any questions you may have,
Tracy Z.