In this video, we will be discussing the preauthorization process regarding arthroscopic procedures of the hip. Preauthorization for arthroscopic hip procedures typically utilize CPT codes 29914, 29915, 29916, and 2999. 29914 is a coding for the femoroplasty, 29915 for the acetabuloplasty, and 29916 for the labor repair. These codes often require preauthorization or predetermination of medical necessity depending on the specific insurance provider. For CPT code 29999, our practice regularly uses it for capsular placation. However, it can be applied to other specified uses as seen here. The CPT code is often not sent for preauthorization because insurance companies typically do not have predefined policies or medical necessity criteria for unlisted codes. Instead, the necessity and the details of the procedure associated with 29999 are typically reviewed after surgery during claims processing. Most insurance companies require the submission of an MRI report along with the clinical notes from the patient's charts. Documenting the patient's conservative treatment is critical. Insurance providers generally expect to see evidence of at least 12 weeks of conservative management such as physical therapy, medication usage, or injections detailed in the clinic notes. These documents support the necessity of the procedure and are essential for obtaining approval. In some cases, a letter is also sent to the insurance provider. This letter includes the patient's diagnosis, reasoning that they are indicated for surgery, a detailed history of their conservative treatment, physical exam findings, radiographic results, the specific CPT codes and procedures, and how the patient meets the insurer's medical policy criteria. These criteria often include factors such as the patient's age, absence of osteoarthritis, severity of the symptoms, failure of conservative management, radiographic assessment demonstrating an alpha angle greater than 50 degrees, and evidence of a labral tear on MRI. If a CPT code is denied during preauthorization or predetermination, a peer-to-peer review can be scheduled to discuss directly with the insurance company's medical director to advocate for approval. If the CPT code is still denied after this discussion, an appeal can then be pursued. During the appeal process, additional clinical documentation not previously reviewed can be submitted to further support the medical necessity of the surgery and potentially overturn the denial. By following these steps and ensuring accurate, thorough documentation, the preauthorization process for hip arthroscopy surgeries can be navigated efficiently.

preauthorization

arthroscopic hip

CPT codes

insurance

documentation