Pre- OP clearance

The final frontier. Deciding when, if and how.
MK1965
Posts: 625
Joined: Thu May 24, 2018 5:32 pm

Pre- OP clearance

Postby MK1965 » Wed Aug 01, 2018 8:49 am

I am in a weird situation right now, scheduled for pre-op clearance with my cardiologist next week Aug 6. I need to do it way in advance ( but in range of less then 30 days before surgery) because I will be out of Country On European vacation with y wife celebrating our 30th wedding anniversary.
My surgery is scheduled for September 5.
Doctors office needs clearance for surgery at least 2 weeks prior to scheduled date. At that time, I will still be out of Country.
Yesterday, I called insurance verification department at my doctors office and was told: They won’t know if it is approved or not until about 2 weeks prior to surgery.
We are coming back from vacation on August 27th which is only 8 days before surgery ( if it is approved).
I told verification people about me being on vacation. Also told Hospital admission office.
Rescheduling is always an option but I prefer to stay on current date.
Weird, isn’t it.
MK
IPP 9/5/18; TITAN OTR 18 +1cm RTE,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED,TRIMIX painful, BIMIX ineffective,lost 2+ inches of length after RP. Revision 12/2/20 by Dr Clavell, AMS 700 CX, L 21 R 21+1.5 RTE.

Larry10625

Re: Pre- OP clearance

Postby Larry10625 » Wed Aug 01, 2018 9:19 am

MK1965 wrote:I am in a weird situation right now, scheduled for pre-op clearance with my cardiologist next week Aug 6. I need to do it way in advance ( but in range of less then 30 days before surgery) because I will be out of Country On European vacation with y wife celebrating our 30th wedding anniversary.
My surgery is scheduled for September 5.
Doctors office needs clearance for surgery at least 2 weeks prior to scheduled date. At that time, I will still be out of Country.
Yesterday, I called insurance verification department at my doctors office and was told: They won’t know if it is approved or not until about 2 weeks prior to surgery.
We are coming back from vacation on August 27th which is only 8 days before surgery ( if it is approved).
I told verification people about me being on vacation. Also told Hospital admission office.
Rescheduling is always an option but I prefer to stay on current date.
Weird, isn’t it.
MK



I would move ahead just like you would if you already had insurance clearance IF others with the same insurance company have been approved. Good luck. :)

Larry

David_Webb
Posts: 108
Joined: Tue Mar 13, 2018 1:47 pm
Location: New Hampshire

Re: Pre- OP clearance

Postby David_Webb » Wed Aug 01, 2018 12:33 pm

I asked my insurance company if they covered the medical code for my surgery “CPT 54405” and was told if the doctor requests and checks all the conditions it would be approved. My Surgeon provided all the information up front but I didn’t get final confirmation it was approved until the Friday prior to my Monday Surgery.

It is my understanding if the procedure is covered under your insurance it is up to your doctor to make the case that this is the next step and it will be approved. In my case that required a history of pills, VED/rings, injections, and finally an ultrasound that showed the VL. My doctor said he has had some insurance companies come back and recommend injections if they were not tried as part of the progression of treatment

Good Luck.
New Hampshire, 42, Diagnosed with ED early 20’s. VL Left side, Implanted 7-9-18, Dr. Gross, Titan OTR, 22cm +1 RTE, Penoscrotal.

oldbeek
Posts: 2481
Joined: Sun Sep 10, 2017 1:46 pm
Location: Los Angeles area

Re: Pre- OP clearance

Postby oldbeek » Wed Aug 01, 2018 1:03 pm

Had my pre-op 7 days prior to surgery at my family dr office. Told the girls in the office to get the results to the URO fast. Implant surgeon got the results the next morning.
82, good health, RP 7-2017, all nerves taken , PSA 0.05, 4-18,, .07 1/19,.05 4/19, .03 11-21, .04 11-23, implanted 4-1-18, Infra-pubic, AMS lgx 15 cm with 5cm rte. Implant at USC Keck. Dr Boyd and Dr Loh Doyle 6.5 x 5, 800 AUS 7-21-20

MK1965
Posts: 625
Joined: Thu May 24, 2018 5:32 pm

Re: Pre- OP clearance

Postby MK1965 » Wed Aug 01, 2018 1:29 pm

David,
Doctors office gave me same CPT code you mentioned 54405 and an ICD10 code N52.31 which means - Erectile Dysfunction After Radical Prostatectomy.
So, who knows? Everything depends on insurance people.

MK
IPP 9/5/18; TITAN OTR 18 +1cm RTE,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED,TRIMIX painful, BIMIX ineffective,lost 2+ inches of length after RP. Revision 12/2/20 by Dr Clavell, AMS 700 CX, L 21 R 21+1.5 RTE.

navy6587
Posts: 236
Joined: Mon Apr 23, 2018 8:22 pm
Location: Providence Forge, VA
Contact:

Re: Pre- OP clearance

Postby navy6587 » Wed Aug 01, 2018 1:34 pm

All...great discussion to have in advance of procedure day. I had been very concerned about a similar insurance coverage issue: whether or not Medicare covered the anesthesia/ anesthesiologist portion of the surgery. I just spoke to the patient accounting office at the surgical center where my urologist will perform my implant on 11/1. CPT 54405 covers the procedure and CPT 0054405 covers the anesthesia. Their facility does NOT outsource the anesthesia portion of the procedure as might other medical facilities. The anesthesiologist is part of Virginia Urology so the cost is covered under the procedure code. The surgical center must still confirm a pre-approval from Medicare for the procedure prior to 11/1 and, when I asked specifically, will contact me with any changes in policy that Medicare or Tricare for Life has made prior to my procedure. "So many insurance and medical plans...so little detail unless we look closely."
Edd
77; ED at 50. Fired by 1st doc (Szobota - VA Uro) too many q's & contact w/ Coloplast rep. New doc: Ellen (VA Uro) implanted 11/8/18. 22cm Titan + 2cm RTEs; moron docs, product rep, intake/ dischg nurses! NEVER again! L- 6.75"; G- 5.5" oval.


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